The Third Universal Definition of Myocardial Infarction(MI) requires cardiac myocyte necrosis with an increase and/or a decrease in a patient's plasma of cardiac troponin(cT n) with at least one cT n measurement g...The Third Universal Definition of Myocardial Infarction(MI) requires cardiac myocyte necrosis with an increase and/or a decrease in a patient's plasma of cardiac troponin(cT n) with at least one cT n measurement greater than the 99 th percentile of the upper normal reference limit during:(1) symptoms of myocardialischemia;(2) new significant electrocardiogram(ECG) ST-segment/T-wave changes or left bundle branch block;(3) the development of pathological ECG Q waves;(4) new loss of viable myocardium or regional wall motion abnormality identified by an imaging procedure; or(5) identification of intracoronary thrombus by angiography or autopsy.Myocardial infarction,when diagnosed,is now classified into five types.Detection of a rise and a fall of troponin are essential to the diagnosis of acute MI.However,high sensitivity troponin assays can increase the sensitivity but decrease the specificity of MI diagnosis.The ECG remains a cornerstone in the diagnosis of MI and should be frequently repeated,especially if the initial ECG is not diagnostic of MI.There have been significant advances in adjunctive pharmacotherapy,procedural techniques and stent technology in the treatment of patients with MIs.The routine use of antiplatelet agents such as clopidogrel,prasugrel or ticagrelor,in addition to aspirin,reduces patient morbidity and mortality.Percutaneous coronary intervention(PCI) in a timely manner is the primary treatment of patients with acute ST segment elevation MI.Drug eluting coronary stents are safe and beneficial with primary coronary intervention.Treatment with direct thrombin inhibitors during PCI is non-inferior to unfractionated heparin and glycoprotein Ⅱb/Ⅲa receptor antagonists and is associated with a significant reduction in bleeding.The intra-coronary use of a glycoprotein Ⅱb/Ⅲa antagonist can reduce infarct size.Pre- and post-conditioning techniques can provide additional cardioprotection.However,the incidence and mortality due to MI continues to be high despite all these recent advances.The ini展开更多
目的探讨左西孟旦治疗老年缺血性心肌病所致急性失代偿性心力衰竭患者的疗效和安全性。方法选择老年缺血性心肌病所致急性失代偿性心力衰竭患者60例,根据治疗方法随机分为左西孟旦组30例和常规治疗组30例。2组患者治疗前和治疗后1周分...目的探讨左西孟旦治疗老年缺血性心肌病所致急性失代偿性心力衰竭患者的疗效和安全性。方法选择老年缺血性心肌病所致急性失代偿性心力衰竭患者60例,根据治疗方法随机分为左西孟旦组30例和常规治疗组30例。2组患者治疗前和治疗后1周分别测定血压、心率、左心室射血分数、血浆N末端钠尿肽前体和肌酐水平,并进行疗效和安全性比较。结果左西孟旦组治疗后左心室射血分数明显高于常规治疗组,血浆N末端钠尿肽前体水平明显低于常规治疗组(36.5%vs 34.0%,1872.9ng/L vs 2499.6ng/L,P<0.05)。左西孟旦组与常规治疗组治疗后血压、心率和肌酐水平比较,差异无统计学意义(P>0.05)。结论老年缺血性心肌病导致的急性失代偿性心力衰竭患者使用左西孟旦后,左心室射血分数升高,N末端钠尿肽前体水平降低,而血压、心率和肾功能并无异常,证实了左西孟旦治疗老年缺血性心肌病导致的急性失代偿性心力衰竭患者安全有效。展开更多
基金Supported by Research facilities at the James A Haley VA Hospitalin part+3 种基金Grants from the Florida King Biomedical Research Programthe Muscular Dystrophy Associationthe Robert O Law Foundationthe Cornelius Foundation
文摘The Third Universal Definition of Myocardial Infarction(MI) requires cardiac myocyte necrosis with an increase and/or a decrease in a patient's plasma of cardiac troponin(cT n) with at least one cT n measurement greater than the 99 th percentile of the upper normal reference limit during:(1) symptoms of myocardialischemia;(2) new significant electrocardiogram(ECG) ST-segment/T-wave changes or left bundle branch block;(3) the development of pathological ECG Q waves;(4) new loss of viable myocardium or regional wall motion abnormality identified by an imaging procedure; or(5) identification of intracoronary thrombus by angiography or autopsy.Myocardial infarction,when diagnosed,is now classified into five types.Detection of a rise and a fall of troponin are essential to the diagnosis of acute MI.However,high sensitivity troponin assays can increase the sensitivity but decrease the specificity of MI diagnosis.The ECG remains a cornerstone in the diagnosis of MI and should be frequently repeated,especially if the initial ECG is not diagnostic of MI.There have been significant advances in adjunctive pharmacotherapy,procedural techniques and stent technology in the treatment of patients with MIs.The routine use of antiplatelet agents such as clopidogrel,prasugrel or ticagrelor,in addition to aspirin,reduces patient morbidity and mortality.Percutaneous coronary intervention(PCI) in a timely manner is the primary treatment of patients with acute ST segment elevation MI.Drug eluting coronary stents are safe and beneficial with primary coronary intervention.Treatment with direct thrombin inhibitors during PCI is non-inferior to unfractionated heparin and glycoprotein Ⅱb/Ⅲa receptor antagonists and is associated with a significant reduction in bleeding.The intra-coronary use of a glycoprotein Ⅱb/Ⅲa antagonist can reduce infarct size.Pre- and post-conditioning techniques can provide additional cardioprotection.However,the incidence and mortality due to MI continues to be high despite all these recent advances.The ini
文摘目的探讨左西孟旦治疗老年缺血性心肌病所致急性失代偿性心力衰竭患者的疗效和安全性。方法选择老年缺血性心肌病所致急性失代偿性心力衰竭患者60例,根据治疗方法随机分为左西孟旦组30例和常规治疗组30例。2组患者治疗前和治疗后1周分别测定血压、心率、左心室射血分数、血浆N末端钠尿肽前体和肌酐水平,并进行疗效和安全性比较。结果左西孟旦组治疗后左心室射血分数明显高于常规治疗组,血浆N末端钠尿肽前体水平明显低于常规治疗组(36.5%vs 34.0%,1872.9ng/L vs 2499.6ng/L,P<0.05)。左西孟旦组与常规治疗组治疗后血压、心率和肌酐水平比较,差异无统计学意义(P>0.05)。结论老年缺血性心肌病导致的急性失代偿性心力衰竭患者使用左西孟旦后,左心室射血分数升高,N末端钠尿肽前体水平降低,而血压、心率和肾功能并无异常,证实了左西孟旦治疗老年缺血性心肌病导致的急性失代偿性心力衰竭患者安全有效。
