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🏥 | Easy and nutritionally balanced!Udon noodles for lunch at home


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Easy and nutritionally balanced!Udon noodles for lunch at home

 
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Natto is also said to help prevent myocardial infarction and cerebral infarction by preventing the formation of blood clots in the contained components nattokinase and dietary fiber.
 

Many people work from home and eat at home in the morning, day and night.Lunch to eat between work is easy if possible ... → Continue reading

 Daily Gendai Healthcare

We will deliver the medical and health articles of the evening paper "Daily Gendai". From everyday health laws to the latest medical information, all articles are based on interviews with doctors and specialists.


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Nattokinase

Nattokinase(Nattokinase)NattoIt is a kind of enzyme protein contained in.Fibrin (main component of blood clots)Fibrin) Has a dissolving effect[2].Hiroyuki Sumi[3]Due to[4][5]Discovered and named in 1980[6][7]..Formerly calledSubtilisin NAT(Subtilisin NAT)[8]..NattokinaseBacillus subtilisIs a variant ofBacillus subtilis natto(Natto bacteria) Is an enzyme secreted outside the body[9].soyFermentNattoIt is produced in the production process of.

Known for its ability to prevent blood clots[10]It has been reported that thrombolytic ability is maintained even when taken orally.[11].

However, there is still no clear evidence that orally administered nattokinase is absorbed from the digestive tract and exerts its action in the blood.[12].proteinNattokinase is a gastrointestinal digestive enzymeamino acid,peptideThe numerator is too large to be absorbed into the blood from the intestine as it is.Nattokinase is of a certain sizepeptideDisassembled intothrombusHas lytic activitypeptideIt is believed that there is.The mechanism of uptake into intestinal cells is not yet fully understood.[13][14].

Nattokinase in clinical studies uses capsules to prevent it from being degraded by stomach acid[4][11][15]..In addition, the intake of 2,000 FU is equivalent to 2 packs of commercially available natto.Blood coagulation factorsTo activateVitamin KHas also been removed[13][16].

Name

The name Nattokinase isNatto bacteria (natto-kin) with the suffix -ase for enzyme.Kinase(Kinase, phosphorylating enzyme), notSubtilisinFamilySerine protease.

Formerly known as subtilisin NAT[8].

Structure and basic properties

Nattokinase is composed of 275 amino acid residues and has a molecular weight of 27,728.[17], Or 27,724[9]Is said to be.Polypeptide structure with no SS bonds[9]..StructurallySubtilisinClose to E (subtilisin) and has 99.5% homology[2].

Similar to subtilisinSerine proteaseHas activity[2]..In vitro fibrin (Fibrin) Is decomposed, and in the experiment using ratsPlasminHas four times the thrombolytic effect of[18].

Bacillus subtilisIs a variant ofBacillus subtilis nattoProduces, but is just Bacillus subtilisBacillus subtilisSo there is no nattokinase[9]..A typical natto contains 1 international units of nattokinase per gram, and the one labeled as having a large amount of nattokinase is 0.99 international units.[9].

There is a report that nattokinase produced by Thai fermented soybean food Tua Now was more active than that of Miyagi's natto bacterium.[19].

Examples of research on health

1990

Feeding dogs with nattokinase enteric coated capsules can dissolve blood clots in thrombotic dogsAngiographyIt was reported that it was observed by[20][21]..In a study conducted by Sumi in which five subjects were given dried natto containing a high titer of prourokinase activator (PUA), natto may contain thrombolytic activity in addition to nattokinase. To[22].

2007

Heart diseaseThere is no scientific basis for nattokinase supplements foraspirinShould be selected first[23].

2008

Randomized controlled trials using nattokinase supplements reduced systolic and diastolic blood pressure in 73 patients, including hypertension[24].

2009

NattokinaseProteinase K,SubtilisinWith a kind of CarlsbergAlzheimerHarmfulAmyloidIt has been reported that it has the decomposing activity of fibrils (fibers).[8]..This report simply compares the ability of nattokinase to degrade amyloid fibrils in vitro with other proteolytic enzymes.

2014

Has a thrombolytic effect similar to nattokinaseUrokinase(Derived from human urine) has been approved as a drug for the effect of "dissolution of coronary thrombosis in acute myocardial infarction".Intravenously administeredBe done[25][26]..Nattokinase enhances the effects of urokinase[27].

NattokinaseCariesStrongly inhibited the causative bacteria of (cavities) from forming biofilms[28].

2015

In a small, double-blind study of 12 people, a single-dose supplement showed fibrinolysis and anticoagulant effects after hours, and the number of human clinical trials is still small at this point.[2].

2016

79 patients received nattokinase supplementsRandomized controlled trialResults in reducing diastolic blood pressure[29].

2017

Seventy-six people participated in a randomized controlled trial, some taking nattokinase supplements and reducing carotid plaque size.[30].

2019

Studies have shown that common thrombolytic agents already in use are expensive and have drawbacks, so a safe thrombolytic agent such as nattokinase is needed.[27].

Food category

Food categoryInFood"Hits the,"Blood is smooth"Become"MedicineEffectiveness and efficacy display (including oral explanations at stores and briefings)Food Labeling LawSubject to regulation[31] [32]..For this reason, each company's supplements are labeled as "smooth grains," "smooth nattokinase," and "approach to clear tours."[33][34].

2020- Kobayashi Pharmaceutical,Yakult Health Foods,Japan Institute of Biological SciencesIs a supplement containing nattokinaseFoods with functional claimsAsConsumer Affairs AgencyIt has been reported to.Foods with functional claimsThe government does not carry out the examination, and the business operator displays the functionality at its own risk. Is displayed. "This is 2008Randomized controlled trialIt is evaluated by the business operator, and it is said that the function can be expected for those with high blood pressure I who are "those with high blood pressure in a healthy range".[35][36][37].

安全 性

National Cardiovascular Research CenterIs nattoBlood coagulation factorsTo activateVitamin KBecause it contains a lot ofWarfarinOf patients receivingNattoIngestionTabooIs trying[38].WarfarinIt is,Vitamin KIt is a drug that suppresses the activity of blood and makes it difficult for blood to clot.Natto,Green juice,chlorellaな どVitamin KFoods with high contentWarfarinInhibits the work of.

National Institute of Health and NutritionSays that while healthy adults are probably safe when natto is taken as a regular food, there is not enough reliable information on the safety of nattokinase as a supplement or other concentrate.In particular, we are careful to avoid taking it at our own discretion in pregnant / lactating women, patients with bleeding disorders, and patients with hypotension.[39].AnticoagulantAndaspirinSuch asAntiplatelet drugWhen used in combination withIntracerebral hemorrhageSuch asBleedingMay increase risk[40].

NOAEL

NOAELReference value: Rat, oral, 90 days 1000 mg / kg body weight / day[41]

footnote

  1. ^ Yanagisawa, Y .; Chatake, T .; Chiba-Kamoshida, K .; Naito, S .; Ohsugi, T .; Sumi, H .; Yasuda, I .; Morimoto, Y. (2010). “Purification, crystallization and preliminary X-ray diffraction experiment of nattokinase from Bacillus subtilis natto”. Acta Crystallographica Section F 66 (12): 1670-1673. two:10.1107 / S1744309110043137. PMC 2998380. PMID 21139221. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998380/. 
  2. ^ a b c d “A single-dose of oral nattokinase potentiates thrombolysis and anti-coagulation profiles”. Scientific reports. (2015). two:10.1038 / srep11601. PMC PMC4479826. PMID 26109079. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479826/. 
  3. ^ "Hiroyuki Sumi". researchmap. 2020/7/9Browse.
  4. ^ a b Tetsuya Hayashi, Hiroaki Maeda "Blood fluidity improving effect of natto bacterium culture filtrate dried product "NKCP""Journal of the Japan Society for Mibyou Systems," Vol. 8, No. 2, Japan Society for Mibyou Systems, 2002, pp. 204-205, two:10.11288 / mibyou1998.8.204, ISSN 1347-5541, NOT 130004186124.
  5. ^ Tsune Mihara, "Enzymatic thrombolytic action of Lumbricus rubellus (red earthworm) (PDF) "Angiology2010 Vol.50 January 1th issue (No.17),NOT 10029414573, Japanese Society of Angiology
  6. ^ Sumi, H .; Hamada, H .; Tsushima, H .; Mihara, H .; Muraki, H. (1987). “A novel fibrinolytic enzyme (nattokinase) in the vegetable cheese Natto; a typical and popular soybean food in the Japanese diet ”. Experientia 43 (10): 1110-1111. two:10.1007 / BF01956052. PMID 3478223. 
  7. ^ Hiroyuki Sumi, Nobuyoshi Nakajima, Naotoshi Taya, "Method for measuring the activity of thrombolytic enzyme nattokinase"Journal of the Brewing Society of Japan, 1993, Vol. 88, No. 6, p.482-486, two:10.6013 / jbrewsocjapan1988.88.482.
  8. ^ a b c Hsu, Ruei-Lin; Lee, Kung-Ta; Wang, Jung-Hao; Lee, Lily Y.-L .; Chen, Rita P.-Y. (2009). “Amyloid-Degrading Ability of Nattokinase from Bacillus subtilis natto". J. Agr. Food Chem. 57 (2): 503-508. two:10.1021 / jf803072r. PMID 19117402. 
  9. ^ a b c d e Hiroyuki Sumi, Tadanori Osugi, Sawa Naito, Chieko Yadakai "Nattokinase, a special enzyme possessed by Bacillus natto: its titer and features"Journal of the Brewing Society of Japan, Vol. 106, No. 1, January 2011, 1, pp. 15-28," two:10.6013 / jbrewsocjapan.106.28.
  10. ^ "July 7th is "Natto Day" About 10% of doctors eat natto for their health?”. Financial Field (July 2020, 7). 2020/11/23Browse.
  11. ^ a b Hiroyuki Sumi, Nobuyoshi Nakajima "Research on fibrinolytic enzymes in fermented foods"Journal of the Japan Society for Bioscience and Biotechnology," Vol. 65, No. 7, Japan Society for Bioscience and Biotechnology, 1991, pp. 1125-1127, two:10.1271 / nogeikagaku1924.65.1125, ISSN 0002-1407, NOT 130001228153.
  12. ^ Natto (natto), Natto fungus -"Health food" safety and efficacy information (National Institute of Health and Nutrition
  13. ^ a b "About the health benefits of nattoOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences (Pharmacy) Department of Bioregulation Science Department of Disease Pharmacology Control Science. 2021/6/9Browse.
  14. ^ ""Natto and blood smooth" is a lie "A certain encyclopedia" and NHK's trick”. Motoharu Miyoshi. 2021/6/9Browse.
  15. ^ "Study on thrombus-dissolving action by nattokinase”. Grant-in-Aid for Scientific Research Database. 2021/7/3Browse.
  16. ^ "High content of NSK nattokinase / Bacillus natto culture extract”. Japan Biology Co., Ltd. Scientific Research Institute. 2021/7/4Browse.
  17. ^ Fujita M, Nomura K, Hong K, Ito Y, Asada A, Nishimuro S (December 1993). “Purification and characterization of a strong fibrinolytic enzyme (nattokinase) in the vegetable cheese natto, a popular soybean fermented food in Japan”. Biochem. Biophys. Res. Commun. 197 (3): 1340-1347. two:10.1006 / bbrc.1993.2624. PMID 8280151. 
  18. ^ Fujita M, Hong K, Ito Y, Fujii R, Kariya K, Nishimuro S (October 1995). “Thrombolytic effect of nattokinase on a chemically induced thrombosis model in rat”. Biol. Pharm. Bull. 18 (10): 1387-1391. PMID 8593442. 
  19. ^ Yasuhiro Inazu, Nobutaka Nakamura, Kamal Willakody, Fushimi Chikara, Ladder Watthana Siritam, Shinichi Kawamoto "Properties of Bacillus natto isolated from unsalted soybean fermented food in Thailand"Abstracts of Conference Research Presentations," Vol. 17, 0, 2005, pp. 132-132, two:10.11402 / ajscs.17.0.132.0.
  20. ^ Sumi H, Hamada H, Nakanishi K, Hiratani H (1990). “Enhancement of the fibrinolytic activity in plasma by oral administration of nattokinase”. Acta Haematol. 84 (3): 139-143. two:10.1159/000205051. PMID 2123064. https://doi.org/10.1159/000205051. 
  21. ^ Hiroyuki Sumi "Nattokinase and fibrinolytic system"Chemistry and Biology," Vol. 29, No. 2, Japan Society for Bioscience and Biotechnology, 1991, pp. 119-123, two:10.1271 / kagakutoseibutsu1962.29.119, ISSN 0453-073X, NOT 130004807996,2021/7/7Browse.
  22. ^ Hiroyuki Sumi, Takeshi Baba, Noriaki Kishimoto "Prourokinase activating enzyme and thrombolytic ability in natto"Journal of the Japan Society for Food Science and Engineering," Vol. 43, No. 10, Japan Society for Food Science and Engineering, May 1996, pp. 10-1124, two:10.3136 / nskkk.43.1124, ISSN 1341027X, NOT 10007582940,2021/7/7Browse.
  23. ^ Cho L (April 2007). “Ask the doctor: I have read good news about nattokinaze and would like to use it to keep my blood thin. Is it a good substitute for aspirin?”. Heart Advis 10 (4): 8. PMID 17500089"Not very much is known about nattokinaze ... there is not enough information from human studies to know for sure what it can do or to recommend it for people with cardiovascular disease. Aspirin should be your first choice." 
  24. ^ Kim JY, Gum SN, Paik JK, Lim HH, Kim KC, Ogasawara K, Inoue K, Park S, Jang Y, Lee JH (August 2008). “Effects of nattokinase on blood pressure: a randomized, controlled trial”. Hypertens. Res. 31 (8): 1583-1588. two:10.1291 / hypres.31.1583. PMID 18971533. 
  25. ^ "Medical drug: Urokinase Note "Fuji"”. KEGG (April 2014). 2018/3/13Browse.
  26. ^ A type of enzyme protein that exhibits this thrombolytic effect, "Urokinase, Is approved for use by intravenous injection.This is an enzyme protein (amino acid) by pepsin in the gastric fluid and membrane digestion of the small intestine (degradation by the membrane digestive enzyme of microvilli that grows about 1 per small intestinal mucosal epithelial cell) before being absorbed into the body when taken orally. This is because the enzyme is lost by breaking down the tripeptide (three amino acids linked), dipeptide (two amino acids bound) or even a single amino acid.Of course, nattokinase is also an enzyme protein, so when taken orally, it is decomposed into amino acids, dipeptides, and tripeptides, and loses its activity as nattokinase.
  27. ^ a b Chen H, McGowan EM, Ren N, Lal S, Nassif N, Shad-Kaneez F, Qu X, Lin Y (2018). “Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases”. Biomark Insights 13: 1177271918785130. two:10.1177/1177271918785130. PMC 6043915. PMID 30013308. https://doi.org/10.1177/1177271918785130. 
  28. ^ Naoki Narizawa, Yukimasa Kawasaki, Keisuke Nakajima, Shin Abe, Yasuyoshi Torii, Akio Takenaga "Inhibitory effect of nattokinase on biofilm formation of cariogenic Streptococci"Journal of the Japanese Society of Food Storage Science," Vol. 40, No. 6, November 2014, pp. 11-273.
  29. ^ Jensen GS, Lenninger M1, Ero MP, Benson KF (2016). Consumption of nattokinase is associated with reduced blood pressure and von Willebrand factor, a cardiovascular risk marker: results from a randomized, double-blind, placebo-controlled, multicenter North American clinical trial. Integr Blood Press Control 9: 95-104.
  30. ^ “[A clinical study on the effect of nattokinase on carotid artery atherosclerosis and hyperlipidaemia]” (Chinese). Zhonghua Yi Xue Za Zhi 97 (26): 2038-2042. (July 2017). two:10.3760 / cma.j.issn.0376-2491.2017.26.005. PMID 28763875. 
  31. ^ "Precautions regarding the prize labeling law and health promotion law regarding health foods (PDF)”. Consumers, (June 2016, 6). 2021/7/23Browse.
  32. ^ "About medicinal effects”. Tokyo Metropolitan Health and Welfare Bureau. 2021/7/23Browse.
  33. ^ "Nattokinase PREMIUM”. Kobayashi Pharmaceutical. 2021/7/24Browse.
  34. ^ "Smooth natto kinase”. FANCL. 2021/7/24Browse.
  35. ^ "Kobayashi Pharmaceutical”. Search for notification information of foods with functional claims. 2021/7/24Browse.
  36. ^ "Yakult Health Foods”. Search for notification information of foods with functional claims. 2021/7/24Browse.
  37. ^ "Japan Institute of Biological Sciences”. Search for notification information of foods with functional claims. 2021/7/24Browse.
  38. ^ Seihito Sakuma (January 2010, 1). “Cardiovascular disease this and that> 78 Pulmonary embolism”. National Cardiovascular Research Center Cardiovascular Information Service. 2020/2/5Browse.
  39. ^ Natto (natto), Natto fungus -"Health food" safety and efficacy information (National Institute of Health and Nutrition
  40. ^ Chang YY, Liu JS, Lai SL, Wu HS, Lan MY (2008). “Cerebellar hemorrhage provoked by combined use of nattokinase and aspirin in a patient with cerebral microbleeds”. Intern. Med. 47 (5): 467-469. PMID 18310985. 
  41. ^ “Toxicological assessment of nattokinase derived from Bacillus subtilis var. Natto”. Food and chemical toxicology 88. two:10.1016 / j.fct.2015.12.025. PMID 26740078. 

Related item

外部 リンク

Myocardial infarction

Myocardial infarction(Shinkin Kosou,British: myocardial infarction) IsIschemic heart diseaseone of.心 臓Supplies oxygen and nutrients to muscle cellscoronary arteryOccurrence of obstruction or stenosisbloodThe flow rate ofMyocardium IschemiaBecome a stateNecrosisThe state that has been done. It usually refers to "acute myocardial infarction (AMI)" that occurs acutely.Heart attack-heart attack(British: heart attack) Is also called.

Even if myocardium falls into an ischemic stateNecrosisThe previous stage that does not reachAnginaIs a general term for a series of pathological conditions from angina to acute myocardial infarction.Acute coronary syndrome(acute coronary syndrome, ACS) has been proposed.

Form of onset

  • Acute myocardial infarction (AMI): Within 3 days after onset
  • Subacute myocardial infarction (SMI): Within 30 days after onset
  • Old myocardial infarction (OMI): 30 days or more after onset

Cause

Coronary blood flow decrease is mainly due toArteriosclerosisDue to some factor such as stenosis. This factor is due to the coronary arteryPorridgePlaque ruptureSpasm (spasm) is deeply related, butsyphilisStenosis at the origin of coronary artery caused by arteritis, obstruction caused by dissecting aortic aneurysm extending to coronary artery,Kawasaki diseaseIn the coronary artery due tothrombus(Emboli) There is also formation[1].

(English editionResearchers have summarized their findings to date,Blood type OIn myocardial infarction, 44% less likely than other blood types[2].. These studies were also published on the American Heart Association site, and research studies for over 20 years showed low risk for type O men and women[3].

symptom

Strong chest painAgonyA feeling occurs and lasts for more than 15 minutes,IschemiaIf the condition is not resolved, it will continue for several hours or more.The face becomes pale,cold sweat,blood pressureOf thepulseMay become unconscious with rising[1].. And, in the worst case, a deadly illness.

Left heart failureIn many cases, the sound can be heard in a wide range.KillipEt al. summarized these ra sound findings in a severity rating table, which is called the Killip table.[1].

About 75% of patients who are 20 years or older and have diabetes, etc. are not accompanied by painPainless myocardial infarctionMay cause[4][5]..Studies have shown that 21% to 41% of diabetic patients who develop myocardial infarction are painless, and 6% to 15% of those who do not have diabetes.[6].. Cerebrovascular disease is the cause of painlessness[7]It is thought that there are many autonomic disorders caused by diabetic neuropathy. Since the condition of myocardial infarction progresses without any subjective symptoms, it is often in a serious condition (including death) at the time of discovery.[8].

Pathogenic factor

Inspection

electro-cardiogram

electro-cardiogram (ECG) findings show ST rise[1]And abnormal Q waves are characteristic, and the infarction site and the responsible blood vessel site can be diagnosed depending on which guiding limb this appears. Of course, including ST deterioration of the mirror image[1].. Hyper acute T is judged in combination with clinical findings.

Failure siteST rise inductionST descent guidance (Reciprocal image)Responsible vessel
SeptalV1, V2(-)Left anterior descending coronary artery (LAD)
Front wall (Anterior)V3, V4(-)Left anterior descending coronary artery (LAD)
Anterior septumV1, V2, V3, V4(-)Left anterior descending coronary artery (LAD)
AnterolateralV3, V4, V5, V6, I, aVLII, III, aVFLeft anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), left main coronary artery (LMT)
Extensive anteriorV1, V2, V3, V4, V5, V6, I, aVLII, III, aVFLeft coronary artery (LCA)
Lower wall (Inferior)II, III, aVFI, aVLRight coronary artery (RCA), left circumflex coronary artery (LCX)
LateralI, aVL, V5, V6II, III, aVFLeft circumflex coronary artery (LCX), left main coronary artery (LMT)
PosteriorV7, V8, V9V1, V2, V3, V4Back descent (PDA)
Right ventricular infarction (RV)II, III, aVF, V1, V4RI, aVLRight coronary artery (RCA)

Cardiac catheterization

Cardiac catheterizationIs coronary artery stenosis/occlusionContrast agentTo draw. It is also an invasive test, but following lesion visualization,Endovascular treatmentIsPercutaneous coronary angioplastyThere is an advantage that can be done.

Echocardiography

心 臓Ultrasonography(Echo) is a simple and most useful test that is superior to electrocardiogram and serum biochemical tests in detecting a very mild myocardial infarction, and is diagnosed by detecting a decrease in myocardial wall motion.[1].. However, in some cases, such as infarction confined to the apex or inferior wall, it may be difficult to detect a clear wall motion abnormality (asynergy). Furthermore, if there is a collateral circulation, wall motion abnormalities (asynergy) do not occur, and the electrocardiogram does not show abnormalities, so diagnosis is often difficult.

It is also useful in diagnosing the presence or absence of MR (mitral regurgitation) due to myocardial infarction. By measuring the pressure difference (TRPG) of the tricuspid valve, it is possible to estimate the pulmonary arterial pressure, which is also useful in the evaluation of heart failure. If the area with reduced wall motion is already thin and the brightness is high, it is an old lesion.

Swan-Ganz catheter test

In the Swan-Ganz catheter test, a catheter inserted from a vein is passed through the right atrium and right ventricle.Pulmonary arteryThen, a method of indirectly measuring the pressure of the left atrium (pulmonary artery wedge pressure) using a balloon is adopted. There is also a method of knowing the amount of blood flow by injecting cold water from the tip and measuring the temperature using a sensor.[1].

The pulmonary artery wedge pressure (mmHg) obtained from theseHeart coefficient(CI, cardiac output/body surface area, L/min/m2) Is the Forrester classification.A cardiac index of 2.2 or less is considered to be terminal circulatory insufficiency, and a pulmonary artery wedge pressure of 18 or more is considered to be pulmonary congestion.MedicineThe type and treatment of[1].

Myocardial scintigraphy

A test to check whether there is a myocardial infarction, where there is little blood flow, whether the myocardium is working normally, or whether it is functioning as the heart. Scintigraphy is administered inside the bodyglucoseな どRadioisotopeEmitted fromradiationDetected and imaged its distribution[1].. Called positron emission tomography (PET)[1]One of the diagnostic imaging methods. It is also used to diagnose the functions of tumors (cancer) and various organs. It is also used for detection of ectopic gastric mucosa and examination of thyroid gland and salivary glands using the tissue affinity of nuclides.

The site of myocardial infarctiontechnetium-99mPyrophosphateAnd normal myocardiumthalliumIt has the property of incorporating -201. If scintigraphy is performed using this, the progress of myocardial infarction can be confirmed.[1].

Coronary angiography CT

  • Coronary angiographyCT
The morphology of coronary arteries can be visualized with a contrast medium. Visualization of coronary artery lesions by 64-row multislice CT感 度 88%,Specificity 96%,Positive predictive value 79%,Negative predictive value Reported as 98%[9].. It has high specificity and is considered to be useful for exclusion diagnosis in screening[10].. A randomized controlled trial of patients with atypical suspected angina and a first coronary CT scan was reported to reduce catheter coronary angiography and shorten hospital stay[11].

Chest X-ray

ChestX-rayThe test does not show specific findings for myocardial infarction, but is used to determine the severity and diagnose to remove aneurysms[1].

Blood test

Troponin
Troponin T and I are verySpecificityHighly useful for diagnosing myocardial infarction 3 hours or more after onset[1].. Each product of the Troponin T and Troponin I measurement kit has its own characteristics.感 度-SpecificityIs excellent in balance[12][13][14].
H-FABP (= Heart-type fatty acid-binding protein = heart type)
Rapid check[15]And rapid chip H-FABP[16](Sekisui MedicalManufacturing and sales) and other rapid diagnostic equipment and reagents are on the market in Japan.
Earlier (about an hour and a half),感 度,SpecificityThere is a product on the market that can be diagnosed in 15 minutes, which is high. However, in patients with renal failure, it is known that TnT and H-FABP may become positive regardless of damage to the myocardium.
CK-MB
Highly myocardial. AlsoMyocardiumReflect the degree of disability (necrosis)[1].

The first non-specific but always seen white blood cell elevation[1], AST (GOT), LDH, CK, and myosin light chain are elevated, and when they start to increase, they help predict the onset time.

The time to cause an abnormality in a general blood test isWhite blood cell 2-3 hours,CK 2〜4時間、AST 6〜12時間、LDH 12〜24時間、CRP 1〜3日、ESR 2〜3日である。

治療

Acute period

Absolute rest is the principle. Fatal arrhythmias are easy to occur in the acute phase after onset, and the risk of death is very high. In addition, the longer the time of ischemia, the more myocardial death progresses, and the irreversible decline in cardiac function progresses. When suspected to be ill, it is necessary to keep an eye on the patient and request an ambulance immediately. When the patient loses consciousness and does not touch the pulse, it is necessary to do heart massage without hesitation. In the case of functional cardiac arrest, no treatment for 3 to 5 minutes or more almost eliminates the reintegration rate. It is necessary to start life-saving measures (heart massage, etc.) immediately without waiting for the arrival of the ambulance.

Myocardial infarction is caused by a relative and absolute lack of oxygen supply to the myocardium, and oxygen is inhaled at rest. In addition, for the purpose of analgesia and reduction of body oxygen consumption,morphineMay be administered. In the acute phase, the greatest purpose is to prevent the expansion of lesions of myocardial infarction. Typically"morphine""Oxygen inhalation""Nitric acid""aspirinIt is mainly done with "internal medicine",Morphine, Oxygen, Nitrate, AspirinFirst name is "MONA" and the first aid for myocardial infarction (First Aid) Known as.

Necrosis progresses rapidly 2 hours after the onset,[17]In the case of myocardial infarction within 6 hours, it is possible to reduce the extent of myocardial necrosis by positively performing reperfusion therapy of the coronary artery that has been occluded.[17].. Not limited to this, reperfusion therapy is considered to be highly meaningful in cases within 24 hours of onset. BroadlyCatheter treatment (PTCA, PCI) And whenThrombolysisTherapy (PTCR) is available, and depending on the country, insurance policy and treatment policy may be divided according to the doctor's judgment. In Japan, there are many facilities where PCI is possible, and PCI is often performed during the acute phase. However, there are many complications because the inspection/treatment is performed via the artery. In particular, when ST is elevated on the electrocardiogram, how fast PCI is important is important, but hospitals that are ready to receive the therapy immediately after emergency delivery are the advanced countries of heart disease treatment in the United States. But few[18].

Emergency when there are three or more stenosis sitesCoronary artery bypass surgery (CABG) is also available at some facilities. When PCI and CABG are compared, it is said that PCI causes 25 to 30% restenosis, and therefore, there is also a theory that CABG is superior even with one branch lesion. However, since 1, drug-eluting stents (Drug-eluting stent, DES) Is covered by insurance, and it is expected that the performance of PCI will be improved.

stable period

Successful interventions in the acute phase often maintain a relatively good prognosis. During the stable period, resting and oral treatment are the main factors, and because of the characteristics of the disease, diabetes, hypertension, hyperlipidemia, cholesterin embolism, etc. are often present together. Become.

The following complications often occur in cases of unsuccessful intervention, and cases in which time has passed since the onset.

complications

It is roughly classified according to the site of the coronary artery where the stenosis occurred and the time from the occurrence.

arrhythmia

Most acute deaths due to myocardial infarctionarrhythmiaby. It occurs most often within 24 hours in the acute phase and is the leading cause of death in myocardial infarction.

Extra systole
Mostly merged.
Ventricular fibrillation
Left coronary artery (LCA) infarction, especially anterior infarction. It often occurs within a few hours after onset. It is a fatal complication.
Atrioventricular block
Since most of the AV node is perfused with the blood flow from the right coronary artery, atrioventricular block is likely to occur along with the inferior myocardial infarction caused by the occlusion of the right coronary artery. Sick Sinus Syndrome (SSS) can occur when the sinoatrial node itself is compromised.

heart failure

Infrequently,heart failureWill developmortality rateIs high. Treat symptomatically according to the Forrester classification to assess cardiac function with the Swan-Ganz catheter.

Papillary muscle rupture

It often occurs days after onset and often in the inferior infarct of the right coronary (RCA) infarction. Onset is often associated with severe mitral regurgitation and causes heart failure. If CABG is used as a treatment, mitral valve replacement may be performed at the same time.[19].

Burst heart

A condition in which the outer wall of the heart muscle ruptures due to necrosis of the heart muscle and intolerance of the blood pressure of the heart. Basically when this happensBlood lossHeart tamponadeByInstant deathIt is often difficult to help. By the way, a hole between the right and left ventricles is called ventricular septal perforation.

Ventricular aneurysm

Ventricular aneurysms often occur in the apex of the heart as a result of a left anterior descending coronary artery (LAD) infarction. It is one of the causes of ST elevation that persists after myocardial infarction treatment. It is easy to burst and causes heart tamponade.

Dressler syndrome (post myocardial infarction syndrome)

Dressler syndromeIs autoimmune epicarditis that occurs several weeks after the onset of myocardial infarction.

prognosis

When onsetLethalityIs very high at 20%. Most of them occur in the acute phasearrhythmiaIt is an example of merging. Since the mortality rate within 48 hours after onset is particularly high, surviving it will increase the chance of saving lives.

Source

[How to use footnotes]
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  2. ^ Ewald DR, Sumner SC (November 2016). “Blood type biochemistry and human disease”. Wiley Interdiscip Rev Syst Biol Med 8 (6): 517–535. two:10.1002 / wsbm.1355. PMC 5061611. PMID 27599872. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061611/. 
  3. ^ Research announcement that people with blood type O have a lower risk of developing coronary heart disease QLifePro August 2012, 08
  4. ^ Elderly myocardial infarction Japan Geriatrics Society Magazine Vol.30 (1993) No.8 P680-687
  5. ^ Angina/myocardial infarction you should know
  6. ^ Are Diabetic Patients Really Asymptomatic Myocardial Infarction? Northern Kanto Medicine Vol.39 (1989) No.6 P715-717
  7. ^ Analysis of factors associated with asymptomatic myocardial ischemia in the elderly Japan Geriatrics Society Magazine Vol.34 (1997) No.4 P285-291
  8. ^ Clinical significance of subclinical myocardial ischemia on the prognosis of patients with angina and myocardial infarction Nippon Medical School Magazine Vol.58 (1991) No.1 P74-85
  9. ^ Hamon, Michele, et al. (2007). “Coronary Arteries: Diagnostic Performance of 16-versus 64-Section Spiral CT Compared with Invasive Coronary Angiography—Meta-Analysis 1”. Radiology 245 (3): 720-731. two:10.1148 / radiol.2453061899. 
  10. ^ Akira Yamashina et al. (2009). "Guidelines for Diagnosis and Treatment of Cardiovascular Diseases (2007-2008 Joint Research Group Report) Guidelines for Non-Invasive Diagnosis of Coronary Artery Lesions" (PDF). Circ J 73 (Suppl III): 1040-1043. http://www.j-circ.or.jp/guideline/pdf/JCS2010_yamashina_h.pdf 2016/1/15Browse.. 
  11. ^ Dewey M, et al. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial.BMJ 2016;355:i5441
  12. ^ Keller T, et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med. 2009 Aug 27;361(9):868-77.
  13. ^ Reichlin T, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med. 2009 Aug 27; 361 (9): 858-67.
  14. ^ http://rockymuku.sakura.ne.jp/zyunnkannkinaika/toroponinnTtoroponinnI.pdf
  15. ^ http://www.wakunaga.co.jp/reagent/products/rabbi.html
  16. ^ http://www.sekisuimedical.jp/news/release/150427.html
  17. ^ a b There is an acute myocardial infarction that does not cause myocardial infarction! ? Nikkei Medical Online Article: May 2014, 5 Viewing: May 1, 2014
  18. ^ Moscucci M, Eagle KA. "Reducing the door-to-balloon time for myocardial infarction with ST-segment elevation." NEJM. 2006 Nov 30; 355 (22): 2364-5. Epub 2006 Nov 13. PMID 17101618
  19. ^ Case Study of 4 cases of emergency surgery for mitral regurgitation due to papillary muscle rupture associated with acute myocardial infarction Heart Vol.30 (1998) No.2 p.91-96

References

  • Edit:Komuro Issei, Editorial cooperation: Masatoshi Kawana, Masahisa Hagiwara, Fumitaka Nakamura, Katsuya Yoshida, "Lecture Record Cardiology" Medical View, 2006, 1st edition, 2nd edition.ISBN 4-7583-0056-9.

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