Wahba Alexander, Flobak Frode, Stakkevold Tor Ivar, Sellevold Olav M, Greiff Guri, Wiseth Rune
St. Elisabeth-Klinikk for hjerte- og lungekirurgi, St. Olavs Hospital, Hans Nissensgate 3, 7018 Trondheim.
Tidsskr Nor Laegeforen. 2008 Jan 3;128(1):46-8.
A 76-year-old, previously healthy man who presented with acute onset of central chest pain is described. An ECG taken in the ambulance showed ST-elevation in chest leads V1 to V4, whereupon thrombolysis was initiated before hospitalization. A new ECG taken on admission at the local hospital showed reduced ST-elevation. Shortly afterwards, auscultation followed by eccocardiography revealed a ventricular septal rupture. The patient was transferred to the regional hospital, and emergency repair of the ventricular septum was performed successfully. On the 6th postoperative day, the patient suffered septal rupture recurrence and subsequently died of multi-organ failure. Postinfarction ventricular septal rupture is a serious complication with a high mortality. Cardiac surgery is indicated in most cases. Delayed diagnosis may result in early death for a considerable number of patients. The present case underscores the importance of cardiac auscultation in patients with suspected myocardial infarction before angiography or primary coronary intervention is performed.
本文描述了一位76岁、既往健康的男性，他突发中央胸痛。在救护车上进行的心电图显示胸前导联V1至V4 ST段抬高，随后在住院前开始溶栓治疗。在当地医院入院时进行的新心电图显示ST段抬高减轻。不久之后，听诊并随后进行超声心动图检查发现室间隔破裂。患者被转至地区医院，并成功进行了室间隔紧急修复。术后第6天，患者室间隔破裂复发，随后死于多器官功能衰竭。心肌梗死后室间隔破裂是一种严重并发症，死亡率很高。大多数情况下需要进行心脏手术。延迟诊断可能导致相当数量的患者早期死亡。本病例强调了在进行血管造影或冠状动脉介入治疗之前，对疑似心肌梗死患者进行心脏听诊的重要性。
