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Antoniu PetrisMD, PhD, FESC
AntoniuAntoniu PetrisPetris MD, PhD, FESCMD, PhD, FESC
St. Spiridon Hospital Iasi, Romania
St. Spiridon Hospital Iasi, Romania
UMF Gr. T. Popa Iasi, Romania
UMF Gr. T. Popa Iasi, Romania
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Sindroame Coronariene Acute
Murphy SA, et al.Murphy SA, et al.,, EHJEHJ 20072007;; 2828:: 2077207720862086
AI / NSTEMIAI / NSTEMISTEMISTEMI
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TIME IS MONEYTIME IS MONEY
TIME IS MUSCLETIME IS MUSCLETIME IS LIFETIME IS LIFE 2626 lifeslifes saved / 1000 ptssaved / 1000 pts -- TL in first 3 hTL in first 3 h
3737 lifeslifes saved / 1000 ptssaved / 1000 pts -- TL in first 2 hTL in first 2 h
6565 lifeslifes saved /1000 ptssaved /1000 pts -- TL in first hTL in first h
BoersmaBoersma E et al. Lancet 1996; 348: 771E et al. Lancet 1996; 348: 771--775775
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RemodelareaRemodelarea precoceprecoce
RemodelareaRemodelarea tardiva/progresivatardiva/progresiva
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2012
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EDUCATIE
COMUNICARE
COLABORARE
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Istoric de durere toracic/discomfort
Supradenivelare de segment ST persistent sau bloc major deramur stng nou aprut (presupus). Adesea sunt necesare
nregistrri ECG repetate.
Creterea markerilor de necroz miocardic (CK-MB, troponine).Nu trebuie ateptat rezultatul pentru a iniia tratamentul dereperfuzie.
Ecocardiografia 2D pentru a exclude ischemia miocardic majorsau alte cause de durere/discomfort toracic
ESC, 2008
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:
Durat
> 20 minute, uneori cteva ore.
Caracter Durere constrictiv, de strivire, apsare sau strngere toracic.
Localizare - retrosternal, uneori doar n zonele de iradiere (articulaia pumnului);
- atipic - epigastric.
Iradiere - baza gtului, membrul superior stng pe faa cubitalabraului pnla nivelul minii i degetelor;- uneori la nivelul mandibulei sau n regiunea interscapular.
Simptome de
nsoire
- dispnee, transpiraii, grea, vrsturi, febr.
Condiii de
apariie
- exerciiu fizic, stress emoional, condiii care cresc cererea de oxigen,
intervenii chirurgicale, spasm coronarian.
Condiii de
ameliorare
sau dispariie
- nu cedeaz la administrarea de nitroglicerin s.l. sau n repaus -seamelioreaz sub opiacee;- durerea dispare atunci cnd se reia circulaia n zona infarctului.
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DURERE TORACICA
CARDIACA NON-CARDIACA
ISCHEMICA NON-ISCHEMICA PULMONARA GASTRO-
INTESTINALA
PSIHOGENICA NEURO-
MUSCULO-
SCHELETICA
Angina pectorala
Infarct miocardic acut
HTA
HTP severa
Stenoza aortica
CMHO
Anemie severa
Disectie de aorta
Pericardita
Ruptura de cordaje
Ruptura sinus
Valsalva
PVM
Cardiomiopatii
Embolie pulmonara
Pneumotorax
Pneumonie
Spasm esofagian
Reflux esofagian
Ruptura esofag
Anxietate
StressZona zoster
DepresieSpondiloza
Costocondrita
Sdr. de traversare
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Limitele potentiale ale diagnosticului
diferential sunt, in general vorbind, invers
proportionale cu grija cu care a fost luatistoricul.
Matthews, 1977
Limitele potentiale ale diagnosticului
diferential sunt, in general vorbind, invers
proportionale cu grija cu care a fost luatistoricul.
Matthews, 1977
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TRASEULTRASEUL ECGECG
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Istoric de durere toracic/discomfort
Supradenivelare de segment ST persistent sau bloc major deramur stng nou aprut (presupus). Adesea sunt necesare
nregistrri ECG repetate.
Creterea markerilor de necroz miocardic (CK-MB, troponine).Nu trebuie ateptat rezultatul pentru a iniia tratamentul dereperfuzie.
Ecocardiografia 2D pentru a exclude ischemia miocardic majorsau alte cause de durere/discomfort toracic
ESC, 2008
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PatrickPatrick Goldstein, 2007Goldstein, 2007
ElectrocardiogramaElectrocardiograma in IMAin IMA
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ElectrocardiogramaElectrocardiograma in IMAin IMA
SensibilitateSensibilitate 95%95% dacadaca esteeste efectuataefectuata inin dinamicadinamica !!!!!!
10%10% -- normalanormala
50%50% -- diagnosticadiagnostica
40%40% -- anormalaanormala dardarnunu punepune diagnosticuldiagnosticul
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IM supraIM supra--acutacut primeleprimele min.min.
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IMIM acutacut 77 zilezile
IM recentIM recent 77--2828 zilezile
IMIM vechivechi pestepeste 2828 zilezile
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ENZIMAENZIMA
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Istoric de durere toracic/discomfort
Supradenivelare de segment ST persistent sau bloc major deramur stng nou aprut (presupus). Adesea sunt necesare
nregistrri ECG repetate.
Creterea markerilor de necroz miocardic (CK-MB, troponine).Nu trebuie ateptat rezultatul pentru a iniia tratamentul dereperfuzie.
Ecocardiografia 2D pentru a exclude ischemia miocardic majorsau alte cause de durere/discomfort toracic
ESC, 2008
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faciliteaza contractia
inhiba contractia in repaus
Proteine reglatoare care controleaza interactiunea calciu-mediatadintre actina si miozina.
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22--3 h3 h
33--4 h4 h
1.51.5--2 h2 h
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ACUSON P10 SystemACUSON P10 System
FeaturesFeaturesAt 1.6 lbs (.725kg), the first pocket ultrasoundAt 1.6 lbs (.725kg), the first pocket ultrasound
device.device.Designed for ease of use with an intuitive PDADesigned for ease of use with an intuitive PDA--
style user interface.style user interface.
Ready anywhere, anytime with instant powerReady anywhere, anytime with instant power--up.up.
HighHigh--quality images (fundamental and harmonicquality images (fundamental and harmonic
2D2D--mode).mode).
IndustryIndustry--standard USB port for informationstandard USB port for information
sharing, upgrades.sharing, upgrades.
CAND?
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N = 10037
CAND?
UNDE?
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STAY and PLAY?STAY and PLAY?
LOAD and RUN?LOAD and RUN?
UNDE?
CUM?
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TRIAJTRIAJ
TRANSFERTRANSFER
TRATAMENTTRATAMENT
TRIAJTRIAJ
TRANSFERTRANSFER
TRATAMENTTRATAMENT
TrombolizaTromboliza
AspirinaAspirina
ClopidogrelClopidogrel
HeparinaHeparina
GPGP IIb/IIIaIIb/IIIa
CUM?
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GhidGhid, 2008, 2008
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ESC, 2008
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ESC, 2003ESC, 2003
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ESC, 2008
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16 septembrie 197716 septembrie 1977
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ESC
,2008
ESC
,2008
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ESC, 2008ESC, 2008
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ESC, 2008ESC, 2008
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