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心肌梗死全球統(tǒng)一定義與影像學(xué)診斷

2013-11-08 16:47 閱讀:1612 來源:愛愛醫(yī) 作者:7****i 責(zé)任編輯:78322li
[導(dǎo)讀] 【專家課件】 心肌梗死全球統(tǒng)一定義與影像學(xué)診斷 內(nèi)容預(yù)覽: (點擊下圖可對專家課件進行全文預(yù)覽) 【專家課件】 心肌梗死全球統(tǒng)一定義與影像學(xué)診斷 內(nèi)容簡介: 心肌梗死全球統(tǒng)一定義與影像學(xué)診斷 心肌梗死全球統(tǒng)一定義與影像學(xué)診斷何作祥 中國醫(yī)學(xué)科學(xué)院阜

心肌梗死全球統(tǒng)一定義與影像學(xué)診斷  內(nèi)容預(yù)覽: 

(點擊下圖可對專家課件進行全文預(yù)覽)

心肌梗死全球統(tǒng)一定義與影像學(xué)診斷  內(nèi)容簡介:

心肌梗死全球統(tǒng)一定義與影像學(xué)診斷
心肌梗死全球統(tǒng)一定義與影像學(xué)診斷何作祥
中國醫(yī)學(xué)科學(xué)院阜外心血管病醫(yī)院

BiomarkerEvaluation
Thepreferredbiomarkerformyocardialnecrosisiscardiactroponin(IorT),whichhasnearlyabsolutemyocardialtissuespecificityaswellashighclinicalsensitivity,therebyreflectingevenmicroscopiczonesofmyocardialnecrosis.
Iftroponinassaysarenotavailable,thebestalternativeisCKMB(measuredbymassassay).

ElectrocardiographicDetectionof
MyocardialInfarction
TheECGisanintegralpartofthediagnosticwork-upofpatientswithsuspectedmyocardialinfarction.
TheacuteorevolvingchangesintheST-TwaveformsandtheQ-waveswhenpresentpotentiallyallowthecliniciantodatetheevent,tosuggesttheinfarct-relatedartery,andtoestimatetheamountofmyocardiumatrisk.

ElectrocardiographicDetectionof
MyocardialInfarction
Coronaryarterydominance,sizeanddistributionofarterialsegments,collateralvessels,andlocation,extent,andseverityofcoronarystenosesc**soimpactECGmanifestationsofmyocardialischemia.


ElectrocardiographicDetectionof
MyocardialInfarction
TheECGbyitselfisofteninsufficienttodiagnoseacutemyocardialischemiaorinfarctionsinceSTdeviationmaybeobservedinotherconditionssuchasacutepericarditis,LVhypertrophy,LBBB,Brugadasyndrome,andearlyrepolarizationpatterns.AlsoQ-wavesmayoccurduetomyocardialfibrosisintheabsenceofcoronaryarterydisease,asin,forexample,cardiomyopathy.

ImagingTechniques
Theunderlyingrationaleisthatregionalmyocardialhypoperfusionandischemialeadtoacascadeofeventsincludingmyocardialdysfunction,celldeath,andhealingbyfibrosis.
Importantimagingparametersarethereforeperfusion,myocyteviability,myocardialthickness,thickening,andmotion,andtheeffectsoffibrosisonthekineticsofradiolabeledandparamagneticcontrastagents.

Echocardiography
Echocardiographyisanexcellentreal-timeimagingtechniquewithmoderatespatialandtemporalresolution.Itsstrengthistheassessmentofmyocardialthickness,thickening,andmotionatrest.ThiscanbeaidedbytissueDopplerimaging.Echocardiographiccontrastagentscanimproveendocardialvisualization,butcontraststudiesarenotyetfullyvalidatedforthedetectionofmyocardialnecrosis,althoughearlyworkisencouraging.

RadionuclideImaging
Severalradionuclidetracersallowviablemyocytestobeimageddirectly,includingthallium-201,technetium-99mMIBI,tetrofosmin,and[18F]2-fluorodeoxyglucose(FDG).
Thestrengthofthetechniquesarethattheyaretheonlycommonlyavailabledirectmethodsofassessingviability,althoughtherelativelylowresolutionoftheimagesdisadvantagesthemfordetectingsmallareasofinfarction.

RadionuclideImaging
Thecommonsinglephoton-emittingradio-pharmaceuticalsarealsotracersofmyocardialperfusionandsothetechniquesreadilydetectareasofinfarctionandinducibleperfusionabnormalities.
ECG-gatedimagingprovidesareliableassessmentofmyocardialmotion,thickening,andglobalfunction.

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