非 ST 段抬高型心肌梗死

最后审阅: 24 四月 2022
最后更新: 20 一月 2021

小结

定义

病史和体格检查

关键诊断因素

  • 胸痛
  • 心血管疾病危险因素
  • 大量出汗
  • 心源性休克
  • 急性心力衰竭
完整详情

其他诊断因素

  • 恶心和呕吐
  • 心律失常
  • 心脏杂音
  • 上腹痛
  • 呼吸困难
  • 晕厥
  • 背痛
完整详情

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
完整详情

诊断性检查

首要检查

  • 心电图(ECG)
  • 高敏肌钙蛋白
  • 胸部 X 线检查
  • 全血细胞计数
  • 尿素、电解质和肌酐
  • 肝功能检测
  • 血糖
  • C 反应蛋白
完整详情

需考虑的检查

  • 超声心动图
  • 有创性冠状动脉血管造影术(invasive coronary angiography, ICA)
完整详情

治疗流程

急症处理

临床情况不稳定(疑似或确诊 NSTEMI)

持续性治疗

稳定后

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.

Adam Hartley, MBBS, BSc, MRCP

Wellcome Trust Clinical Research Fellow

Imperial College London

Specialist Registrar in Cardiology

Imperial College Healthcare NHS Trust

London

UK

利益声明

AH declares that he has no competing interests.

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

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.

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.

编辑

Annabel Sidwell,

Section Editor, BMJ Best Practice

利益声明

AS declares that she has no competing interests.

Susan Mayor,

Lead Section Editor, BMJ Best Practice

利益声明

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

利益声明

RW 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.

  • 非 ST 段抬高型心肌梗死 images
  • 鉴别诊断

    • ST 段抬高型心肌梗死
    • 不稳定型心绞痛
    • 主动脉夹层
    更多 鉴别诊断
  • 指南

    • 急性冠脉综合征
    • 欧洲心脏病学会关于无持续 ST 段抬高型急性冠脉综合征患者的管理指南
    更多 指南
  • 医学计算器

    预测急性冠脉综合征患者预后的 GRACE 评分

    用于不稳定型心绞痛、非 ST 段抬高型心肌梗死的 TIMI 评分

    更多 医学计算器
  • Videos

    关于如何进行心电图的动画演示

    更多 videos
  • 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
  • padlock-locked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