THE DIAGNOSIS OF ACUTE MYOCARDIAL-INFARCTION

被引:18
作者
CALIFF, RM [1 ]
OHMAN, EM [1 ]
机构
[1] DUKE UNIV, MED CTR, DEPT MED, DIV CARDIOVASC, BOX 3151, DURHAM, NC 27710 USA
关键词
D O I
10.1378/chest.101.4_Supplement.106S
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Changes in the economic and therapeutic environment have altered the time frame in which an accurate diagnosis of acute myocardial infarction (AMI) must be made. The advent of effective reperfusion therapies and the increasing emphasis on reducing cost produce an environment in which rapid diagnosis can reduce morbidity and mortality while simultaneously reducing overall cost by avoiding unnecessary hospitalization and intervention. The first element of a diagnostic strategy remains a brief, directed history and physical examination. The orientation of this phase is to identify important causes of symptoms other than AMI, while rapidly leading to more definitive evaluation for myocardial ischemia when another diagnosis is not found. The ECG provides the most rapid definitive diagnosis, but the diagnosis remains equivocal in many patients with nondiagnostic ECGs. In this group, the use of cardiac enzyme measurements early in the course holds promise in directing intensive care at high-risk patients while avoiding unnecessary intervention in low-risk patients. A protocolized approach to patient evaluation should become a part of standard practice patterns in every hospital.
引用
收藏
页码:S106 / S115
页数:10
相关论文
共 83 条
[1]   OLDER AGE AND ELEVATED BLOOD-PRESSURE ARE RISK-FACTORS FOR INTRACEREBRAL HEMORRHAGE AFTER THROMBOLYSIS [J].
ANDERSON, JL ;
KARAGOUNIS, L ;
ALLEN, A ;
BRADFORD, MJ ;
MENLOVE, RL ;
PRYOR, TA .
AMERICAN JOURNAL OF CARDIOLOGY, 1991, 68 (02) :166-170
[2]  
[Anonymous], 1979, Circulation, V59, P607
[3]   MYOCARDIAL REPERFUSION, LIMITATION OF INFARCT SIZE, REDUCTION OF LEFT-VENTRICULAR DYSFUNCTION, AND IMPROVED SURVIVAL - SHOULD THE PARADIGM BE EXPANDED [J].
BRAUNWALD, E .
CIRCULATION, 1989, 79 (02) :441-444
[4]  
BREN GB, 1987, CIRCULATION, V76, P18
[5]   USE OF THE INITIAL ELECTROCARDIOGRAM TO PREDICT IN-HOSPITAL COMPLICATIONS OF ACUTE MYOCARDIAL-INFARCTION [J].
BRUSH, JE ;
BRAND, DA ;
ACAMPORA, D ;
CHALMER, B ;
WACKERS, FJ .
NEW ENGLAND JOURNAL OF MEDICINE, 1985, 312 (18) :1137-1141
[6]   FROM MYOCARDIAL SALVAGE TO PATIENT SALVAGE IN ACUTE MYOCARDIAL-INFARCTION - THE ROLE OF REPERFUSION THERAPY [J].
CALIFF, RM ;
TOPOL, EJ ;
GERSH, BJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1989, 14 (05) :1382-1388
[7]  
CALIFF RM, 1988, ACUTE CORONARY CARE, P217
[8]   SEMI-QUANTITATIVE ESTIMATION OF SERUM MYOGLOBIN BY A RAPID LATEX AGGLUTINATION METHOD - AN EMERGENCY SCREENING-TEST FOR ACUTE MYOCARDIAL-INFARCTION [J].
CHAPELLE, JP ;
HEUSGHEM, C .
CLINICA CHIMICA ACTA, 1985, 145 (02) :143-150
[9]  
CHRISTENSON RH, 1989, CLIN CHEM, V35, P2179
[10]   COMPLETE ATRIOVENTRICULAR-BLOCK COMPLICATING INFERIOR WALL ACUTE MYOCARDIAL-INFARCTION TREATED WITH REPERFUSION THERAPY [J].
CLEMMENSEN, P ;
BATES, ER ;
CALIFF, RM ;
HLATKY, MA ;
ARONSON, L ;
GEORGE, BS ;
LEE, KL ;
KEREIAKES, DJ ;
GACIOCH, G ;
BERRIOS, E ;
TOPOL, EJ .
AMERICAN JOURNAL OF CARDIOLOGY, 1991, 67 (04) :225-230