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Wysłany: Śro 1:28, 23 Mar 2011
Temat postu: UGG boots Italia 8 cases of atypical acute myocard
8 cases of acute atypical diagnosis and treatment of myocardial infarction
Drugs; for heart failure were treated with a diuretic, reducing the heart load and angiotensin converting enzyme inhibitor (ACEI) class of drugs to correct such failure; for the thrombolysis window period and no contraindication to thrombolysis given thrombolytic treatment. 2 of 2 results automatically from hospital patients, failed to observe the results, and the remaining patients were in stable condition after the turn of Cardiology, continue treatment until the serum levels of cardiac structural proteins and enzymes returned to normal, sT segment returned to isoelectric line, After correction of complications were discharged. 3 For a discussion of acute myocardial infarction typical clinical symptoms, typical ECG evolution and structure of protein and serum cardiac enzyme level changes are not difficult to diagnose, but the emergency encountered in the typical clinical manifestations, ECG in patients without characteristic changes are not uncommon. 8 patients are listed in this article are the author encountered during the year nearly half of cases. The 8 patients with 60 patients over the age of majority, of which 5 patients had no chest pain, 1 case of chest pain, and the remaining 2 patients, aged 36,40 years old, respectively, abdominal pain,
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, sore throat treatment. Acute inferior myocardial infarction patients often have gastrointestinal symptoms, gastrointestinal symptoms in only a small number of complaint cases of treatment often causes confusion to the clinical diagnosis, clinical to the role played hide and easier to make a clinical misdiagnosis. Therefore, symptoms of abdominal pain, but signs do not match, or unexplained abdominal pain associated with heart palpitations, shortness of breath, blood pressure reduction, as well as elderly patients with abdominal pain, routine ECG should, if necessary, review the ECG, myocardial enzymes and muscle calcium combined Dynamic changes in protein levels, a clear diagnosis. Mechanisms and clinical manifestations of such vagus nerve stimulation by myocardial necrosis and cardiac output decrease caused by inadequate tissue perfusion related, and might have hiccups. For elderly patients, particularly diabetes, coronary heart disease in older patients, to the performance of treatment failure, the emergency physicians do not meet the diagnosis of heart failure and stand still,
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, we must pay attention to its existence without acute myocardial infarction. Such patients may be atypical mechanism of myocardial infarction: ① chronic coronary insufficiency, cardiac neuropathy, reduced or interrupted neural conduction; ② old high pain threshold, sensitivity and poor response; ③ diabetic patients acute myocardial infarction, chest pain symptoms are atypical, mainly in patients with autonomic neuropathy and diabetes related to the existence,
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, but may have fatigue,
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, shortness of breath and other atypical symptoms. The few neurological symptoms as the first symptom of patients, partly because the time of acute myocardial infarction and cardiac output decrease caused serious cardiac arrhythmia cerebral circulation disorder, cerebral vasospasm or cerebral infarction occurs, the heart and brain syndrome ( Because many elderly people have multiple systems of the body hardening of the arteries, are more likely in this case); the other hand, myocardial sympathetic innervation by the left common carotid before, the occurrence of acute myocardial infarction in this region through the cortex of the brain stem reticular formation may be the reflection role in the disorder caused by circulatory function, such a case, because the characteristics of older persons themselves, but also easy to overlook the symptoms of myocardial infarction, and focus on the nervous system. Thus, in the treatment of a problem also appears that this episode of cerebrovascular disease should be included in the thrombolytic contraindications, TIA) 1 history of Characterized by acute and emergency patients, while the number of emergency patients every day more and emergency workload. Emergency in the heavy work,
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, to avoid misdiagnosis, it requires emergency physicians have a solid theoretical foundation in the premise, but also has a wealth of clinical experience, the complexity of clinical manifestations of disease have a full understanding; from the macro comprehensive and profound understanding of cases, with the overall concept, so that the necessary differential diagnosis, clinical manifestations do not rigidly adhere to local, do not come to meet in the diagnosis of local symptoms, to prevent interference by a surface phenomenon. For the treatment of patients, some of the necessary auxiliary examinations such as: ECG, urine routine and so should be routine, to prevent misdiagnosis.
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