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目的 分析以急性左心衰竭为主要表现的老年人急性心肌梗死 (AMI)的临床特点 ,探讨其心力衰竭的发生机制。 方法 回顾性分析 2 4例以急性左心衰竭为主要表现的AMI老年患者的临床特点 ,根据NYHA心功能分级及超声心动图所示左室射血分数 (LVEF)探讨AMI时发生急性左心衰竭的机制。随访了 14例患者的预后。 结果 2 4例中 ,18例 (75 0 % )为无痛性梗死 ;19例(90 5 % )为急性非透壁性梗死 ,3例并发完全性左束支传导阻滞 ;超声心动图LVEF <40 % 8例 ,≥ 40 %14例。随访 14例 ,半年内死亡 5例 (35 7% )。 结论 以急性左心衰竭为主要表现的AMI多为无痛性梗死 ,心电图表现多为急性非透壁性梗死。AMI时发生急性左心衰竭的机制为左室收缩功能及舒张功能的严重损害。
Objective To analyze the clinical features of elderly acute myocardial infarction (AMI) with acute left heart failure as the main manifestation and to explore the mechanism of heart failure. Methods The clinical features of 24 elderly patients with acute left heart failure (AMI) were retrospectively analyzed. According to NYHA functional class and echocardiographic left ventricular ejection fraction (LVEF), acute left ventricular failure Mechanisms. The prognosis of 14 patients was followed up. Results Of 24 cases, 18 cases (75 0%) were painless infarction; 19 cases (90 5%) were acute non-transmural infarction and 3 cases were complicated with complete left bundle branch block. Echocardiography LVEF <40% 8 cases, ≥ 40% 14 cases. Fourteen patients were followed up, and 5 patients died in half a year (35.7%). Conclusions AMI with acute left heart failure as the main manifestation is mostly painless infarction. The electrocardiogram mostly shows acute non-transmural infarction. The mechanism of acute left heart failure during AMI is severe impairment of left ventricular systolic and diastolic function.