Department of Hematology/Oncology, MD Anderson Cancer Center, Houston, TX, USA.
Rev Cardiovasc Med. 2011;12(3):157-63.
A 64-year-old woman with hypertension and diabetes presented with acute shortness of breath and left-sides chest discomfort. Electrocardiopgram (ECG) demonstrated Q waves, coved ST-segment elevations, and T-wave inversions in leads V₁-V₄, suggesting acute anterior ST-elevation myocardial infarction (STEMI). catheterization revealed nonocclusive coronary artery disease with elevated pulmonary and right heart pressures, confirmed by echocardiography. Ventilation perfusion scan was deemed high probability for pulmonary embolism (PE). Treatment for a submassive PE was initiated and ECG changes resolved by discharge. This case exemplifies similarities in clinical presentation of PE and acute STEMI. The presence of Q waves in anterior leads wih coved ST-elevation after PE has not been described previously. We review the differential diagnosis of ST elevation and the assorted spectrum of ECG changes seen in PE.
一位 64 岁的女性，患有高血压和糖尿病，因急性呼吸急促和左侧胸部不适就诊。心电图（ECG）显示 V₁-V₄ 导联 Q 波、弓背型 ST 段抬高和 T 波倒置，提示急性前壁 ST 段抬高型心肌梗死（STEMI）。导管检查显示非阻塞性冠状动脉疾病，伴有肺动脉和右心压力升高，超声心动图证实。通气灌注扫描被认为是肺栓塞（PE）的高度可能。开始了亚大块 PE 的治疗，出院时心电图改变得到解决。本例说明了 PE 和急性 STEMI 的临床表现相似。PE 后前导 Q 波伴弓背型 ST 段抬高的情况以前尚未描述过。我们回顾了 ST 段抬高的鉴别诊断和 PE 中所见的各种 ECG 变化谱。
