Chirongwa Chekurwa Kwemwoyo
Kurwadziwa kwemwoyo (kana kuti myocardial infarction) chirwere chakakomba umo chikamu chemwoyo chinouraya, kazhinji nokuti ropa rayo rinoparadzaniswa. Kazhinji, chirwere chemwoyo chinowanikwa apo bhokisi re atherosclerotic rinokurumidza kupera muuroni yerononi (ariti inopa ropa kumutsipa wemoyo), zvichiita kuti kuvharwa kwakanyanya mu arteri.
Kurwadza mwoyo kunogona kuva nemigumisiro yakaipa yakawanda.
Inowanzo (asi kwete nguva dzose) inobereka zviratidzo zvakakura, kunyanya chipfuva, dyspnea (kupfupika kwefema), kana pfungwa yekuparadzwa kunouya. Kana mwoyo wemisipiresi yakaipisisa yakazara zvakakwana kukanganisa mwoyo kunogona kukura, zvichida nemhepo yekuzvidzivirira pachayo pachayo, kana gare gare. Kurwadziwa kwemoyo kunowanzounza kusagadzikana kwemagetsi mumoyo, izvo zvinogona kukonzera kufa kamwe kamwe kubva ku ventricular fibrillation .
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Tarisiro: Kuramba Uine Utano Hwakapedza Kurwadziwa Kwemwoyo
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Chii Chinonzi Hemodynamic Kuchengetedzwa?
Munzvimbo yakanakisisa-mamiriro ezvinhu-iyo inonyanya kuitika kana iwe ukakurumidza kuita chimwe chinhu paunoona zviratidzo zvekurwadziwa kwepfungwa, uye vanachiremba vako vanoziva nokukurumidza dambudziko uye nokukurumidza kutungamirira kurapa kwakanaka-kurwisa kwemwoyo inokura kukuru . Zvinoratidza kuti une chirwere chisingagumi ( chirwere chetachiona chinonzi coronary arter, kana CAD ) icho chave chaita zvisingaiti zvimwe zvinokanganisa mwoyo wako uye zvinogona kuita zvakawanda kukuvara kunze kwekuti iwe utora matanho akakodzera. Mune zvishoma-kupfuura-zvakanakisisa-mamiriro ezvinhu, chirwere chemwoyo chinogona kubvisa urema hwakakosha uye kufa kusati kwasvika. Chero nzira, myocardial infarction ndiyo chiitiko chakakomba muupenyu hwehupi.
Kana iwe uine chirwere chepfungwa, kana kana njodzi yako yekuva neyekukwirira , pane zvakawanda zvaunoda kuziva. Nokunzwisisa zvinokonzera, zviratidzo, maitiro ekudzivirira, uye kurapa kwekurwadziwa kwemwoyo, uye nekushanda pamwe chete nechiremba wako, unogona kuwedzera mikana yako yekurarama hupenyu hurefu hutano hwakanaka.
Chii Chinokonzera Mwoyo Mhosva?
> Kutarisa zvakanyanya kwepaki kuvaka-up mune mishonga inogona kutungamirira kuhope yemwoyo.
Kazhinji kacho, kurwadziwa kwemoyo kunokonzerwa nekuputika kwepakiti mumatriconary artery. Kupisa kwemavara kunokonzera kuvhara mukati meyeri uye mavara emagazi. Ropa revhavha rinovhara ariti kusvika pane imwe nzvimbo. Kana kuvhara kwakanyanya kwakanyanya zvakakwana, mutsara wemwoyo unowanikwa neyeri iyo inotanga kufa-uye kurwisa kwemwoyo kunoitika.
Mubvunzo wekuti nei mabheti achiputika, uye zvikamu zvipi zvinowanzoparara, inzvimbo yekutsvakurudza kwakaitwa kurapa. Nepo dzimwe nguva bhokisi rinoputika mushure mekumwe rudzi rwe "chiitiko" chinokonzera (zvakadai sekurwadziwa mumuviri kana mupfungwa), kazhinji kakawanda kuputika kunowanikwa pasina chikonzero chakajeka, chaizvoizvo, uye pasina zvigadziriswa zvinokonzera.
Uyezve, hazvirevi pachena kuti mabhuku makuru aya anowanzozvidya mwoyo pamusoro ((rudzi rwakaratidzwa mushure memwoyo catheterization se "maitiro anokosha") zvinowanzoitika kudarika zviduku, zvinyorwa zvisingaoneki. Ichokwadi ndechokuti, ani zvake ane CAD anofanira kutorwa seanenge ari pangozi yekurwadziwa kwepfungwa-kana kuti kwete mapepa avo anonzi "anokosha" -uye anofanira kutarisirwa zvakakodzera.
'Zvimwe' zveMwoyo Zvinotyisa
Chirongwa chemapuraneti chinoputika chinogona kubudisa zvinenge zvitatu zvakasiyana-siyana zvemakiriniki, izvo zvose zvinoungana pamwechete pasi pezita rinonzi acon coronary syndrome, kana ACS . Zviratidzo zvemarudzi ose matatu eAAC zvinowanzofanana, uye zvose zvitatu zvinoonekwa sechirwere zvinokurumidza. Zvisinei, vaviri chete avo vanoonekwa sekutambudza mwoyo.
Rudzi rwekutanga rweAACs runonzi unogona kushandiswa angina. Mune angina isina kugadzikana, ropa rinoputika kubva pamapapiro anenge asina kukwana (kana risingapfuuri kwenguva yakakwana) kuti rive nekukuvadza kusingaperi kumutsipa wemwoyo-saka angina isina kusimba haisi kuora mwoyo.
Zvisinei, pasina kushungurudza chirwere chisina kugadzikana chinowanzosangana mune ramangwana riri pedyo nekurwadziwa kwemwoyo. Verenga nezve angina isina kugadzikana .
Mhando inotevera ye ACS inonzi ST-elevation myocardial infarction (STEMI). Zita iri rinobva pakuziva kuti "ST segment" chikamu che electrocardiogram (ECG) inowanikwa yakakwirira mune iyi, iyo yakaoma kwazvo iyo ACS. Ne-STEMI, ropa rakagadzikana rakazara uye rakaoma, saka chikamu chikuru chemutsipa wemwoyo chinopiwa neaiti inoparara ichafa pasina kurapwa nokukurumidza. Verenga nezve STEMI .
Rudzi rwechitatu rwe ACS harusi rutsigiro rwe ST sekumusoro myocardial infarction (NSTEMI), iyo inogona kufungidzirwa semamiriro ezvinhu ari pakati peanina asingagadzikane ne STEMI. Pano, kuvharwa kwegoniyoni inenge isina kukwana, asi ichiri yakakura zvakakwana kuti itange zvimwe zvimwe zvinokanganisa musimba wemwoyo. Verenga pamusoro peNSTEMI.
Zvose STEMI neNSTEMI, pasina kurapa kwakakwana, zvinounza kukuvadza kusingaperi kumutsipa wemwoyo, saka zvose zviri zviviri zveAACS zvinoonekwa sekutambudzika kwemoyo.
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Chikonzero Nei Uchifanira Kutora Aspirin Kana Uri Kutarisana Nemwoyo
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Makomborero eCardiac Rehab Programs
Zvakakosha kuti vanachiremba vatsaure pakati pemhando mbiri idzi dzekurwadziwa kwemoyo nokuti kurapa kwakanyanya kunogona kusiyana pakati pavo.
Zviratidzo zveMwoyo Inotyisa
Chirwere chekare chepfungwa yepfungwa chirwere chepfuva, chinogona kuenderera kumasana kana ruoko, uye izvo zvinogona kuendeswa nekutuka, uye kunzwa kwekutya kwakanyanya kana kuparadzwa.
Zvisinei, vanhu vakawanda vane hutsinye hwemwoyo havana zviratidzo izvi zvekare. Vanogona kunge vasina chirwere chepfupa-kana marwadzo. Vanogona kurondedzera zviratidzo zvavo sekumanikidzwa, kana kuti nondescript isinganzwisisi- "kungoita manzwiro anonyadzisa." Uye zviratidzo zvingaita kuti zvirege kugumira kubhokisi, asi panzvimbo kumashure, mapepa, mutsipa, maoko, kana gomba remukati.
Vanhu vane acute myocardial infarctions vangave nekutsvaga kamwe kamwe kana kurutsira, kana kupererwa kwemhepo. Kana, vangangodaro vane izvo zvavanotsanangura se "kuora mwoyo" uye hapana chimwe chinhu.
Kazhinji kazhinji, zviratidzo zvekurwadziwa kwepfungwa ndezvomunhu akadaro zvokuti zviri nyore kuti zvibvise. Zviri nyore kungovamirira kuti uone kana vachienda ivo pachavo. Uye kakawanda, vanoita. Vanhu ava ndivo ndivo vachazoonekwa mushure mokunge, pavanopedzisira vava kuona chiremba, sekunge vaine izvo zvinonzi " kunyarara kwepfungwa yemoyo ."
Dambudziko nderokuti kushungurudzika kwemwoyo-kunyange ivo vakanyarara-kunogadzirisa kusingagumi kumusana wemwoyo, kazhinji kukanganisa kwakakonzera kukonzera, kana kupfupisa tarisiro yehupenyu nehuwandu hwakawanda. Kugadzirisa kukanganisa, zvakakosha kuziva kuti chirwere chemwoyo chinogona kuitika, uye kuwana rubatsiro rwechirwere pakarepo, apo mwoyo wemisungo uchiri kunyaradzika.
Migumisiro yeChirwere cheMwoyo
Migumisiro Yakadaro. Mukuwedzera pakubereka marudzi ezviratidzo zvatakangotaura nezvazvo, kurwadza kwepfungwa kunokonzera zvinetso zvakanyanya. Kana huwandu hwemutsipa wemoyo hunoitwa nehutachidziro hutachiona huri hwakazara, munhu ane chirwere chepfungwa angasangana nekushaya simba kwemoyo. Iyo kukanganisa kwemwoyo kunogona kuunza kupera kwekufema kwakanyanya, kuderera kwemuropa, kuchena kwemawere kana syncope , uye kusagadzikana kwezvizhinji. Kunze kwekuti ropa risingapfuuri rinogona kudzorerwa kune hutachiona hwemwoyo mushure mekukurumidza, rudzi urwu rwekushaya simba kwemoyo runowanzoguma murufu.
Mukuwedzera, panguva yekurwadza kwepfungwa yakaoma mwoyo musimba unouraya unogona kuva magetsi asingagadzikane, uye unowanzoita ventricular fibrillation. Saka njodzi yekufa kamwe kamwe mukati mekutanga maawa mashomanana ekurwadziwa kwemoyo yakakwirira. Kunyange zvakadaro, utachiona hwemhepo hunowanzoshandiswa zvakanaka (kuburikidza nekuzvidzivirira) kana zvichiitika kana munhu ari pasi pekurapa. Ichi ndicho chikonzero chikonzero nei zvakakosha kuti usaedza "kungobuda" chero zviratidzo zvinogona kureva kurwisa kwemwoyo.
Migumisiro Gare gare. Kunyange mushure mokunge chikamu chakaoma chekutsamwa kwemwoyo kwapfuura, kune zvimwe zvisinei zvinonetsa zvinoda kutariswa.
Chokutanga, kukanganisa kwakaitwa kumwoyo kwemisumbu kunogona kusiya mwoyo wakaneta, uye kukanganisa kwemwoyo kunogona kuitika pakupedzisira. Chechipiri, zvichienderana nehuwandu hwekuparadzwa kwekusingaperi kunokonzerwa nemutsipa wemwoyo, dambudziko rekufa kamwe kamwe rinogona kukwidziridzwa nekusingaperi. Chechitatu, chokwadi chaicho chokuti chirwere chemwoyo chakaitika chinoisa munhu pangozi yakanyanya yekutsvaira kwemoyo.
Izvo zvose izvi zvinoreva kuti kurapwa kwepfungwa yemwoyo hakuperi kana chiitiko chakaoma chapera. Chirwere chinoramba chiripo chinangwa chekudzivirira kana kuderedza mitatu yeiyi "nguva yekupedzisira" zviitiko zvakakosha.
Mwoyo Wokurwisa Unozivikanwa Sei?
Kunyatsoongorora chirwere chemwoyo kazhinji hachisi chakaoma-chero bedzi zviratidzo zvomunhu zvichenjerera vashandi vezvokurapa kune izvozvi. Kazhinji kacho, munhu ane zviratidzo zvinofungidzira zvingave zvakabatana nemwoyo yavo, nekuda kwekuda kufungidzira, kuderedza zviratidzo apo pavanosvika muimba yepamhanho. Iyi ndiyo nzira isina kururama. Kana nokukurumidza vashandi vezvechiremba vanonyeverwa nezvekwaniso yekapopotendi ye myocardial, nokukurumidza ivo vachaita kuti vaite kana kutonga kunze kwekuti kuongororwa.
Yeuka kuti, kana zvasvika pakurwisa kwepfungwa, maminetsi ose anokosha. Saka kana iwe uri kunyanya kufunga kuti zviratidzo zvako zvingangove zvichibva pamwoyo wako, iwe unofanirwa kuti, "Ndinofunga kuti ndine chirwere chemwoyo." Izvi zvichaita kuti bhora rifurure pakarepo.
Muzviitiko zvizhinji, kutumira ECG (iyo inogona kuratidza kuchinja kunhu hunoenderana nehutano hwemwoyo) uye kutumira kuongorora ropa kuenzana nemasikirini emwoyo (iyo ichaona kana kukuvara kwemasero emwoyo ari kuitika) kuchasimbisa kana kusavhiringidza kuongororwa kwepfungwa yepamwoyo nokukurumidza . Nokukurumidza kuongororwa kunoitwa, inhanho dzinokurumidza dzinogona kutorwa kuti dzisire mhirizhonga.
Kurapa: Maawa Okutanga Akakosha
Kurwadza kwepfungwa kwakanyanya chirwere chekurapa chinotarisirwa. Mutsipa wemwoyo uri kufa, uye nokukurumidza kurapwa kunokosha. Maminitsi anogona kuita musiyano pakati pekugadzirisa zvakakwana nekuremara kusingaperi kana kufa. Ichi ndicho chikonzero hakuna munhu anofanirwa kunyatsorega chero chinetso chinokanganisa, chisina kutsanangurwa chinoitika chero kupi kwechiuno.
Kamwe kana munhu ari pasi pehutano uye chirwere chinoramba chiripo chinonzi chikafu chinowanikwa, chirwere chinotanga pakarepo. Izvi zvakanyanyisa kurapwa kazhinji zvinosanganisira nzira mbiri dzakaita pamwe chete: kugadzikana uye revascularization.
"Kutsigira" kunosanganisira kubvisa zviratidzo zvakakomba, kubvisa kushungurudzika pamutsipa wemwoyo, kutsigira ropa (kana zvichidiwa), kutora matanho ekugadzirisa kuputika kwepakiti, nekugadzirisa kuumbwa kweropa rega muyeri yakaora. Izvi zvinoitwa nekupa nitroglycerin , oksijeni, morphine, beta blockers , statin , aspirin , uye imwe mishonga inorwisa-platelet yakaita seLlavix .
Zvisinei, chikonzero chaicho chemugumisiro wakanaka ndechokuti vashandise moyo wemwoyo unofa-kureva kuti, kudzorera ropa kuvhara mukati mekuvharidzirwa kweyeriyeri-uye kuzviita nokukurumidza sezvinobvira. Chigadziriswa chemwoyo chinogara zvachose chinogona kudziviswa kana arteri inogona kuzarurirwa mukati maanenge maawa mana. Uye zvimwe zvinokanganisa zvachose zvingadzivirirwa kana arteri ichivhurwa maawa masere kusvika pa12. Zviri pachena kuti nguva inokosha.
Ne-STEMI (rudzi rwekurwa kwepfungwa umo chironga chegoni chakadzivirirwa zvachose), revascularization yakaitwa, zvichida, kuburikidza nekushandiswa kwechirwere chinonzi invasive- angioplasty uye stenting . Dzimwe nguva nzira iyi haigoneki kana kuti haina ngozi, pane imwe nguva thrombolytic therapy ("drug-clot-busting") inoshandiswa kuparadza muchero uye kudzorera kubuda kweropa.
Ne NSTEMI (rudzi rwekurwadziwa kwemoyo umo iyo arton coronary inongovharwa zvishoma), thrombolytic therapy inoratidzwa kuti inokonzera kukuvadza kupfuura kunaka, uye inofanira kudziviswa. Dzimwe nguva vanhu vane NSTEMI vanogona kurapwa nekugadzirisa matanho voga (izvo zvinowanzova nenzira imwechete angina isina kugadzikana inotapwa). Zvisinei, vazhinji vezvemapurisa vanofunga kuti kupisa kunobatsira mukuchengetedza mutsara wemwoyo pamwe neNSTEMI, uye inowanzotarirwa nzira yeStEMI neNSTEMI.
Izvo zvinangwa mukati mekutanga maawa mashomanana ndekuita kuti ropa riyerere rinodzoserwa kune mungozi yepfungwa inenge iri pangozi, kutora matanho ekudzivirira kushandiswa patsva nekugadzirwa kweropa clot, uye kuderedza basa rehuwandu hwemoyo. Muzvizhinji zvezviitiko-kunyanya kana kurapwa kwakatanga nokukurumidza-vanhu vane kurwadza kwepfungwa kwakanyanyisa mukati meawa makumi maviri nemaviri.
Mushure meZuva Rokutanga: Wakaponeswa Moyo Wakaipa-Zvino Chii?
Kana iwe wapedza kubudirira kufamba nechikamu chakakomba chekurwadziwa kwepfungwa-maawa makumi maviri ekutanga kana kuti-ndiyo nguva iwe nevanachiremba vako kutanga chirongwa chinotarisirwa kudzivisa matambudziko matatu ekupedzisira ekurwadziwa kwepfungwa: mwoyo kusakatika, kufa kamwe kamwe, uye kuwedzera kwemwoyo.
Kurwadziwa kwemoyo kunouraya mamwe musimba wemwoyo. Mwoyo wemutsipa wakafa unoshandurwa kuva mutsvuku, unobata mwoyo pamwe chete asi hauiti kuti basa remoyo. Zvichida kana kuti kwete munhu anovandudza kukanganisa kwemoyo mushure mekurwa kwepfungwa kunobva pauwandu hwekukuvadza uye kuti kusara kwemoyo musimba "kunogadzirisa" sei mamiriro matsva. Iyo yakasara, yakasvibiswa yemutsipa wemwoyo kazhinji inopindura kuburikidza nekushandura chimiro chayo, chirongwa chinonzi "kugadzirisa". Kunyange zvazvo chimwe chigadziro chekugadzirisa chinogona kuva chakanaka pakutanga, chisingagumi, kugadziridza kunogona kutungamirira kumoyo kukanganisa. Verenga nezvekugadzirisa mwoyo.
Kune zvinhu zvakawanda izvo vanachiremba vanofanira kuita kuti vabatsire mwoyo yevarwere vavo kuti varege kugadzirisa mwoyo uye kubatsira kudzivirira mwoyo kusakundikana. Mukuru pakati peiyi iko kushandiswa kwe beta blockers uye ACE inhibitors , asi mamwe matanho anodiwa zvakare. Iwe unofanirwa kunge uchiziva matanho ose anowanikwa ekudzivirira mwoyo kusakundikana, uye ona kuti chiremba wako ari kukurudzira iyo inoshanda kwauri.
Kubvunzurudza kwepfungwa kwepfungwa inowanzowanzo "kuputika" nema cardiologists ndiko kukurukurirana pamusoro pekufa kamwe kamwe. Iyi ihurukuro iyo vanachiremba vazhinji vanowana zvakaoma zvikuru kutaura nezvazvo. Zvisinei, kufa kamwe kamwe kune ngozi yakawanda kune vanhu vakawanda mushure mekurwadziwa kwepfungwa, kunyanya vanhu vakave nekukuvadza kukuru pamwoyo yavo. Uyezve, njodzi yekufa kamwe kamwe inogona kuderedzwa zvakanyanya, kune vanhu vane ngozi yakawanda kwazvo, kuburikidza nekushandiswa kwezvigadziriswa. Bvisa mirayiridzo iripo pamusoro pekuti vanhu vanofanirwa kufungidzirwa sei kuti vashandise zvinokonzerwa nemwoyo, uye chiremba wenyu anokubhadharai kukurukura kana iwe ungave uri wevanhu ivavo.
Munhu anenge apona chirwere chemoyo anoziva chimwe chinhu pamusoro pavo ivo vangave vasati vaziva kare: Vane CAD, uye vari pangozi yakawanda yehumwe hurombo hwemwoyo. Ngozi iyo inogona kunyatsovandudzwa nemishonga uye kutora mararamiro ane hutano. Mukuwedzera kune beta blockers uye ACE inhibitors (inobatsira pakudzivirira kugadzirisa mwoyo), vanhu vakawanda vane chirwere chemwoyo vanoda kuve mumasimini ne aspirin, uye zvichida pamishonga yekurapa kana kudzivirira mamwe angina (zvakadai se nitrate kana calcium channel blockers ).
Upenyu hunoita hunoita kuti huve nehutano hwemangwana huripo hunosanganisira kupedzisa kushandiswa kwefodya, kudya moyo unofadza kudya , kuisa uremu, kuwana hutano hwakanaka hwechirwere cheshuga nehuwandu hwehutachiona (kana uine izvi), uye uchiita zvekuita muviri nguva dzose (zvichida kutanga nehutano hwekugadzirisa mwoyo purogiramu ).
A Post-Heart Attack Ongororo
Icho chinhu chakanyanya kuti iwe uzive uye ufunge nezvazvo. Fembera chii? Izvo zvakare zvakawandisa kuti chiremba wako azive uye afunge nezvazvo. Uye mumazuva ano maitiro ekurapa akaoma, zvinoita kuti kunyange chiremba akanyanya kunyanya kushaya humwe huchakanganwa mamwe matanho anokosha anodiwa kuti ave nechokwadi chekugadzirisa zvakaguma mushure mekurwa kwemoyo.
Saka heino hutsva hwekutsvaga kwemoyo hunogona kuwanikwa. Enda pamusoro pemutsara wekutsvakurudza uku nachiremba wako, kuti uone kuti iwe kana iwe usingafungi hauna hanya nhanho kusvika kune utano hwako hwehutano hwakanaka. Wakave uine zvizhinji pamwe chete-ngatitenderei kuti mumwe wenyu abvure bhora kuti risiwe ikozvino.
Shoko Rinobva
Kurwadziwa kwemoyo kunobata bhizinesi. Nenzira inofadza, nezvatakadzidza pamusoro pemhirizhonga yemwoyo mumakumi emakumi apfuura, uye nemishonga mitsva iyo yakagadzirirwa kuvabata, mikana yekufa kana kuva nekuremara kwekusingaperi mushure mekurwadziwa kwemoyo kwakanyanya kuderera.
Zvisinei, kuitira kuti mugamuchire zvikomborero zvekufambira mberi kwekurapa kunoshamisa, unoda kuziva zvose zvaunogona pamusoro pekurwadziwa kwemoyo-kunyanya, kuti ungaziva sei kuti unogona kuva neumwe, uye chii chaunofanira kutarisira munzira yekurapa. Isu tinotarisira kuti nyaya ino ichakuita iwe kutanga nezvinodiwa kuziva.
> Sources:
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> Goldberger JJ, Kaini ME, Hohnloser SH, et al. American Heart Association / American College of Cardiology Foundation / Heart Rhythm Society nhepfenyuro yesayenzi pamusoro pemagadzirirwo asina kukanganisa maitiro ekudzivirira kukanganisa varwere vari pangozi yekufa kamwe kamwe kwemoyo: chirevo chesayenzi chinobva kuAmerica Heart Association Council paCliniki Cardiology Committee ye Electrocardiography uye Arrhythmias uye Council pane Epidemiology uye Kudzivirira. Circulation 2008; 118: 1497.
> Kushora SA, Abraham WT, Chin MH, et al. 2009 yakagadziriswa patsva yakaiswa muAAC / AHA 2005 Mirayiridzo yeKutsvaga uye Kutungamirirwa Kwekushaya Mwoyo Muvanhu Vakuru: mushumo weAmerican College of Cardiology Foundation / American Heart Association Task Force pamusoro pekushandisa mazano: yakagadziridzwa pamwe nekushandira pamwe ne International Society of Heart uye Muchengetedzwa. Circulation 2009; 119: e391.
> O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF / AHA nhungamiro yehutungamiri hwe ST-elevation myocardial infarction: mushumo weAmerican College of Cardiology Foundation / American Heart Association Task Force pamusoro pekushandisa mazano. Circulation 2013; 127: e362.
> Thygesen K, Alpert JS, White HD, et al. Zvose zvinoreva myocardial infarction: Kristian Thygesen, Joseph S. Alpert naHarvey D. White panzvimbo ye Joint ESC / ACCF / AHA / WHF Task Force nokuda kweReferencing of Myocardial Infarction. Eur Heart J 2007; 28: 2525.