深入解析急性冠狀動脈綜合症診斷:從症狀到現代技術

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急性冠狀動脈綜合症是一系列血栓相關的冠狀動脈疾病,包括不穩定性心絞痛及ST段抬高和非ST段抬高型心肌梗塞。其診斷依賴於心電圖和對心肌缺血跡象的仔細評估。風險分級有助於適當地將病患轉介至胸痛中心或急診部門,並進行心肌酶水平評估。高風險患者通常需要住院治療,中風險患者應進行結構化評估。許多低風險患者可在適當的隨訪下出院。心肌肌鈣蛋白T或I是目前最敏感的急性冠狀動脈綜合症指標,但肌酸激酶MB同工酶也被使用。

急性冠狀動脈綜合症的診斷

Diagnosis of acute coronary syndrome

Achar SA, Kundu S, Norcross WA. Diagnosis of acute coronary syndrome. Am Fam Physician. 2005 Jul 1;72(1):119-26. PMID: 16035692.

https://pubmed.ncbi.nlm.nih.gov/16035692/

Abstract

The term “acute coronary syndrome” encompasses a range of thrombotic coronary artery diseases, including unstable angina and both ST-segment elevation and non-ST-segment elevation myocardial infarction. Diagnosis requires an electrocardiogram and a careful review for signs and symptoms of cardiac ischemia. In acute coronary syndrome, common electrocardiographic abnormalities include T-wave tenting or inversion, ST-segment elevation or depression (including J-point elevation in multiple leads), and pathologic Q waves. Risk stratification allows appropriate referral of patients to a chest pain center or emergency department, where cardiac enzyme levels can be assessed. Most high-risk patients should be hospitalized. Intermediate-risk patients should undergo a structured evaluation, often in a chest pain unit. Many low-risk patients can be discharged with appropriate follow-up. Troponin T or I generally is the most sensitive determinant of acute coronary syndrome, although the MB isoenzyme of creatine kinase also is used. Early markers of acute ischemia include myoglobin and creatine kinase-MB subforms (or isoforms), when available. In the future, advanced diagnostic modalities, such as myocardial perfusion imaging, may have a role in reducing unnecessary hospitalizations.

摘要

“急性冠狀動脈綜合症”一詞涵蓋了一系列血栓性冠狀動脈疾病,包括不穩定型心絞痛、ST段抬高和非ST段抬高心肌梗死。診斷需要心電圖和對心肌缺血的跡象和症狀進行仔細審查。在急性冠狀動脈綜合症中,常見的心電圖異常包括T波豎帳或倒置、ST段抬高或下降(包括多導程中的J點抬高)以及病理性Q波。風險分層允許將患者適當轉介至胸痛中心或急診部門,以評估心肌酶水平。大多數高風險患者應住院治療。中間風險患者應進行結構性評估,通常在胸痛單元進行。許多低風險患者可以在適當的隨訪下出院。肌鈣蛋白T或I通常是急性冠狀動脈綜合症最敏感的決定因素,儘管也使用肌酸激酶的MB異構酶。早期急性缺血的標誌物包括肌紅蛋白和肌酸激酶-MB亞型(或異型),如果有的話。未來,先進的診斷方式,如心肌灌注成像,可能在減少不必要的住院治療方面發揮作用。