Asada Satoshi, Kawasaki Tatsuya, Taniguchi Takuya, Kamitani Tadaaki, Kawasaki Shingo, Sugihara Hiroki
Int J Cardiol. 2006 May 24;109(3):411-3. doi: 10.1016/j.ijcard.2005.05.036. Epub 2005 Jun 24.
A case of ST-segment elevation provoked by distended stomach conduit is presented. An 83-year-old woman was admitted to our hospital with worsening chest discomfort. She had a previous history of subtotal esophagectomy, which was reconstructed using a stomach conduit in the posterior mediastinum. Electrocardiogram showed ST-segment elevation in the inferior leads and a prominent negative P wave in lead V1. Echocardiography demonstrated normal left ventricular function without regional wall motion abnormality; however, the left atrium and ventricle compressed by a substantially distended stomach conduit was noted. Subsequent angiocardiography revealed no coronary atherosclerotic stenosis and normal contractility of the left ventricle. Chest symptoms resolved soon after nasogastric suction, leading to resolution of electrocardiographic changes. The stomach conduit diminished on following repeated echocardiography. The patient was discharged without any evidence of myocardial infarction. Esophagus disease of the reconstructed stomach conduit should be recognized as a rare but considerable cause for electrocardiographic changes.
本文报告一例因胃代食管扩张导致ST段抬高的病例。一名83岁女性因胸部不适加重入住我院。她既往有食管次全切除术史,采用胃代食管在后纵隔进行重建。心电图显示下壁导联ST段抬高,V1导联出现明显的负向P波。超声心动图显示左心室功能正常,无节段性室壁运动异常;然而,注意到左心房和心室被明显扩张的胃代食管压迫。随后的心血管造影显示无冠状动脉粥样硬化狭窄,左心室收缩功能正常。经鼻胃管抽吸后胸部症状很快缓解,心电图改变也随之消失。在重复超声心动图检查时,胃代食管缩小。患者出院时无心肌梗死迹象。重建胃代食管的食管疾病应被视为心电图改变的罕见但重要原因。