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Diagnosis
A suspicion of AMI arises on the basis of pangs in the chest for a length of 15 minutes and more. It should be taken into consideration the presence of IHD in the anamnesis, irradiation of pains to the neck, lower jaw and left arm. A dyspnea and loss of consciousness may be in persons of elderly age. When these symptoms are available it is necessary, as soon as possible, to register ECG (no later than 20 min after an admission to the hospital). In case of ECG changes typical for AMI, a frequent repeated ECG registration is recommended in dynamics. As additional measures it is recommended to determine markers of myocardial necrosis in blood plasma, and in difficult cases — echocardiography and coronarography. Of the markers of myocardial necrosis the following isoenzymes are determined: LDG, fraction (sharply elevated) and creatine phosphokinase (CPK), however, recently, the level of troponin is recognized as the best among the markers. CPK activity increases in the first 6 hours, then AST activation is observed and in 24-48 hours LDG is activated. By these findings we may judge of long standing of AMI. It is also necessary to carry out investigations of transaminase activity: glutamic-oxalic-acetic transaminase (GOAT) that is elevated (normally 6-10 U) and glutamic-pyruvic transaminase GPT). C-reactive protein is also determined as the marker of inflammatory activity. Differential diagnosis is necessary with other causes of pains in the chest: dissecting aortic aneurysm, acute pericarditis, acute myocarditis, spontaneous
pneumothorax and TEPA. Arrhythmias develop in 90% of cases of AMI. Tachycardia more than 100 beats per min., hypotonia (AP<100 mm Hg), shock,
pulmonary edema give evidence of the extreme degree of AMI severity. Дата добавления: 2015-02-05 | Просмотры: 661 | Нарушение авторских прав |