小结
定义
病史和体格检查
关键诊断因素
- 胸痛
- 呼吸困难
- 苍白
- 发汗
- 心源性休克
其他诊断因素
- 恶心和/或呕吐
- 头晕或头重脚轻感
- 虚弱
- 痛苦
- 心动过速
- 额外心音
- 不典型部位或性质的疼痛
- 意识模糊
- 低血压
- 呼吸音异常
危险因素
- 吸烟
- 高血压
- 糖尿病
- 肥胖
- 代谢综合征
- 缺乏体力活动
- 血脂异常
- 肾功能不全
- 已确诊冠状动脉病变
- 早发冠状动脉病变家族史
- 吸食可卡因
- 男性
- 高龄
诊断性检查
首要检查
- 心电图（ECG）
- 心脏生物标志物
- 葡萄糖
- 电解质、尿素和肌酐
- 血脂
- 胸部 X 线检查（CXR）
- 冠状动脉造影
需考虑的检查
- 超声心动图
新兴检查
- 和肽素
治疗流程
疑似心肌梗死
血流动力学不稳定
血流动力学稳定
STEMI 后
撰稿人
作者
Mahi L. Ashwath, MD, FACC, FASE
Director, Cardiac MRI
Clinical Associate Professor of Medicine and Radiology
Division of Cardiology
Department of Internal Medicine
University of Iowa Hospitals and Clinics
University of Iowa Health Care
Iowa
IA
利益声明
MLA declares that she has no competing interests.
Sanjay Gandhi, MD, FACC, FAHA, FSCAI
Director, Endovascular Cardiology
Associate Professor of Medicine, Endovascular Cardiology
Case Western Reserve University
Cleveland
OH
利益声明
SG declares that he has no competing interests.
鸣谢
Dr Mahi L. Ashwath and Dr Sanjay Gandhi would like to gratefully acknowledge Dr Thomas Vrobel, a previous contributor to this topic. TV declares that he has no competing interests.
同行评议者
Dale Adler, MD, FACC
Vice Chairman of Medicine for Network Development and Strategic Planning
Brigham and Women's Hospital
Boston
MA
利益声明
DA declares that he has no competing interests.
Deepak L. Bhatt, MD
Associate Professor of Medicine
Department of Cardiovascular Medicine
Cleveland Clinic
OH
利益声明
DLB declares that he has no competing interests.
Gregory Lip, MD, FRCP, FACC, FESC
Consultant Cardiologist and Professor of Cardiovascular Medicine
University Department of Medicine
City Hospital
Birmingham
UK
利益声明
GL declares that he has no competing interests.
鉴别诊断
- 不稳定型心绞痛
- 非 ST 段抬高型心肌梗死
- 主动脉夹层
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