[순환기내과] 급성심근경색(acute myocardial infarction)

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목차

■ Pathophysiology
■ Risk factors
■ Clinical presentations
■ Laboratory findings
■ Diagnosis
■ Management
■ Prognosis

본문내용

■ Pathophysiology
atherosclerotic plaque의 rupture, fissure, ulceration -> 혈소판의 활성화 ->thrombotic
occlusion -> necrosis

■ Risk factors - coronary risk factor
- unstable angina
- Prinzmetal's variant angina
- hypercoagulability, collagen vascular disease, cocaine abuse, coronary emboli
- 흡연, 비만, HTN, Hyperlipidemia, DM
- 고령(남 >45, 여 >55), 남성, 폐경 (특히 조기폐경)

■ Clinical presentations
- 유발인자 : vigorous physical exercise, emotional stress, medical or surgical illness
early in the day ( sympathetic tone and thrombosis)
- 증상
1) chest pain : deep & visceral pain (angina pain과 비슷, but 더 오래 지속되고 심함)
heavy, squeezing, crushing
central portion of chest and/or epigastrium
radiation-arm(30%). abdomen, back, low jaw, neck
2) 동반증상 : weakness, sweating, N/V, anxiety, sense of impending doom
- 진찰소견
1. 안면 창백, 발한
2. 심첨부 박동 촉지 : ant. wall MI에서 dyskinetic bulging 때문
3. 심실 기능 부전시 : S3, S4 감소, paradoxical splitting of S2 (severe)
4. pericardial friction rub
5. 경정맥 확장 : RV infarct
6. 체온 상승
7. PR & BP : ant. infarct -> 빈맥 & 고혈압 (sym. tone 항진)
inf. infarct -> 서맥 & 저혈압 (vagal tone 항진)
- 감별진단 : pericarditis, AS, AR, HCM, aortic dissection, pulmonary embolism...

참고 자료

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