小结
定义
病史和体格检查
关键诊断因素
- 心悸
- 脉率不规则
- 危险因素
其他诊断因素
- 呼吸困难
- 有症状性低血压
- 胸痛/胸部紧束感/胸闷
- 疲劳
- 焦虑
- 认知障碍
- 头晕
- 多尿
- 呼吸音异常
- 额外心音
- 颈静脉压升高。
- 卒中征兆
- 晕厥先兆和晕厥
危险因素
- 年龄增长
- 高血压
- 心力衰竭
- 糖尿病
- 阻塞性睡眠呼吸暂停
- 肥胖
- 冠状动脉疾病
- 瓣膜疾病
- 其他心脏疾病
- 经常大量饮酒
- 心胸外科手术
- 其他房性心律失常
- 既往卒中/短暂性脑缺血发作
- 甲状腺功能亢进症
- 锻炼强度达到运动员水平
- 慢性阻塞性肺疾病 (COPD)
- 吸烟
诊断性检查
首要检查
- 心电图（ECG）
- 全血细胞计数 (FBC）
- 凝血功能检查
- 电解质、尿素和肌酐
- 甲状腺功能
- 胸部 X 线检查（CXR）
- 经胸超声心动图 (TTE)
需考虑的检查
- 心肌肌钙蛋白
- 动脉血气分析 (ABG)
- C 反应蛋白 (CRP)
- B型脑钠肽（BNP）/氨基端B型脑钠肽前体（NT-pro-BNP）
- 肝功能检查 (LFT)
- 红细胞沉降率
- 经食道超声心动图 (TOE)
- 住院病人遥测心电图或 24 小时动态心电图
- 冠状动脉造影（CT 或传统检查）或运动负荷试验
- 后续钆造影剂增强心脏 MR（cardiac MR, CMR）
- 头颅 CT
- 脑部 MRI
- 计算机断层扫描肺动脉造影 (CTPA)
治疗流程
血流动力学不稳定
血流动力学稳定：发作时间 <48 小时
血流动力学稳定：发作时间 ≥48 小时或不确定
稳定后
撰稿人
专家顾问
Shrilla Banerjee, MD, FRCP
Consultant Interventional Cardiologist
East Surrey Hospital
Surrey and Sussex Healthcare NHS Trust
UK
利益声明
SB has received speaker fees for educational lectures (presentation content was her own) and meeting participation from Menarini, Edwards Lifesciences, Abbott Vascular, and Shockwave IVL. She has also participated in an Advisory Board for Sahajanand Medical Technologies Limited. SB has received travel sponsorship from Biosensors International to attend the PCR meeting in Paris in 2022. She has prepared a manuscript on coronary microvascular dysfunction for Abbott for Cardiovascular News (no royalties).
鸣谢
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:
Arti N. Shah, MS, MD
Director
Cardiac Electrophysiology
Elmhurst Hospital Center
Elmhurst
Assistant Professor of Medicine
Mount Sinai School of Medicine
New York
NY
ANS is an author of a number of references cited in this topic.
Bharat K. Kantharia MD, FRCP, FAHA, FACC, FESC, FHRS
Cardiovascular and Heart Rhythm Consultant
Attending and Consultant Cardiac Electrophysiologist
Mount Sinai Hospitals
New York Methodist Hospital
New York
NY
West Houston Medical Center
Memorial Hermann Hospital
Houston
TX
BKK is an author of a number of references cited in this topic.
Resham Baruah MBBS, BSc, MRCP, PhD
Consultant Cardiologist
Chelsea and Westminster Hospital and the Royal Brompton and Harefield NHS Trust
London
UK
RB has received honorarium/speaker fees from Novartis and Boehringer Ingleheim.
Adam D. Hartley MBBS, BSc, MRCP
Wellcome Trust Clinical Research Fellow
Imperial College London
Specialist Registrar in Cardiology
Imperial College Healthcare NHS Trust
London
UK
ADH declares that he has no competing interests.
同行评议者
Gregory Lip, MD, FRCP, DFM, FACC, FESC, FEHRA
Price-Evans Professor of Cardiovascular Medicine
University of Liverpool
Senior Investigator
National Institute for Health Research
UK
Distinguished Professor
Faculty of Medicine
Aalborg University
Denmark
Adjunct Professor
Yonsei University
Seoul
South Korea
利益声明
GL is a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo. He is a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally. GL is an author of a number of references cited in this topic.
编辑
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
利益声明
RW declares that she has no competing interests.
Jo Haynes
Head of Editorial, BMJ Knowledge Centre
利益声明
JH declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
Shouvik Haldar
Consultant Cardiologist and Electrophysiologist
Royal Brompton and Harefield Hospitals
London
UK
利益声明
SH was a Section Editor, BMJ Best Practice. SH declares that he has no competing interests.
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