amg4 curs ima

7/22/2019 Amg4 Curs Ima

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Antoniu PetrisMD, PhD, FESC

AntoniuAntoniu PetrisPetris MD, PhD, FESCMD, PhD, FESC

St. Spiridon Hospital Iasi, Romania

St. Spiridon Hospital Iasi, Romania

UMF Gr. T. Popa Iasi, Romania

UMF Gr. T. Popa Iasi, Romania


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Sindroame Coronariene Acute

Murphy SA, et al.Murphy SA, et al.,, EHJEHJ 20072007;; 2828:: 2077207720862086

AI / NSTEMIAI / NSTEMISTEMISTEMI


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TIME IS MONEYTIME IS MONEY

TIME IS MUSCLETIME IS MUSCLETIME IS LIFETIME IS LIFE 2626 lifeslifes saved / 1000 ptssaved / 1000 pts -- TL in first 3 hTL in first 3 h

3737 lifeslifes saved / 1000 ptssaved / 1000 pts -- TL in first 2 hTL in first 2 h

6565 lifeslifes saved /1000 ptssaved /1000 pts -- TL in first hTL in first h

BoersmaBoersma E et al. Lancet 1996; 348: 771E et al. Lancet 1996; 348: 771--775775


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RemodelareaRemodelarea precoceprecoce

RemodelareaRemodelarea tardiva/progresivatardiva/progresiva


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2012


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EDUCATIE

COMUNICARE

COLABORARE


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Istoric de durere toracic/discomfort

Supradenivelare de segment ST persistent sau bloc major deramur stng nou aprut (presupus). Adesea sunt necesare

nregistrri ECG repetate.

Creterea markerilor de necroz miocardic (CK-MB, troponine).Nu trebuie ateptat rezultatul pentru a iniia tratamentul dereperfuzie.

Ecocardiografia 2D pentru a exclude ischemia miocardic majorsau alte cause de durere/discomfort toracic

ESC, 2008


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:

Durat

> 20 minute, uneori cteva ore.

Caracter Durere constrictiv, de strivire, apsare sau strngere toracic.

Localizare - retrosternal, uneori doar n zonele de iradiere (articulaia pumnului);

- atipic - epigastric.

Iradiere - baza gtului, membrul superior stng pe faa cubitalabraului pnla nivelul minii i degetelor;- uneori la nivelul mandibulei sau n regiunea interscapular.

Simptome de

nsoire

- dispnee, transpiraii, grea, vrsturi, febr.

Condiii de

apariie

- exerciiu fizic, stress emoional, condiii care cresc cererea de oxigen,

intervenii chirurgicale, spasm coronarian.

Condiii de

ameliorare

sau dispariie

- nu cedeaz la administrarea de nitroglicerin s.l. sau n repaus -seamelioreaz sub opiacee;- durerea dispare atunci cnd se reia circulaia n zona infarctului.


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DURERE TORACICA

CARDIACA NON-CARDIACA

ISCHEMICA NON-ISCHEMICA PULMONARA GASTRO-

INTESTINALA

PSIHOGENICA NEURO-

MUSCULO-

SCHELETICA

Angina pectorala

Infarct miocardic acut

HTA

HTP severa

Stenoza aortica

CMHO

Anemie severa

Disectie de aorta

Pericardita

Ruptura de cordaje

Ruptura sinus

Valsalva

PVM

Cardiomiopatii

Embolie pulmonara

Pneumotorax

Pneumonie

Spasm esofagian

Reflux esofagian

Ruptura esofag

Anxietate

StressZona zoster

DepresieSpondiloza

Costocondrita

Sdr. de traversare


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Limitele potentiale ale diagnosticului

diferential sunt, in general vorbind, invers

proportionale cu grija cu care a fost luatistoricul.

Matthews, 1977

Limitele potentiale ale diagnosticului

diferential sunt, in general vorbind, invers

proportionale cu grija cu care a fost luatistoricul.

Matthews, 1977


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TRASEULTRASEUL ECGECG


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ESC, 2008


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PatrickPatrick Goldstein, 2007Goldstein, 2007

ElectrocardiogramaElectrocardiograma in IMAin IMA


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ElectrocardiogramaElectrocardiograma in IMAin IMA

SensibilitateSensibilitate 95%95% dacadaca esteeste efectuataefectuata inin dinamicadinamica !!!!!!

10%10% -- normalanormala

50%50% -- diagnosticadiagnostica

40%40% -- anormalaanormala dardarnunu punepune diagnosticuldiagnosticul


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IM supraIM supra--acutacut primeleprimele min.min.


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IMIM acutacut 77 zilezile

IM recentIM recent 77--2828 zilezile

IMIM vechivechi pestepeste 2828 zilezile


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ENZIMAENZIMA


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ESC, 2008


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faciliteaza contractia

inhiba contractia in repaus

Proteine reglatoare care controleaza interactiunea calciu-mediatadintre actina si miozina.


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22--3 h3 h

33--4 h4 h

1.51.5--2 h2 h


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ACUSON P10 SystemACUSON P10 System

FeaturesFeaturesAt 1.6 lbs (.725kg), the first pocket ultrasoundAt 1.6 lbs (.725kg), the first pocket ultrasound

device.device.Designed for ease of use with an intuitive PDADesigned for ease of use with an intuitive PDA--

style user interface.style user interface.

Ready anywhere, anytime with instant powerReady anywhere, anytime with instant power--up.up.

HighHigh--quality images (fundamental and harmonicquality images (fundamental and harmonic

2D2D--mode).mode).

IndustryIndustry--standard USB port for informationstandard USB port for information

sharing, upgrades.sharing, upgrades.

CAND?


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N = 10037

CAND?

UNDE?


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STAY and PLAY?STAY and PLAY?

LOAD and RUN?LOAD and RUN?

UNDE?

CUM?


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TRIAJTRIAJ

TRANSFERTRANSFER

TRATAMENTTRATAMENT

TRIAJTRIAJ

TRANSFERTRANSFER

TRATAMENTTRATAMENT

TrombolizaTromboliza

AspirinaAspirina

ClopidogrelClopidogrel

HeparinaHeparina

GPGP IIb/IIIaIIb/IIIa

CUM?


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GhidGhid, 2008, 2008


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ESC, 2008


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ESC, 2003ESC, 2003


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ESC, 2008


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16 septembrie 197716 septembrie 1977


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ESC

,2008

ESC

,2008


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ESC, 2008ESC, 2008


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ESC, 2008ESC, 2008

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