小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 胸痛
- 发汗
- 近期经皮冠状动脉介入治疗或既往冠状动脉旁路移植术
其他诊断因素
- 强体力活动
- 呼吸短促
- 虚弱
- 焦虑
- 恶心
- 呕吐
- 腹痛
- 高血压
- 寒冷暴露
- 情绪不安
- 清晨发作
- 晕厥
- 低血压
- 心律失常
- 异常心音
危险因素
- 动脉粥样硬化（心绞痛、心肌梗死、卒中、短暂性脑缺血发作和外周血管疾病史）
- 糖尿病
- 吸烟
- 血脂异常
- 早发冠状动脉病变 (CAD) 的家族史
- 年龄＞65 岁
- 高血压
- 肥胖及代谢综合征的表型
- 缺乏体力活动
- 使用可卡因
- 抑郁症
- 支架内血栓形成或再狭窄
- 慢性肾病
- 手术治疗（包括手术期间及手术后期）
- 睡眠呼吸暂停
诊断性检查
首要检查
- 心电图（ECG）
- 舌下含服硝酸甘油试验
- 心脏肌钙蛋白
- 肌酸激酶 (CK)
- 肌酸激酶同工酶（心肌特异性，CK-MB）
- 全血细胞计数（FBC）
- 尿素和血清肌酐
- 电解质
- 肝功能检查
- 血糖
- 胸部 X 线检查
需考虑的检查
- 脂质
- 脑利钠肽 (BNP) 或 N 末端脑利钠肽原 (NT-pro-BNP)
- 超声心动图
- 血管造影术
- 负荷试验
- 冠状动脉 CT 血管造影 (CCTA)
治疗流程
急性表现
稳定后
撰稿人
作者
Cody S. Deen, MD
Assistant Professor of Medicine
Director of Cardiology
Hillsborough Hospital
University of North Carolina
Hillsborough
NC
利益声明
CSD was previously the Director of Cardiac Rehab for Chatham Hospital, which was financially set up as a consultancy relationship, until 2017. CSD has spoken (unpaid) at the Update in Cardiology and Update in Internal Medicine Conferences at UNC for the last 5 years. CSD has served as the PI for the Dal-GeneE (site now closed) and the ACCELERATE Trials at the University of North Carolina (trial now completed). Each trial required paid travel to an investigator meeting.
鸣谢
Dr Cody S. Deen would like to gratefully acknowledge Dr Sripal Bangalore, Dr Mina Owlia, Dr Thomas Vanhecke, and Dr Dena Krishnan, the previous contributors to this topic.
利益声明
SB, MO, TEV, and DK declare that they have no competing interests.
同行评议者
Nicholas Palaskas, MD, FACC
Assistant Professor
University of Texas MD Anderson Cancer Center
Houston
TX
利益声明
NP declares that he has no competing interests.
Edward Ullman, MD
Associate Professor
Department of Emergency Medicine
Beth Israel Medical Deaconess Center
Boston
MA
利益声明
EU 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.
Shrilla Banerjee, MBMD, MRCP
Consultant Cardiologist
East Surrey Hospital
Surrey and Sussex NHS Trust
Surrey
UK
利益声明
SB declares that she has no competing interests.
鉴别诊断
- 主动脉夹层
- 肺栓塞
- 消化性溃疡疾病
更多 鉴别诊断指南
- 第四版心肌梗死通用定义
- 心肌血运重建指南
更多 指南患者教育信息
Heart attack: what is it?
What you can do to prevent another heart attack
更多 患者教育信息医学计算器
用于不稳定型心绞痛、非 ST 段抬高型心肌梗死的 TIMI 评分
预测急性冠脉综合征患者预后的 GRACE 评分
更多 医学计算器
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明