Wong A K, Marais H J, Jutzy K, Capestany G A, Marais G E
Department of Medicine, Loma Linda University School of Medicine, CA.
Chest. 1991 Jul;100(1):255-6. doi: 10.1378/chest.100.1.255.
Atrial infarction is found in approximately 17 percent of autopsy-proven cases of myocardial infarction, but is a frequently missed clinical diagnosis. The antemortem diagnosis of atrial infarction occurring in the absence of ventricular infarction has not been previously reported. We present a patient with ischemic chest discomfort associated with paroxysmal atrial fibrillation. Electrocardiographic and enzymatic changes were consistent with atrial infarction. Cardiac catheterization demonstrated single vessel critical stenosis at the origin of the sinus node artery. Combined atrial and ventricular infarction occurs frequently and should be considered in the setting of paroxysmal supraventricular arrhythmias occurring early in the course of ventricular myocardial infarction. Lone atrial infarction is a rare but distinct clinical entity. The tetrad of typical ischemic chest discomfort, paroxysmal supraventricular arrhythmia, P-Ta segment shifts, and elevated cardiac enzyme levels without evidence for ventricular infarction strongly suggests isolated atrial infarction.
在经尸检证实的心肌梗死病例中，约17%存在心房梗死，但这是一种临床常被漏诊的疾病。此前尚无关于在无心室梗死情况下发生的心房梗死的生前诊断报告。我们报告一例伴有阵发性心房颤动的缺血性胸部不适患者。心电图和酶学改变符合心房梗死。心导管检查显示窦房结动脉起始处单支血管严重狭窄。心房和心室联合梗死常见，在心室心肌梗死早期出现阵发性室上性心律失常时应予以考虑。孤立性心房梗死是一种罕见但独特的临床实体。典型的缺血性胸部不适、阵发性室上性心律失常、P-Ta段移位以及心肌酶水平升高且无心室梗死证据的四联征强烈提示孤立性心房梗死。
