AMI, cerebral stroke, pulmonary oedema PDF
Preview AMI, cerebral stroke, pulmonary oedema
Rules of treatment in selected emergency states: AMI, cceerreebbrraall ssttrrookkee,, pulmonary oedema acute myocardial infarction AMI acute coronary syndromes (ACS) • acute myocardial • Unstable angina infarction (AMI) necrosis acute coronary syndrome test • Ecg Cardiac biomarkers • hFABP – heart fatty acid binding proteins •• MMiioogglloobbiinn • Creatine kinase • Troponins • Enolase • Echocardiography • Lipids • CBC -complete blood count ECG • ST-segment elevation or presumed new LBBB is characterized by ST-segment elevation >1 mm (0.1 mV) in 2 or more contignous precordial leads or 2 or more adjacent limb leads and is classified as ST-elevation MI (STEMI). • Ischemic ST-segment depression ≥0.5 mm (0.05 mV) or dynamic T- wave inversion with pain or discomfort is classified as high-risk UUAA//nnoonn––SSTT--eelleevvaattiioonn MMII ((NNSSTTEEMMII)).. NNoonnppeerrssiisstteenntt oorr ttrraannssiieenntt SSTT-- segment elevation ≥0.5 mm for <20 minutes is also included in this category. • Normal or nondiagnostic changes in ST segment or T waves are inconclusive and require further risk stratification. This classification includes patients with normal ECGs and those with ST-segment deviation of <0.5 mm (0.05 mV) or T-wave inversion of ≤0.2 mV. Serial cardiac studies (and functional testing) are appropriate. Cardiac biomarkers - creatine kinase (CK) • Elevation of the serum total CK is a sensitive enzymatic detector of AMI • False positive resalts in patients with: – Muscle disease – Alcohol intoxication – DM – Skeletal muscle trauma – Vigorous exercise – Convulsion – Intramuscular injections – Pulmonary embolism • Three isoenzymes of CK: CK-BB (brain and kidney), CK- MM (skeletal muscle) and CK-MB (heart) • A ratio (relative index) of CK-MB/total CK > 6% is indicative of a myocardial rather then other source of the CK-MB elevation Cardiac biomarkers - troponin • Best diagnostic and prognostic marker of AMI • The troponin complex consist of three subunits that regulate the calcium mediated contractil process of strited muscle. – troponin I, T and C • Whereas CK-MB usually increases 10 to 20 fold above tthhee uuppppeerr lliimmiitt ooff tthhee rreeffeerreennccee rraannggee,, ttrrooppoonniinn TT aanndd II typically increase more then 20 times above the reference range. Troponin T and I are more sensitive in diagnosis of minor myocardial damage • Troponin I and T –gold standard in diagnosis of AMI • < 4-6 h- small sensivity (10- 45%) • > 8 h- sensivity 95% • Measurment 2-time: 6- 12 h, 12- 24 h Cardiac biomarkers - the level of troponin increase in • HF • Aortic aneurysm • Pulmonary embolism • Toxic injure of heart muscle (chemiotherapy) •• mmiiooccaarrddiittiiss • Injury of heart muscle • Chronic renal failure • Acute abdominal problem • burns • other: kardioversion, arrhythmias Cardiac biomarkers - mioglobin • Early marker of necrosis • Hight negative prognostic value . Reference range of mioglobin over 8 h aafftteerr cchheesstt ppaaiinn eexxcclluuddee MMII.. • reference range <70- 110 ng/ml, • AMI: 600- 1000 ng/ml Cardiac biomarkers - the level of mioglobin increase in • Injury of heart muscle • heatstroke, frostbite, burns • hypothyreosis •• hhyyppookkaalliieemmiiaa,, • Convulsion, febrilis • Sepsis • Alcohol intoxication • Medication - statines, fibrates (rabdomiolizis)
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