心绞痛和心肌梗塞的区别, 应急措施...

1.
“心绞痛”(Angina) 和“心肌梗塞”(Myocardial infarction = MI)是冠心病 (Coronary artery disease)常见的临床类型;

Angina (low oxygen to heart tissues) = no dead heart tissues;  Myocardial infarction = dead heart tissue present;

2.
“心绞痛”即“狭心症". 表现为胸骨后部的疼痛或压缩感觉，可放射到左肩或左臂，由暂时性心肌缺血所引起。在饭后、情绪紧张或劳动时发生的称“劳累性心绞痛”；发生在静息时称“自发性心绞痛”。一般自发性心绞痛比劳累性严重; 心绞痛多见于冠状动脉性心脏病或主动脉瓣关闭不全; 

应急:  
休息或服硝酸甘油后可缓解 (舌下含服，5分钟一次,  may give up to 三次 to attempt to relieve angina pain); 

应急Medicine:
MOAN ( Morphrine, Nitro, Oxygen, Aspirin);

Angina is chest discomfort that occurs when there is decreased blood oxygen supply to an area of the heart muscle. In most cases, the lack of blood supply is due to a narrowing of the coronary arteries as a result of arteriosclerosis;

Angina is usually felt as:  pressure,  heaviness, tightening, squeezing, or aching across the chest, particularly behind the breastbone.

This pain often radiates to the neck, jaw, arms, back, or even the teeth.  Patients may also suffer:  indigestion,   heartburn,   weakness,  sweating,  nausea, cramping, and  shortness of breath.

Angina usually occurs during exertion, severe emotional stress, or after a heavy meal, when the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver. Angina typically lasts from 1 to 15 minutes and is relieved by rest or by placing a nitroglycerin tablet under the tongue, which relaxes the blood vessels and lowers blood pressure. Both rest and nitroglycerin decrease the heart muscles demand for oxygen, relieving angina.

Angina is classified in one of two types: 1) stable angina or 2) unstable angina.

Stable angina

Stable angina is the most common type of angina, and what most people mean when they refer to angina. People with stable angina have angina symptoms on a regular basis and the symptoms are somewhat predictable (for example, walking up a flight of steps causes chest pain). For most patients, symptoms occur during exertion and commonly last less than five minutes. They are relieved by rest or medication, such as nitroglycerin under the tongue. Stable angina is one of many causes of chronic chest pain.

Unstable angina

Unstable angina is less common but more serious. The symptoms are more severe and less predictable than the pattern of stable angina. Pain is more frequent, lasts longer, occurs at rest, and is not relieved by nitroglycerin under the tongue (or the patient needs to use more nitroglycerin than usual). Unstable angina is not the same as a heart attack, but warrants an immediate visit to your physician or hospital emergency department as further cardiac testing is urgently needed. Unstable angina is often a precursor to a heart
 

Angina treatment options include:
1. rest,
2. medications (nitroglycerin,  beta blockers, Aspirin, or  calcium channel blockers, ),
3. percutaneous coronary intervention (stenting or transluminal coronary angioplasty (PTCA), or
4. coronary artery bypass graft surgery (CABG).

3.
“心肌梗塞”又称“心肌梗死”，由冠状动脉粥样硬化，继以血栓形成，冠状动脉的分枝堵塞，因而一部分心肌失去血液供应而坏死。发病时有剧烈而持久的类似心绞痛的前胸痛, 心悸, 气喘, 脉搏微弱, 血压降低等症状。硝酸甘油含片不能使疼痛缓解，并可伴有大汗和四肢厥冷等症状;

如果出现心肌梗塞的先兆症状，千万不要惊慌，首先病人应立刻卧床，保持安静，避免精神过度紧张，舌下含服硝酸甘油，立即 call 911;   同时做好送往ER的准备, 交通工具必须平稳舒适;  病人应避免走动，运送途中可持续或间断使用硝酸甘油等扩冠药;

应急: 
休息保持安静;  Aspirin (160mg - 325mg, PO);  舌下含服Nitro, 5分钟一次, 三次;  call 911 ;  

Medicine:  
BATH ( Beta inhibiytor, ACE inhibitor, Thrombolytic, Heparin);


A heart attack (also known as a myocardial infarction or MI) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and chest pressure sensation. If blood flow is not restored to the heart muscle within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is eventually replaced by scar tissue.

What causes a heart attack?    Atherosclerosis!!!   Atherosclerosis is a gradual process by which plaques (collections) of cholesterol are deposited in the walls of arteries. Cholesterol plaques cause hardening of the arterial walls and narrowing of the inner channel (lumen) of the artery. Arteries that are narrowed by atherosclerosis cannot deliver enough blood to maintain normal function of the parts of the body they supply.

Coronary atherosclerosis (or coronary artery disease) refers to the atherosclerosis that causes hardening and narrowing of the coronary arteries. Diseases caused by the reduced blood supply to the heart muscle from coronary atherosclerosis are called coronary heart diseases (CHD). Coronary heart diseases include heart attacks, sudden unexpected death, chest pain (angina),  abnormal heart rhythms, and heart failure due to weakening of the heart muscle.

MI victims may experience a variety of symptoms including:  
1. Pain, fullness, and/or squeezing sensation of the chest;
2. Jaw pain, toothache, headache; 
3. Shortness of breath; 
4. Nausea, vomiting, and/or general epigastric (upper middle abdomen) discomfort
5. Sweating
6. Heartburn and/or indigestion
7. Arm pain (more commonly the left arm, but may be either arm); Upper back pain
8. No symptoms (Approximately one quarter of all heart attacks are silent, without chest pain or new symptoms. Silent heart attacks are especially common among patients with diabetes mellitus.)


MI Treatment:

1. Thrombolytic (fibrinolytic or clot dissolving) with in 6 hours therapy has been shown to reduce death from heart attacks similarly in men and women; however, the complication of strokes from the thrombolytic therapy may be slightly higher in women than in men.

2.  Medical treatment for heart attacks may also  include:  antiplatelet, anticoagulant, and clot dissolving drugs as well as angiotensin converting enzyme (ACE) inhibitors, beta blockers, and oxygen;

3. Interventional treatment for heart attacks may include coronary angiography with percutaneous transluminal coronary angioplasty (PTCA), coronary artery stents, and coronary artery bypass grafting (CABG).

4.
心绞痛和心肌梗塞均属于Coronary artery disease;  But 心绞痛和心肌梗塞在治疗和预后方面不同;

（1）心绞痛的疼痛性质多为压榨性或窒息性，常因劳累, 受寒, 激动等因素所诱发。发作时间较短，一般不超过15分钟。发作后服用硝酸甘油有明显好转。一般无气喘、肺水肿症状；血压变化不大，所以无休克现象，也无发热。化验检查：白细胞计数正常、血沉可正常活略快、无血清酶学变化; 心电图可无变化或有暂时性改变;

（2）心肌梗塞的疼痛性质与心绞痛类似，但更为剧烈，可无诱发因素发作。发作时间长，可从数小时到1～2天。服用硝酸甘油不能缓解。常伴有气喘和肺水肿，血压往往下降而出现休克。因有心肌坏死。所以常有发热。化验检查：白细胞计数升高、血沉显著增快、有血沉清酶学变化，心电图可呈进行性特殊改变。