Цитата:
Сообщение от dmblok
Уверен, коллегам было бы полезно узнать от Вас, что, например, для диагноза ОИМ наличие "трех китов" (выражаясь Вашими словами), вовсе не обязательно и тд.
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Это не мои слова ("три кита"), а слова моих учителей.
Если охота цепляться к словам, то может лучше самому гордо выложить что-то предельно педантично, чем принуждать делать это меня?
Да ладно...
Консенсус универсального определения инфаркта миокарда.
J Am Coll Cardiol, 2007; 50:2173-2195
"Criteria for Acute Myocardial Infarction. The term myocardial infarction should be used when there is evidence of myocardial necrosis in a clinical setting consistent with myocardial ischaemia. Under these conditions any one of the following criteria meets the diagnosis for myocardial infarction:
• Detection of rise and/or fall of cardiac biomarkers (preferably troponin) with at least one value above the 99th percentile of the upper reference limit (URL) together with evidence of myocardial ischaemia with at least one of the following:
• Symptoms of ischaemia;
• ECG changes indicative of new ischaemia (new ST-T changes or new left bundle branch block [LBBB]);
• Development of pathological Q waves in the ECG;
• Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.
• Sudden, unexpected cardiac death, involving cardiac arrest, often with symptoms suggestive of myocardial ischaemia, and accompanied by presumably new ST elevation, or new LBBB, and/or evidence of fresh thrombus by coronary angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood.
• For percutaneous coronary interventions (PCI) in patients with normal baseline troponin values, elevations of cardiac biomarkers above the 99th percentile URL are indicative of peri-procedural myocardial necrosis. By convention, increases of biomarkers greater than 3 x 99th percentile URL have been designated as defining PCI-related myocardial infarction. A subtype related to a documented stent thrombosis is recognized.
• For coronary artery bypass grafting (CABG) in patients with normal baseline troponin values, elevations of cardiac biomarkers above the 99th percentile URL are indicative of peri-procedural myocardial necrosis. By convention, increases of biomarkers greater than 5 x 99th percentile URL plus either new pathological Q waves or new LBBB, or angiographically documented new graft or native coronary artery occlusion, or imaging evidence of new loss of viable myocardium have been designated as defining CABG-related myocardial infarction.
• Pathological findings of an acute myocardial infarction.
Criteria for Prior Myocardial Infarction. Any one of the following criteria meets the diagnosis for prior myocardial infarction:
• Development of new pathological Q waves with or without symptoms.
• Imaging evidence of a region of loss of viable myocardium that is thinned and fails to contract, in the absence of a non-ischaemic cause.
• Pathological findings of a healed or healing myocardial infarction."
Т.е. для ОИМ нужно тропонин + одно из (боль, ЭКГ [ST, T, Q или новая БЛНПГ] и/или визуальное доказательство снижения или/и аномалии подвижности стенки миокарда [УЗИ-методы, рентген-методы {включая разнообразную компьютерную томографию, коронарографию, вентрикулографию и т.д.} и т.д.]).
Чего не сделаешь для молодых специалистов и людей далеких от кардиологии...