급성심근경색 레포트

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급성심근경색 레포트에 대한 자료입니다.
목차
Ⅰ. INTRODUCTION.

Ⅱ. PATHOPHYSIOLOGY ; Role of Acute plaque rupture

Clinical Presentation

1.Symptom and Sign

2. Physical Finding

Lab Finding

1.EKG

2.Serum Cardiac Marker

3.Cardiac Imaging

Management

1.prehospital care

2.Initial management in the emergency department

3.Control of pain

4. management stratage

5. Limitation of infarct size

6.Thrombolysis

Hospital Phase Management

1.Coronary care unit

Pharmacotherapy for Acute infarction

1. Antithrombotic agent : antiplatelet and antithrombin therapy

2.beta - Adrenoreceptor blocker

3.Angiotensin converting enzyme inhibitor

4.other agents

COMPLICATION

1. Arrythmia(m/c)

2. heart failure

3. Right ventricular infarction

4. Ventricular septal peroration( VSD)

5. MR(papillary muscle dysfuncruion/rupture )

6. Cardiad rupture ( free wall rupture )

7. Thromboembolism

8. Pericarditis

9. Dressler's syndrome ( post MI syncrome )

10. Ventricular aneurysm

POSTINFART MANAGEMENT

본문내용
Ⅰ. INTRODUCTION.

Ⅱ. PATHOPHYSIOLOGY ; Role of Acute plaque rupture

-갑작스런 coronary artery blood flow의 감소가 있을 때 나타난다.
( atherosclerosis에 의해 생긴thrombotic occlusion of coronary artery)
( 천천히 생기면 collateral artery가 생겨서 AMI유발 안됨 )
* facillitating factor : cigarette smoking, hypertension, lipid accumulation
-atheroscleroic plaque fissure, rupture or ulcerates, thrombogenesis
에서 잘 생긴다.
->mural thrombus formation at rupture site
->coronary artery occlusion 유발

** at rupture site,
A. initially,
platelet monolayer forms( collagen, ADP, epinephrine, serotonin)
: agonist stimulation
1) → platelet activation
→ production and release of thromboxane A2( vasoconstriction)
further platelet activation, potential resistance to thrombolysis
2) → conformational change in the glycoprotein ⅡbⅢa receptor.
→high affirnity for the sequence arginine-glycine-aspartic acid on the fibrinogen gamma chain
→ platelet cross-linking and aggregation
B. coagulation cascade is activated(← damaged endothelium에서 tissue factor분비)
→ Ⅶ, Ⅹ activate → thrombin증가 → fibrin증가
→ coronary artery occlusion

- in rare case, coronary emboli, congenital abnormality, coronary spasm, systemic disease(especially, inflammation)
→ secondary coronary artery occlusion 발생
-AMI 의 risk : ①unstable angina
②Prinzmetal's variant angina
③multiple coronary risk factor
④less common : hypercoagulability
collagen vascular disease
cocaine abuse
intracardiac thrombi or mass


Clinical Presentation
-precipitating factor : ①vigorous physical exercise
②emotional stress
③medical or surgical illness
-myocardial attack : 오전 6시에서 12시에 circadian rhythm - highest in the morning
( sympathetic tone increase, thrombosis tendency 증가)