Vincent R
Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom.
J Accid Emerg Med. 1996 Mar;13(2):74-9. doi: 10.1136/emj.13.2.74.
The effective early diagnosis of acute myocardial infarction still rests primarily on the clinical history and the electrocardiogram. ST segment elevation is specific though sometimes short lived and less than ideally sensitive; but with bundle branch block it defines a population that benefits importantly from thrombolysis. Novel electrode configurations can further enhance diagnosis but have not become popular. Biochemical markers are rarely of help in the first four hours and cardiac scanning is impractical for routine care. Computerised diagnostic systems show promise in prototype but are not widely available. Early management involves reestablishing coronary flow by thrombolytic and antithrombotic agents and reducing myocardial oxygen requirement by analgesics and beta blockers. Nitrates and magnesium have limited roles. Immediate access to defibrillation and advanced life support is mandatory. Diagnosis and management can only begin after help has been sought. Public alertness to the symptoms of myocardial infarction and a coordinated response by health care personnel are fundamental to successful care.
急性心肌梗死的有效早期诊断仍主要依赖于临床病史和心电图。ST段抬高具有特异性，尽管有时持续时间短且敏感性不尽理想；但伴有束支传导阻滞时，它界定了一个能从溶栓治疗中显著获益的人群。新型电极配置可进一步提高诊断水平，但尚未普及。生化标志物在前4小时很少有帮助，心脏扫描对于常规护理而言不切实际。计算机化诊断系统在原型阶段显示出前景，但尚未广泛应用。早期治疗包括通过溶栓和抗栓药物重建冠状动脉血流，以及通过镇痛药和β受体阻滞剂降低心肌需氧量。硝酸盐和镁的作用有限。必须立即获得除颤和高级生命支持。只有在寻求帮助之后才能开始诊断和治疗。公众对心肌梗死症状的警觉以及医护人员的协调反应是成功治疗的基础。
