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目的分析以急性左心衰竭为主要表现的急性心肌梗死(AMI)的临床特点,探讨其发生机制。方法回顾性分析42例以急性左心衰竭为主要表现的AMI患者的临床特点,根据NYHA心功能分级及超声心动图、冠脉造影结果探讨其发生机制。随访了34例患者。结果 42例中,33例(86.8%)为急性非ST段抬高型AMI;30例(78.9%)为前壁梗死,4例并发完全性左束支传导阻滞;超声心动图LVEF<40%者23例,LVEF≥40%者19例。随访34例,1年内死亡6例。CAG示左主干或三支血管病变者22例(71%)。结论以急性左心衰竭为主要表现的AMI多为急性非ST段抬高型MI,前壁梗死、冠脉严重病变者多见。其发生机制为左室收缩及舒张功能的严重损害。
Objective To analyze the clinical features of acute myocardial infarction (AMI) with acute left heart failure as the main manifestation and to explore its mechanism. Methods The clinical features of 42 AMI patients with acute left heart failure were retrospectively analyzed. The pathogenesis of AMI was investigated according to NYHA functional classification, echocardiography and coronary angiography. 34 patients were followed up. Results Of the 42 cases, 33 (86.8%) had acute non-ST-segment elevation AMI, 30 (78.9%) had anterior wall infarction and 4 had complete left bundle branch block. The echocardiographic LVEF was less than 40 % In 23 cases, LVEF ≥ 40% in 19 cases. Follow-up 34 cases, 6 cases died within 1 year. CAG showed left main or three cases of vascular lesions in 22 cases (71%). Conclusions AMI with acute left heart failure as the main manifestation is mostly acute non-ST elevation MI, with anterior infarction and severe coronary lesions. Its mechanism for the left ventricular systolic and diastolic function of the serious damage.