Calcium Channel Blockers in Heart Failure

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2 了 1 年 48 露說 2007/02/24 06:59 PM

3 聯路易 22 年聯

4 年 / 連不兩都年塞年令不不年 38 不料年冷烈累不塞了兩裡了 2 43 老年數都年 2 不了精不塞度 6 神都年不良力不離 1 2

5 不更 :2008/05/10 17:00 行不不不年了量

7 不? 狀年女

8 Case 1 46-year-old man was admitted because of sudden onset of severe chest pain with cold sweating for 30min. No any risk factors except smoking one pack per week, and quit since 6 mon ago Troponin I 0.05 ng/ml CK 113 U/L CK-MB 3.3 U/L

No any risk factors except smoking one pack per week, and

9 Mr. Wang, 46-year-old man, History No: , initial ECG at admission

10 CAG-case 1, before PCI

11 CAG-case 1, after PCI

12 Question of case 1 來不? 不?

14 狀兩狀

15 狀狀降狀狀

16 狀狀狀塞塞

17 塞

18 狀 38% 不不

19 狀塞切狀

20 : ( 年 ) ( ) 糖尿 ( 女 ) 力 ( ) 老年尿

21 年塞 : 40 2

22 : > 90 (35 ) 女 > 80(31 )

23 64 切 256 切

25 1. 不 (Unstable Angina, UA) 2. ST 塞 (STEMI) 3. ST 塞 (NSTEMI) 狀 : : 狀不裂, 不 STEMI NSTEMI

26 JACC 2000;36:970

27 不塞不裂塞

28 ? 狀 : CPK, CPK-MB, Troponin

29 臨狀惡

30 勒 3-15

32 烈

33 0 < h 塞

34 Unstable angina Non STE MI Onset < 20min STEMI Acute injury 30min 不塞塞

35 塞

36 塞

37 降塞

38 塞不塞

39 AMI EKG AMI 不? ACS :

40 Reperfusion, Rescue PCI, Facilitated PCI, Late PCI Hours to days Weeks to years Lancet 2008, Aug 16;372:572

41 療 MONA Therapy Oxygen at 4L/min, Use N.C. or mask NTG 0.6 mg, If SBP> 90 mmhg Morphine IV, 1-3mg q5min Aspirin 160 mg to 325 mg

42 ACS 療 ST ACS 療律不 / : Beta-blocker, ICD 復 : ASA, Heparin, Clopidogrel, 復 ( ): ACEI/ARB, Beta-blocker / : statins 塞 : tpa 療 : NTG

43 ACS 療 ST ACS: 律不 / : Beta-blocker, ICD 復 : ASA, Heparin, Clopidogrel, 復 ( ): ACEI/ARB, Beta-blocker / : statins 塞 : tpa 療 : NTG 不 tpa Glycoprotein IIb/IIIa inhibitors: IV

44 Unstable angina Non STE MI Onset < 20min STEMI Acute injury 30min 不塞塞

45 流療 for STEMI 1. 療 2. 狀 Primary PCI

46 PCI Percutaneous Coronary Intervention PTCA: Percutaneous Transluminal Coronary Angioplasty Devices: Balloon catheter, Stenting Laser, Atherectomy, ect

47 PCI Primary PCI: < 24hrs Rescue PCI: tpa Facilitated PCI: tpa + routine PCI Early PCI : < hrs Delay PCI: > 48-72hrs

48 狀 (CAG): After tpa therapy

49 狀 (PTCA)

50 狀

52 狀 ( Stent)

53 狀

54 Case 2 48-year year-old man was brought to ER because of severe chest pain with cold sweating 15 min ago Smoking 1 PPD for more 20 years Troponin I: 0.02, CK 81, CK-MB 5

55 Mr. Tsae,, 48-year year-old man, History No: , initial ECG at admission

56 CAG-case 2, before PCI

57 CAG-case 2, after PCI Troponin I 0.03, CK 168/68

58 Question of case 2 Did this patient have acute myocardial infarction?

59 塞 Early reperfusion therapies can prevent detectable myonecrosis Fibrinolysis < 1h : Aborted MI is seen in up to 25% of patients JACC 2004;44: 38-43

63 療 : EKG STEMI or New LBBB : 療. BP>180/110, 15mmHg CNS lesion (3 ) 6 GI/GU bleeding CPR>10min,, : 不 SBP<100, HR>100,,

64 Reperfusion 略 : onset of symptoms, Risk of STEMI, Risk of fibrinolysis : t-pa primary PCI PCI t-pa 列 PCI : No skilled PCI facility, no vascular assess 3. Door-to-balloon > 90 min 4. (D-B) - (D-needle) > 60 min

65 Time to PCI vs fibrinolysis in STEMI PCI better Fibrinolysis better Circulation 2006;114:

66 聆

3. / ST 150mg/dL 80mg/dL 110mg/Dl Level B Class I 1. / ST Level C 2. / ST Level C Class IIa 1. / ST Level C 2. / ST, Level C Class I 1. / ST Level A 2

3. / ST 150mg/dL 80mg/dL 110mg/Dl Level B Class I 1. / ST Level C 2. / ST Level C Class IIa 1. / ST Level C 2. / ST, Level C Class I 1. / ST Level A 2 2007 ACC/AHA: / ST Part VI-IV 6. Class I 1. / ST Level B 2. / ST Level B 3. Level B 4. Level B Class I 1. / ST Level A 2. / ST 110mg/dL 180mg/dL HbA1c 7% Level B 3. / ST GP IIb/IIIa I.C.3.A IV.B Level