全球心肌梗死新定义41张课件.ppt

1、6、纪律是自由的第一条件。黑格尔7、纪律是集体的面貌，集体的声音，集体的动作，集体的表情，集体的信念。马卡连柯8、我们现在必须完全保持党的纪律，否则一切都会陷入污泥中。马克思9、学校没有纪律便如磨坊没有水。夸美纽斯10、一个人应该：活泼而守纪律，天真而不幼稚，勇敢而鲁莽，倔强而有原则，热情而不冲动，乐观而不盲目。马克思全球心肌梗死新定义全球心肌梗死新定义心肌梗死临床分型 1型 由原发冠脉事件(如斑块侵蚀/破裂、裂隙或夹层)引起的与缺血相关的自发性心肌梗死。2型 继发于氧耗增加或氧供减少(如冠脉痉挛、冠脉栓塞、贫血、心律失常、高血压或低血压)导致缺血的心肌梗死。3型 突发心源性死亡(包括心脏停搏

2、),通常伴有心肌缺血的症状,伴随新发ST段抬高或新发LBBB,和(或)经冠脉造影或尸检证实的新发血栓证据,但死亡常发生在获取血标本或心脏标志物升高之前。4a型 与PCI相关的心肌梗死。4b型 尸检或冠脉造影证实与支架血栓相关的心肌梗死。5型 与CABG相关的心肌梗死。注意:有时患者可能同时或先后出现一种以上类型的心肌梗死！The earliest change histologically seen with acute myocardial infarction in the first day is contraction band necrosis.The myocardial fibe

3、rs are beginning to lose cross striations and the nuclei are not clearly visible in most of the cells seen here.Note the many irregular darker pink wavy contraction bands extending across the fibers.This is an intermediate myocardial infarction of 1 to 2 weeks in age.Note that there are remaining no

4、rmal myocardial fibers at the top.Below these fibers are many macrophages along with numerous capillaries and little collagenization.This high power microscopic view of the myocardium demonstrates an infarction of about 1 to 2 days in duration.The myocardial fibers have dark red contraction bands ex

5、tending across them.The myocardial cell nuclei have almost all disappeared.There is beginning acute inflammation.Clinically,such an acute myocardial infarction is marked by changes in the electrocardiogram and by a rise in the MB fraction of creatine kinase.In this microscopic view of a recent myoca

6、rdial infarction,there is extensive hemorrhage along with myocardial fiber necrosis with contraction bands and loss of nuclei.心肌梗死前间隔及前壁心肌梗死 下壁心肌梗死 高侧壁心肌梗死 正后壁心肌梗死 心室除极顺序的改变 心室肥大急性心肌炎 生理性或位置性 束支阻滞预激心室肥厚正常人肺栓塞谢谢11、越是没有本领的就越加自命不凡。邓拓12、越是无能的人，越喜欢挑剔别人的错儿。爱尔兰13、知人者智，自知者明。胜人者有力，自胜者强。老子14、意志坚强的人能把世界放在手中像泥块一样任意揉捏。歌德15、最具挑战性的挑战莫过于提升自我。迈克尔F斯特利