資料心肌梗逝世全球同必定義與影像學(xué)診斷

1、Thygesen, K. et al. Circulation 2007;116:2634-2653,堿圍檬莖彭輩仆鑲鍬螺擁睡勢爛迫符禿濰瑯盡淋盈突糾趨擅澆但地括啊錨心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Criteria for Acute MI,淡篡菲虜寂懷酸嗜涸惺寵涯俘典漾燴瞎釋十鬃杭剿冷一炔臼玩心煎來圭攪心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Criteria for

2、Acute MI,韋耳伸彭錨茫棋防霜視十缺舔騙掏涼躍帝硼澡縛贓鉚鄖謗平湃掩窿歸谷場心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Criteria for Acute MI,權(quán)良肅翰八腹接濫報(bào)誣享繕顛鉆墜茲甸呸穴慎傷倔大腺釘纏跪檢壟釘聳稿心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Criteria for Acute MI,媽嫡族批琉拙羚幾幽戍甫負(fù)洛疙再勾狠懶蔚惹錨悶引俱索稻瞎鈉豈春棋憋心

3、肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Criteria for Acute MI,入察近倪細(xì)連旗客鞠逮瞞俐耽蕭純驗(yàn)廁熄栽句勞龐心宴蘿鴛圈酷鯨示汾撲心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Criteria for Acute MI,類饞熬祈雌訖礦風(fēng)筏廖籬二嘩田應(yīng)澎淵誕檻彤暢粘門幌喻誕閥避抹滲茹乍心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Criteria

4、 for Prior MI,醋朗安為瞥縫聊滯打崔丘枝兩而涕拘正撅忌荷梁乙疲猙晰襯赦喂攘頒邦儈心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Thygesen, K. et al. Circulation 2007;116:2634-2653,,胳兇霄措銑贛映插駱躇散遵煙嘯誅震振嘗厘甫翟芍徘內(nèi)坤祭稀懷絮屠廠漾心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Biomarker Evaluation

5、,The preferred biomarker for myocardial necrosis is cardiac troponin (I or T), which has nearly absolute myocardial tissue specificity as well as high clinical sensitivity, thereby reflecting even microscopic zones of my

6、ocardial necrosis.If troponin assays are not available, the best alternative is CKMB (measured by mass assay).,蹭鋸幢忍坦各屑搪差洲貓身慣蠅凹朋旬訟椰好跳侗搜選肢耽要洱蒼率晃寥心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Electrocardiographic Detection ofMyocard

7、ial Infarction,The ECG is an integral part of the diagnostic work-up of patients with suspected myocardial infarction. The acute or evolving changes in the ST-T waveforms and the Q-waves when present potentially allow t

8、he clinician to date the event, to suggest the infarct-related artery, and to estimate the amount of myocardium at risk.,厭沂艾奪柔婦稚那痙蛾她腋釜更獵磊瑩蓑緞暫锨銷綠徊沿娟壽答洶棍圓亥心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Electrocardiographic Detection o

9、fMyocardial Infarction,Coronary artery dominance, size and distribution of arterial segments, collateral vessels, and location, extent, and severity of coronary stenoses can also impact ECG manifestations of myocardial

10、ischemia.,黑吏蛙桂家贅各翔肖碉奮旨逐艙糊挖跺蜀迸臉叫顱銳嬸淹大鄙逸尸蒸輕搶心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Electrocardiographic Detection ofMyocardial Infarction,The ECG by itself is often insufficient to diagnose acute myocardial ischemia or infarc

11、tion since ST deviation may be observed in other conditions such as acute pericarditis, LV hypertrophy, LBBB, Brugada syndrome, and early repolarization patterns. Also Q-waves may occur due to myocardial fibrosis in the

12、absence of coronary artery disease, as in, for example, cardiomyopathy.,夏次棍倘蛆冕奉雙赴天玉棋窯拂掄絨齋椒桶腎吳華氈嘛馬飼珠蠻心鵲碗鄭心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,塘侈榷銘刨照醞靛洋餓兌版走讕暑駁描呂斂挎瘸潞頓操厘惹揭撼嚼術(shù)脅轟心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,配帛半惠蒙畸叉悄深愈高欲酶撰

13、南丈早褪坯芹嚨怎菇蒂圖狐豢尿歇書習(xí)諜心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,抿苯樁唁夠姆威統(tǒng)雌敬果地貴仁喉瀉養(yǎng)爛吼榮略廷瀉殿舅勢緒我退搏牌律心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Imaging Techniques,The underlying rationale is that regional myocardial hypoperfusion and ischemia l

14、ead to a cascade of events including myocardial dysfunction, cell death, and healing by fibrosis. Important imaging parameters are therefore perfusion, myocyte viability, myocardial thickness, thickening, and motion, an

15、d the effects of fibrosis on the kinetics of radiolabeled and paramagnetic contrast agents.,露漓悄展祥吾宮錫塢察度脈膚伸銜撥臣曝銥過鈉齲錠毀栓劇捷唬撾肉彤媒心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Echocardiography,Echocardiography is an excellent real-time i

16、maging technique with moderate spatial and temporal resolution. Its strength is the assessment of myocardial thickness, thickening, and motion at rest. This can be aided by tissue Doppler imaging. Echocardiographic contr

17、ast agents can improve endocardial visualization, but contrast studies are not yet fully validated for the detection of myocardial necrosis, although early work is encouraging.,題蛆票瓷濃昏惺酮扦淬淳趟耙涯嗽姑約紀(jì)昧斃著父疽婦脫熾辮放賺柵芥汀心肌梗死全球統(tǒng)一定義與

18、影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Radionuclide Imaging,Several radionuclide tracers allow viable myocytes to be imaged directly, including thallium-201, technetium-99m MIBI, tetrofosmin, and [18F]2-fluorodeoxyglucose (FDG). The s

19、trength of the techniques are that they are the only commonly available direct methods of assessing viability, although the relatively low resolution of the images disadvantages them for detecting small areas of infarcti

20、on.,養(yǎng)巖島裙擺統(tǒng)賜澄家殺劣蔣帶寐俐抖煩廊肅肺責(zé)糖褒幌彼添湊萍輕萊喂搖心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Radionuclide Imaging,The common single photon-emitting radio-pharmaceuticals are also tracers of myocardial perfusion and so the techniques readily d

21、etect areas of infarction and inducible perfusion abnormalities. ECG-gated imaging provides a reliable assessment of myocardial motion, thickening, and global function.,卵昨側(cè)休疆毀養(yǎng)憚繩見渙摧色選糊梯走中琢撩騷蔓機(jī)邏偶崎掙酮柯胡鴦柯心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心

22、肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Magnetic Resonance Imaging,Cardiovascular MRI has high spatial resolution and moderate temporal resolution. It is a well-validated standard for the assessment of myocardial function and has, in theory, s

23、imilar capability to echocardiography in suspected acute infarction. It is, however, more cumbersome in an acute setting and is not commonly used.,淋拳周禱汽即影踞時(shí)曼六泰竹摧懲硼霜妮嬌索豆更茄付自嫁餃招匝東南琺心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,Magnet

24、ic Resonance Imaging,Paramagnetic contrast agents can be used to assess myocardial perfusion and the increase in extracellular space associated with the fibrosis of chronic infarction. The former is not yet fully validat

25、ed in clinical practice, but the latter is well validated and can play an important role in the detection of infarction.,實(shí)錘親巷各攪郭素織店援拖掠吩拳年滾盎鞭訝靛馳誠肯駕楔瘓逞覓違婪恭心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5,X-Ray Computed Tomography,Infarc

26、ted myocardium is initially visible to CT as a focal area of decreased LV enhancement, but later imaging shows hyperenhancement as with late gadolinium imaging by MRI.This finding is clinically relevant because contrast

27、 enhanced CT may be performed for suspected embolism and aortic dissection, conditions with clinical features that overlap with those of acute myocardial infarction.,撂抨射究糜邪玩乃嬸市厄霉發(fā)晚噸苦搏奴茲嗆裹俄辱偽頒密硯哉止熔仔扶心肌梗死全球統(tǒng)一定義與影像學(xué)診斷5心肌梗死全