Caseanalysis病例分析ChiefComplaintsParoxysmalprecordiumpainfor2months，exacerbationfor16hours.

病例分析Medicalhistory：achelocation、character、

degree？radiation？duration？Inducingandrelieffactor？

treatmentprocess?病例分析PresentillnessPrecordiumpainaggravatedwithoutinducingfactor16hoursago,accompaniedwithbackandbothupperlimbspain,leftshoulderandupperlimbobviously,accompaniedwithnausea.Takenomeprazolecapsule,thesymptomcouldn’trelieve,precordiumpainstillexistedpersistentlyafterlocalhospitaltreatment.病例分析PresentillnessInemergencyroomofourhospital,taken“aspirin300mg,ticagrelor180mg”,“isosorbidemononitrate20mg”

intravenousdrip.病例分析PastMedicalHistory：2014.09.19gastroscope:esophagitis,gastriculcer,erosivegastritis,duodenalbulbinflammation.

FamilyHistory：Hismotherhavehistoryofhypertension,coronaryheartdiseaseanddiabetes.Brotherhashistoryofdiabetesandhypertension.病例分析Physicalexamination：Vitalsigns!Chestandheartexamination

abdomenexamination病例分析ChestpainDiagnosisDifferentialdiagnosis病例分析

Differentialdiagnosis？AnginaAcutepericarditisAcutepulmonaryembolism

AcuteabdominalpainAorticdissection…病例分析ECG：ThemostimportantthemostquicklyLocation

Inferiorwall——ⅡⅢaVFAnteriorwall——V1－6Anteroseptalwall——V1-3Apicalorlateralwall—V4－6Posteriorwall-----V7-9

Right-sided

----V4R-V5R15病例分析cTnI7.092ng/mL,CK-MB156.43ng/mL，MYO

251.09ng/ml。X-ray:heartshadowincreased,bronchitis.UCG：Segmentalventricularwallmotionabnormalities,EF：45%.病例分析

Diagnosis1.coronaryheartdiseaseacuteanteriorwallmyocardialinfarctionKillipclassII.

2.bronchialpneumonia.3.esophagitis,gastriculcer,erosivegastritis,duodenalbulbinflammation.病例分析Complications？Dysfunctionorruptureofpapillary

muscleRuptureoftheheartEmbolism

Cardiacaneurysm

Postinfarctionsyndrome病例分析How