duration ？
Inducing and relief factor ？ treatment process?
病例分析
Present illness
Paroxysmal precordium pain in the
past 2 months. Broke out after agitation or overwork ed,last for 2-3minutes， relieved after rest , didn’t treatment.
病例分析
Chest pain
Diagnosis
Differential
diagnosis
病例分析
Cardiovascular
gastrointestinal
pleural
Chest pain
Mental
Pulmonary
neuromuscular
病例分析
Differential diagnosis？
病例分析
Physical examination： Vital signs! Chest and heart examination abdomen examination
病例分析
T 36.7℃ , P 72/min, R 20/min, BP117/75mmHg. Regular respirations. No edema in eye-lips. The lips are red. No sternum tenderness. Breathing sounds are rough, with both bottom of the lung moist rales. No abnormal pulsation an uplift in precordial region. The heart percussed normal in size. Heart beat 72. Abdomen is flat, No tenderness. No distension.
病例分析
Location
Inferior wall ——Ⅱ Ⅲ aVF Anterior wall —— V1－6 Anteroseptal wall ——V1-3 Apical or lateral wall —V4－6 Posterior wall-----V7-9 Right-sided ----V4R-V5R
病例分析
Present illness
Precordium pain aggravated without inducing factor 16 hours ago,accompanied with back and both upper limbs pain, left shoulder and upper limb obviously , accompanied with nausea. Taken omeprazole capsule,the
15
cTnI 7.092ng/mL, CK-MB 156.43ng/mL， MYO 251.09 ng/ml。 X-ray: heart shadow increased, bronchitis . UCG： Segmental ventricular wall motion abnormalities ,EF：45%.
病例分析
Past Medical History：2014.09.19 gastroscope : esophagitis, gastric ulcer , erosive gastritis, duodenal bulb inflammation.
Family History：His mother have history of hypertension, coronary heart disease and diabetes.Brother has history of diabetesay in bed monitoring, oxygen Pain relief anti-ischemia Anti-platelet anti-coagulation Reperfusion thrombolytic treatment PCI CABG
病例分析
symptom couldn’t relieve,precordium
Present illness
In emergency room of our hospital, taken“aspirin 300mg, ticagrelor 180mg”, “isosorbide mononitrate 20mg” intravenous drip.
Case analysis
Chief Complaints
Paroxysmal precordium pain for
2 months，exacerbation for 16 hours.
病例分析
Medical history：ache location、 character、 degree？ radiation？
病例分析
Diagnosis
1.coronary heart disease acute anterior wall myocardial infarction Killip class II. 2.bronchial pneumonia. 3. esophagitis, gastric ulcer , erosive gastritis, duodenal bulb inflammation.
病例分析
Complications ？ Dysfunction or rupture of papillary muscle Rupture of the heart Embolism Cardiac aneurysm Postinfarction syndrome
病例分析
病例分析
How select thrombolytic treatment or PCI ? 3 6 12 24
病例分析
prevention A A B B C C D D E E
病例分析


Angina Acute pericarditis Acute pulmonary embolism Acute abdominal pain Aortic dissection …
病例分析
Auxiliary examinations ？
病例分析
ECG：The most important the most quickly