Abstract

Chest discomfort before severe chest pain represents a marker of clinical ischemia and indicates live myocardium in jeopardy and often precedes cardiac arrest or acute myocardial infarction (MI). The intermittent or “stuttering” symptoms that precede MI are referred to as “prodromal symptoms.” These symptoms have been shown to correlate with cyclic ST changes and repeated episodes of spontaneous reperfusion and occlusion, occurring during a period of hours or days before the acute ischemia proceeds to death or heart damage. These symptoms of premonitory angina have been associated with improved outcomes due to ischemic pre-conditioning or opening of collateral vascular channels around the area of ischemia. Acute prevention of an MI through recognition of prodromal symptoms represents an opportunity to significantly reduce heart attack deaths. The Early Heart Attack Care (EHAC) program puts emphasis on prodromal symptom recognition and allows for a shift in time backward to prevent the ischemic process from proceeding to MI. This strategy has been shown to detect the 15% of patients with ischemia in the low-probability group and to reduce inappropriate admissions to hospital as well as to reduce the number of patients with missed MI being sent home from the emergency department.

中文翻译：

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急性心脏病发作的预防

摘要

严重胸痛之前的胸部不适是临床缺血的标志，表明活心肌处于危险之中，并且通常先于心脏骤停或急性心肌梗塞 (MI)。心肌梗死之前出现的间歇性或“口吃”症状被称为“前驱症状”。这些症状已被证明与周期性 ST 变化以及自发再灌注和闭塞的反复发作相关，这些症状发生在急性缺血发展到死亡或心脏损伤之前的数小时或数天内。这些先兆性心绞痛症状与由于缺血预适应或缺血区域周围侧支血管通道的开放而改善的结果相关。通过识别前驱症状来急性预防心肌梗死是显着减少心脏病死亡的机会。早期心脏病护理 (EHAC) 计划强调前驱症状识别，并允许时间向后转移，以防止缺血过程发展为心肌梗死。该策略已被证明可以检测出低概率组中 15% 的缺血患者，减少不当入院，并减少因漏诊心肌梗死而从急诊室送回家的患者数量。