coronary embolism
Introduction
Introduction Arterial embolization refers to a pathological process in which the embolus is detached from the heart or the proximal arterial wall or enters the artery from the outside, pushed to the distal side by the blood flow, and blocks the blood flow of the artery, resulting in ischemia or even necrosis of the limb or internal organs. Acute myocardial infarction (acutemyocardialinfarction) refers to sudden complete occlusion of the coronary artery, ischemia, injury and necrosis of the myocardium, and an acute ischemic heart disease characterized by severe chest pain, electrocardiogram and dynamic changes of myocardial enzymology. Most of the underlying lesions are coronary atherosclerosis, and a few are other lesions such as acute coronary embolism.
Cause
Cause
Coronary atherosclerosis causes stenosis and myocardial insufficiency, and when the collateral circulation has not been established, myocardial infarction can occur due to aggravation of myocardial ischemia for the following reasons.
First, the coronary artery is completely occluded
Intravascular or subendocardial hemorrhage of the diseased atherosclerotic plaque, intraluminal thrombosis or persistent arterial spasm, complete occlusion of the lumen.
Second, the heart discharge volume plummeted
Shock, dehydration, hemorrhage, severe arrhythmia, or surgery cause a sudden drop in cardiac output, and coronary perfusion is severely inadequate.
Third, myocardial aerobic demand for blood surge
When severe physical labor, emotional agitation or blood pressure rises sharply, left ventricular load increases sharply, catecholamine secretion increases, and myocardial aerobic blood demand increases.
Acute myocardial infarction can also occur in coronary artery spasm without coronary atherosclerosis, and occasionally due to coronary embolism, inflammation, and congenital malformations.
Severe arrhythmia, shock or heart failure after myocardial infarction can further reduce coronary perfusion and expand myocardial necrosis.
Examine
an examination
Related inspection
Cardiovascular dynamic electrocardiogram (Holter monitoring)
1. General inspection
Blood lipid measurement, electrocardiogram, heart function and fundus examination.
2. Non-invasive vascular examination
Ultrasound Doppler blood flow examination and segmental arterial pressure measurement, electrical impedance plethysmography or photoplethysmography, etc., to understand the blood flow of the affected limb. Ultrasound Doppler imaging can show the shape of the blood vessels and blood flow.
3. X-ray film
Sometimes there are irregular calcifications in the diseased arteries, and there are degenerative changes such as osteoporosis in the distal segment of the affected limb.
4. Arteriography
It is important to accurately display the location, extent, extent, collaterals, and occlusion of the distal arterial trunk. Both magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) can achieve the purpose of diagnosis and guidance therapy.
Diagnosis
Differential diagnosis
Differential diagnosis of coronary embolism:
1 angina pectoris is light in nature, short in time, nitroglycerin is effective, blood pressure is elevated, systemic symptoms are less, and ST segment is temporarily depressed.
2 acute pericarditis pain and fever at the same time, breathing, coughing increased, early pericardial friction sound, ECG in addition to aVR, the rest of the lead is ST segment arch back up, no abnormal Q wave.
3 Acute pulmonary embolism was mainly due to right heart failure, electrocardiogram I guided S wave depth, and III guided Q wave was significant.
4 history of acute abdomen, physical examination, electrocardiogram and myocardial zymogram can be identified.
5 Aortic dissection separation The blood pressure and pulse of the two upper limbs are obviously different. The chest pain starts to peak at the beginning, and often radiates to the back, ribs and lower limbs. Aortic valve regurgitation can be identified, and two-dimensional echocardiography is helpful for diagnosis.
