ST 段抬高型心肌梗死
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
- 心脏危险因素
- 呼吸音异常
- 额外心音
- 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
- 苦恼和焦虑
- 心悸
- 意识模糊
- 低血压
- 不典型部位或性质的疼痛
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
- 年龄＞50 岁
诊断性检查
首要检查
- 心电图 (ECG)
- 冠状动脉造影
- 心肌肌钙蛋白
- 葡萄糖
- 全血细胞计数
- 电解质、尿素、肌酐和估算的肾小球滤过率（estimated glomerular filtration rate, eGFR）
- C 反应蛋白 (CRP)
- 血清脂质
需考虑的检查
- 动脉血气
- 胸部 X 线检查
- 床旁经胸超声心动图
新兴检查
- 心脏肌球蛋白结合蛋白 C（cardiac myosin-binding protein C, cMyC）
治疗流程
STEMI 的疑似或临床诊断（心肌缺血症状 + ECG 显示 ST 段抬高）
STEMI 后
撰稿人
专家顾问
Resham Baruah, MBBS, BSc MRCP, PhD
Consultant Cardiologist
Chelsea and Westminster Hospital NHS Foundation Trust
Royal Brompton & Harefield NHS Foundation Trust
London
UK
简介
RB is specialist advisor to the 2018 NICE guideline on chronic heart failure in adults and is a member of the European Heart Failure Association Task Force on palliative care in heart failure.
利益声明
RB has received honoraria/speakers’ fees from Novartis and Boehringer Ingelheim.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:
Aung Myat
NIHR Clinical Lecturer in Interventional Cardiology
Brighton and Sussex Medical School
Honorary Interventional Cardiology Fellow
Royal Sussex County Hospital
Brighton
UK
Duha Ilyas
ST4 in Renal Medicine
Leeds Teaching Hospitals
NHS Trust Leeds
UK
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
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
AM, MLA, and SG declare that they have no competing interests.
同行评议者
Gavin Galasko, BM, BCh, MA, DM (Oxon), FRCP
Consultant Interventional Cardiologist
Director of Research, Development and Innovation
Blackpool Teaching Hospitals NHS Foundation Trust
Blackpool
UK
利益声明
GG declares that he has no competing interests.
Anthony Gershlick
Honorary Professor of Interventional Cardiology
University of Leicester
Consultant Cardiologist
University Hospitals of Leicester NHS Trust
Leicester
UK
利益声明
At the time of review, AG did not declare any competing interests. Unfortunately, we have since been made aware that AG has passed away.
编辑
Helena Delgado-Cohen
Section Editor, BMJ Best Practice
利益声明
HDC 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.
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
更多 鉴别诊断指南
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