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经验:心血管医生临床经验吐血总结

2015-11-20 佚名 医学之声

生动比喻型 心梗后心肌室壁瘤,就像“自行车被磨薄的内胎”,一打气,薄的地方就会突出来。   稳定型斑块是一种脂核小,纤维帽厚,没有活跃的炎症细胞的稳定斑块,就像附着在血管壁上的“小馅厚皮饺子”,不容易破,就不会有血小板粘附激活聚集,就很少有血栓事件!   不稳定的血管斑块,就像“皮薄馅大的饺子”,很容易破;稳定的斑块则是“皮厚馅少”的包子,虽然不容易破,但

生动比喻型

心梗后心肌室壁瘤,就像“自行车被磨薄的内胎”,一打气,薄的地方就会突出来。
 
稳定型斑块是一种脂核小,纤维帽厚,没有活跃的炎症细胞的稳定斑块,就像附着在血管壁上的“小馅厚皮饺子”,不容易破,就不会有血小板粘附激活聚集,就很少有血栓事件!
 
不稳定的血管斑块,就像“皮薄馅大的饺子”,很容易破;稳定的斑块则是“皮厚馅少”的包子,虽然不容易破,但会慢慢堵死血管。
 
时间就是生命,时间就是心肌----AMI后冠脉再通需争分夺秒!
 
温馨提示型
 
1.心肌梗死2个月后ST段抬高持续存在,提示室壁瘤的存在!
 
2.不典型的主动脉夹层:一是血压低,因为双肺CT检查发现心包积血才发现主动脉夹层破入心包;二是双下肢突然瘫痪,因为夹层影响脊髓动脉供血所致。医学之声微信号vom120
 
3.ACEI、B受体阻滞剂和醛固酮受体拮抗剂是慢性充血性心力衰竭治疗的三大基石。
 
4.ST段抬高的是溶栓(红色血栓),ST段压低的是抗栓(白色血栓)。
 
短小精悍型

1.查看心电图时,先看心律而非心率。
 
2.急性心梗抗凝前一定要除外主动脉夹层!
 
3.右室心梗以补液为主,左室心梗谨慎补液。
 
4.年轻人讲心要想到胃,老年人讲胃要想到心。
 
以小见大型

1.扩张型心肌病“一大二薄三小四弱”:
 
大(心脏扩大)
 
薄(室壁薄)
 
小(瓣膜相对小,多有瓣膜返流)
 
弱(室壁运动减弱)

2.治疗心力衰竭的3+X+TWO:
 
3代表利尿、强心、扩血管
 
X代表争对心力衰竭的诱因进行治疗
 
TWO代表block和 AcEI两大类药

3.前胸部不适,都要想到心梗,特别是老年患者,常规做个心电图非常必要:
 
上——牙痛、咽痛、恶心、呕吐
 
下——腹部不适
 
左右——肩部、胳膊不适
 
前后——肋部不适

4.继发性高血压速记:“两肾原醛嗜铬瘤”
 
肾血管、肾实质、原发性醛固酮增多症、嗜铬细胞瘤;
 
皮质动脉和妊高(皮质醇增多症、主动脉缩窄、妊娠高血压病)
 
通俗易懂型

1.冠心病有6条防线,一防发病,二防事件,三防后果,四防复发,五防心衰及再发心梗,六防心理情绪异常。
 
2.左心衰治疗:端坐下垂位,吸氧打吗啡,利尿强心扩张剂,氨茶碱静滴。
 
3.教育高血压患者:宁可少吃一餐饭,不可少吃一次药!
 
4.心律失常就是心脏的快跳、慢跳、乱跳或者不跳。
 
5.回旋更喜脊柱,前降常走向心尖;前降有如一把梳子帮你区分回旋。(在阅读冠脉影像和图片时,无论什么体位离脊柱近的就是回旋,走向心尖的常常是前降支,前降支发出数条间隔支,就像一把梳子样,不仅有助于区分回旋和前降支,还有助于区分前降支和其发出的对角支。)
 
形象贴切型

1.形容二尖瓣狭窄时的开瓣音,“弹性好的瓣膜就像赶车的马鞭”----马鞭的弹性很好,用力挥出去,然后再使劲回拉时就会出现很大的响声。

2.房颤发生机制如同发动机,一旦“点火”成功,就会“循环”下去。

3.心衰就好比水涝,肺中发生涝灾,就是左心衰。当涝灾发生在除肺以为的部位就是右心衰。

4.一度房室阻滞就像小两口关系变差,说话间隔变长(P-R间期延长);二度就像关系更恶化,一方时而就不回家了(QRS脱落);三度就是离婚了,各过各的~(房跳房,室跳室)。

5.狭窄降前负荷,关闭不全降后负荷­如同一匹载着一车石头的疲惫不堪的马,你应该先卸下石头(利尿),让他再歇一歇(扩血管),歇歇以后再给它一鞭(强心),则马能渡过难关。­而你如果不先卸下石头(利尿),让他再歇一歇(扩血管),而是直接上来就给它几鞭,马肯定要被累死的。
 
金玉良言型

1.心绞痛不只是痛,其“痛”的性质包含着闷、憋、喘、痛四种不同性质的症状。
 
2.糖尿病是心血管疾病的等危症,冠心病患者是高血糖的高危人群。
 
3.服用地高辛病人出现黄绿视、心律失常一定查地高辛血药浓度,警惕地高辛中毒。
4.心率很慢或很快的病人要常规检查“甲功”,以排除甲状腺功能异常。
 
5.平时有房颤的病人如果心电图突然规整了,那么你要小心电解质紊乱了,尤其是高钾血症的发生。
 
总结到位型

1.洋地黄类药物禁忌症:肥厚梗阻二尖窄,急性心梗伴心衰;二度高度房室阻,预激病窦不应该。
 
2.不稳定性心绞痛3机制:斑块破裂,狭窄加重,冠脉痉挛。
3.不明原因晕厥患者心电图要寻找3波:Brugada波、明显的J波、Epsilon波,有则提示晕厥为心源性!
 
4.血小板的5个10:——血小板的寿命约为10天、每天约有1010个血小板产生,需要时产量可增加10倍。(由于每日均有新的血小板产生,而当新的血小板产生占到整体的10%时,血小板的功能即可恢复正常,所以需每日维持服用。)
 
5.心梗的五种并发症:动脉栓塞心室膨,乳头断裂心脏破,梗死后期综合症。
 
经验分享型

1.突发辗转不安伴心率血压变化(升高或降低),背部不适应首先考虑主动脉夹层分离
 
2.主动脉夹层患者可没有明显胸背痛,表现为腹痛,脏器缺血引起。
 
3.PCI术后病人下床活动时突然出现胸闷气短伴全身大汗,血压下降等情况,千万不要忘了考虑肺梗塞
 
4.排除其他原因的突发低血压,不要太相信貌似“正常”的心电监护,做个床边心电图,可能有意想不到的发现——室性心动过速。
 
5.如果一个胸疼患者出现“休克样表现”伴有血压升高,那么诊断应该是主动脉夹层。
 
6.急性胸痛考虑急性下壁心肌梗塞的病人,一定要加做右胸导联,因为V3r-V5r诊断右室梗塞敏感性特异性均高,但是持续时间短,很多时间只能在急诊室心电图中出现。

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    2017-06-26 医望无涯

    这块定是我的难点

    0

  2. 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    2017-06-12 蒋光崇

    谢谢分享

    0

  3. 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    2017-04-27 1e1f1c35m81(暂无匿称)

    很好

    0

  4. 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    2017-04-26 laymankey

    感谢分享一下!

    0

  5. 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    2017-04-21 努力成长

    总结的不错

    0

  6. 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likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:56:00 CST 2016, time=2016-01-09, status=1, ipAttribution=)]
    2017-01-05 飘飘爱

    非常生动

    0

  7. 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likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:56:00 CST 2016, time=2016-01-09, status=1, ipAttribution=)]
    2016-11-08 清幽蓝燕yan

    挺形象的

    0

  8. 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  9. 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likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:56:00 CST 2016, time=2016-01-09, status=1, ipAttribution=)]
    2016-03-30 宇宙无敌小包子

    收藏。

    0

  10. 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createdName=蒋光崇, createdTime=Mon Jun 12 20:48:21 CST 2017, time=2017-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=191195, encodeId=fd8319119594, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K7clZrGDNXCpBVQT5jSkTxiadcu1aLgPy3SKYZO4R4ANicWhrFcEc11BEB7mATFGkOCmJIKNJyKfV6/0, createdBy=ba5f2012149, createdName=1e1f1c35m81(暂无匿称), createdTime=Thu Apr 27 20:59:47 CST 2017, time=2017-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190892, encodeId=ed3c19089237, content=感谢分享一下!, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=20971999626, createdName=laymankey, createdTime=Wed 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createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib2emBzjO0FtqTJ05AqrEEdRmp6tmlsLXqpzfxWdtgbbgPGWRHagoK9fLTd3IayRPgkJVIVBWtdlmnkBhOIR4cFM/0, createdBy=e8d51649330, createdName=飘飘爱, createdTime=Thu Jan 05 00:05:35 CST 2017, time=2017-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154240, encodeId=92c315424087, content=挺形象的, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJHmctib8wsjB1Y0etxU20nsCbR8rZ2fpibp2STmwH2YzicIsTe9oHRGB6XIMeBqNdIvxODicmzfeQibIw/132, createdBy=82211964557, createdName=清幽蓝燕yan, createdTime=Tue Nov 08 07:15:17 CST 2016, time=2016-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1940262, encodeId=7863194026252, content=<a href='/topic/show?id=de9022964a5' target=_blank style='color:#2F92EE;'>#临床经验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22964, encryptionId=de9022964a5, topicName=临床经验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8e4c53, createdName=jiyangfei, createdTime=Sat Jan 23 15:14:00 CST 2016, time=2016-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=74482, encodeId=362fe4482f1, content=收藏。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160329/IMG56FA8E2FCF4164330.jpg, createdBy=61711706029, createdName=宇宙无敌小包子, createdTime=Wed Mar 30 00:34:00 CST 2016, time=2016-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55482, encodeId=e2315548244, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:56:00 CST 2016, time=2016-01-09, status=1, ipAttribution=)]
    2016-01-09 medsic

    谢谢分享!

    0

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