Mangialavori G, Bartoletti A, Mazzoni V, Poggi P, Calamai G, Vaccari M, Bini A
Unità Operativa di Cardiologia, USL 18, Ospedale S. Giuseppe, Empoli.
G Ital Cardiol. 1992 Jul;22(7):863-7.
A case of an undetected myocardial infarction in a patient with diabetes mellitus in which the first clinical sign was a syncope due to rupture of the left ventricular inferior wall is described. Survival was enhanced by a fast diagnosis (aided by the availability of an ECO 2D in the emergency room), by emergency pericardiocentesis with temporary haemodynamic stabilization and by prompt access to the Cardiosurgical Unit. A prompt diagnosis and treatment can allow the survival of patients, even in the extreme case that the ventricular wall rupture represents the first clinical manifestation of the myocardial infarction. The left ventricular free wall rupture in the course of myocardial infarction has a subacute pattern in about 30%, due to various mechanisms such as thrombosis or pericardial adherence over the ruptured wall.
本文描述了一例糖尿病患者未被检测出的心肌梗死病例，其首个临床症状是因左心室下壁破裂导致的晕厥。快速诊断（得益于急诊室有二维超声心动图）、紧急心包穿刺以实现临时血流动力学稳定以及迅速转诊至心脏外科，提高了患者的生存率。即使在心室壁破裂是心肌梗死的首个临床表现这种极端情况下，及时的诊断和治疗也能使患者存活。在心肌梗死过程中，约30%的左心室游离壁破裂呈亚急性模式，这是由多种机制引起的，如血栓形成或破裂壁上的心包粘连。
