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酷似前间隔急性心肌梗死的肺栓塞

Pulmonary embolism mimicking anteroseptal acute myocardial infarction.

作者信息

Wilson Gregory T, Schaller Frederick A

机构信息

Department of Internal Medicine at the Plaza Medical Center, FortWorth, TX, USA.

出版信息

J Am Osteopath Assoc. 2008 Jul;108(7):344-9.

Abstract

Pulmonary embolism (PE) is a potentially lethal condition that presents in patients with chest pain or shortness of breath. Although electrocardiograms (ECGs) typically demonstrate abnormalities associated with PE, ST-segment elevation, which can indicate anteroseptal acute myocardial infarction (AMI), has-on rare occasions-been noted on ECGs of patients with acute PE. The current report documents the case of a 57-year-old man who presented to the emergency department with chest pain. Findings from an ECG suggested anteroseptal AMI; however, cardiac catheterization indicated that the patient did not have critical ischemic heart disease. On further examination, the patient was found to have a massive bilateral PE. The present report emphasizes that physicians must investigate PE in all patients presenting with chest pain, dyspnea, or both, even in the face of ECG changes that are suggestive of a cardiac etiology. A brief discussion of the current theories of ST-segment elevation in the setting of PE is also included.

摘要

肺栓塞(PE)是一种潜在的致命疾病,常表现为胸痛或呼吸急促的患者。尽管心电图(ECG)通常会显示与PE相关的异常,但ST段抬高,这可能提示前间壁急性心肌梗死(AMI),在急性PE患者的心电图上偶尔也会出现。本报告记录了一名57岁男性因胸痛就诊于急诊科的病例。心电图结果提示前间壁AMI;然而,心脏导管检查表明该患者没有严重的缺血性心脏病。进一步检查发现,该患者患有大面积双侧PE。本报告强调,即使面对提示心脏病因的心电图变化,医生也必须对所有出现胸痛、呼吸困难或两者兼有的患者进行PE检查。本文还简要讨论了PE情况下ST段抬高的当前理论。

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