(1) pain: acute myocardial infarction in the first and most prominent symptoms appear, the typical site for the chest or heart until the anterior pharynx to the left shoulder, left arm radiation. Sometimes pain in the abdomen or xiphoid at the same time, often the back of the lower sternum does not feel oppressed, or accompanied by nausea, vomiting, common in inferior wall myocardial infarction. There is not a typical part of the right chest, jaw, neck, teeth, a rare head, legs and even toes thigh pain. The nature of strangulation-like pain or pressure pain, or tightening feeling, burning pain, often accompanied by irritability, sweating, fear, or sense of impending doom. Duration, often more than 30min, even up to more than 10 hours, rest and nitroglycerin are generally not alleviated.
A small number of patients with acute myocardial infarction without pain, but in heart failure, shock, sudden death and arrhythmia as the first symptom. No pain can also be found in the following cases: ① diabetes mellitus patients; ② the elderly; ③ after the onset of surgical anesthesia were acute myocardial infarction; ④ associated with cerebrovascular disease patients; ⑤ dehydration, acidosis patients.
(2) systemic symptoms: mainly fever, accompanied by tachycardia, increased leukocyte and erythrocyte sedimentation rate and rapid growth, due to necrosis caused by material absorption. Pain usually occurs after 24 ~ 48h, the degree of infarct often has a positive correlation, the upper and lower body temperature normally at 38 ℃, rarely more than 39 ℃, for 1 week or so.
(3) gastrointestinal symptoms: severe pain often accompanied by frequent nausea, vomiting and abdominal pain, and myocardial necrosis vagus nerve stimulation and reduced cardiac output, tissue hypoperfusion and so on. Flatulence is not uncommon. Severe hiccups may occur.
(4) arrhythmia: found in 75% to 95% of patients, onset occurred within 1 to 2 weeks, and to 24h in most common, may be associated with fatigue, dizziness, fainting and other symptoms. The most common arrhythmia, especially ventricular premature beat, if the frequency of ventricular premature beat (5 times / min or more), in pairs or ventricular tachycardia was paroxysmal, multi-source or off the vulnerability of the previous stroke (RonT), often indicate an impending ventricular tachycardia or ventricular fibrillation. Some patients is the onset of ventricular fibrillation, can cause sudden cardiac death. Accelerated ventricular rhythm also occurred independently. Various degrees of atrioventricular block and bundle branch block are often seen in severe cases can be as complete atrioventricular block. Supraventricular arrhythmias are less common, occurs in persons with heart failure. Anterior myocardial infarction prone to ventricular arrhythmias; inferior wall myocardial infarction-prone atrioventricular block; anterior myocardial infarction event of atrioventricular block, indicating a wide range of infarct, and often accompanied by shock or heart failure, So serious, the prognosis is poor.
(5), hypotension and shock: pain period common blood pressure, if not the performance of micro-circulatory failure can only be known as hypotension. Such as pain relief and systolic blood pressure is still lower than 80mmHg, the patient irritability, pale, clammy skin, thin and fast pulse, sweating, decreased urine output (<20ml / h), slow mind, or even who was shock fainting performance. More than a few hours after the onset of shock to occur within 1 week, found 20% of patients, mainly cardiac, as myocardial extensive (40%) necrosis, a sharp decrease in cardiac output, caused by peripheral nerve reflex vasodilator for the secondary factors, some patients still lack factors involved in blood volume. Severe shock may die within a few hours, usually last a few hours to several days and can be repeated.
(6) heart failure: occurrence rate of 30% to 40%, this time left ventricular infarct size generally have> 20% for infarction significantly decreased myocardial contractility, ventricular compliance decreased, and myocardial contraction co-ordination. Mainly acute left heart failure, can occur in the pathogenesis of the first few days or in pain, shock improvement stages, but also sudden pulmonary edema as the initial performance. Patients had chest pressure, nausea, choking dyspnea, orthopnea, cough, sputum white or pink foam, sweating, cyanosis, irritability, etc., can cause severe neck vein distention, hepatomegaly, and edema, right heart failure performance. Right ventricular myocardial infarction may occur the outset the performance of right heart failure, with blood pressure.
A small number of patients with acute myocardial infarction without pain, but in heart failure, shock, sudden death and arrhythmia as the first symptom. No pain can also be found in the following cases: ① diabetes mellitus patients; ② the elderly; ③ after the onset of surgical anesthesia were acute myocardial infarction; ④ associated with cerebrovascular disease patients; ⑤ dehydration, acidosis patients.
(2) systemic symptoms: mainly fever, accompanied by tachycardia, increased leukocyte and erythrocyte sedimentation rate and rapid growth, due to necrosis caused by material absorption. Pain usually occurs after 24 ~ 48h, the degree of infarct often has a positive correlation, the upper and lower body temperature normally at 38 ℃, rarely more than 39 ℃, for 1 week or so.
(3) gastrointestinal symptoms: severe pain often accompanied by frequent nausea, vomiting and abdominal pain, and myocardial necrosis vagus nerve stimulation and reduced cardiac output, tissue hypoperfusion and so on. Flatulence is not uncommon. Severe hiccups may occur.
(4) arrhythmia: found in 75% to 95% of patients, onset occurred within 1 to 2 weeks, and to 24h in most common, may be associated with fatigue, dizziness, fainting and other symptoms. The most common arrhythmia, especially ventricular premature beat, if the frequency of ventricular premature beat (5 times / min or more), in pairs or ventricular tachycardia was paroxysmal, multi-source or off the vulnerability of the previous stroke (RonT), often indicate an impending ventricular tachycardia or ventricular fibrillation. Some patients is the onset of ventricular fibrillation, can cause sudden cardiac death. Accelerated ventricular rhythm also occurred independently. Various degrees of atrioventricular block and bundle branch block are often seen in severe cases can be as complete atrioventricular block. Supraventricular arrhythmias are less common, occurs in persons with heart failure. Anterior myocardial infarction prone to ventricular arrhythmias; inferior wall myocardial infarction-prone atrioventricular block; anterior myocardial infarction event of atrioventricular block, indicating a wide range of infarct, and often accompanied by shock or heart failure, So serious, the prognosis is poor.
(5), hypotension and shock: pain period common blood pressure, if not the performance of micro-circulatory failure can only be known as hypotension. Such as pain relief and systolic blood pressure is still lower than 80mmHg, the patient irritability, pale, clammy skin, thin and fast pulse, sweating, decreased urine output (<20ml / h), slow mind, or even who was shock fainting performance. More than a few hours after the onset of shock to occur within 1 week, found 20% of patients, mainly cardiac, as myocardial extensive (40%) necrosis, a sharp decrease in cardiac output, caused by peripheral nerve reflex vasodilator for the secondary factors, some patients still lack factors involved in blood volume. Severe shock may die within a few hours, usually last a few hours to several days and can be repeated.
(6) heart failure: occurrence rate of 30% to 40%, this time left ventricular infarct size generally have> 20% for infarction significantly decreased myocardial contractility, ventricular compliance decreased, and myocardial contraction co-ordination. Mainly acute left heart failure, can occur in the pathogenesis of the first few days or in pain, shock improvement stages, but also sudden pulmonary edema as the initial performance. Patients had chest pressure, nausea, choking dyspnea, orthopnea, cough, sputum white or pink foam, sweating, cyanosis, irritability, etc., can cause severe neck vein distention, hepatomegaly, and edema, right heart failure performance. Right ventricular myocardial infarction may occur the outset the performance of right heart failure, with blood pressure.
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Unknown - Thursday, 28 April 2011
