Merlin G, Lepoitevin L, Bukowski J G, Houet J F, Delhumeau A
Département d'Anesthésie-Réanimation, CHR 17X, Angers.
Ann Fr Anesth Reanim. 1990;9(1):75-8. doi: 10.1016/s0750-7658(05)80038-3.
A case is reported of a 47 year-old man who suffered from a right ventricular myocardial infarct which occurred as a result of right coronary arterial dissection after non-penetrating anteroposterior chest compression. The patient was admitted with right heart failure and a central venous pressure of 17 cm H2O. The ST segment in leads V1 to V3 (V2: 7mm) was significantly elevated. Echocardiography showed dilatation of both right atrium and ventricle, with a deviated septum. Emergency cardiac angiography confirmed a hypokinetic right ventricle, with no other abnormal finding. Coronary angiography, performed 24 h after admission, revealed a dissection of the second part of the right coronary artery, with a normal left coronary system which reperfused that part of the right coronary arterial territory located beyond the dissection. The ST segment elevation stopped at the 10th hour. Initially, the patient's condition worsened. Thereafter, he slowly improved under treatment (5.5 micrograms.kg-1.min-1 dobutamine, and fluids so as to maintain a pulmonary wedged pressure of about 15 mmHg). As post-traumatic myocardial infarction is rare, the diagnostic and therapeutic strategies are discussed.
报告了一例47岁男性患者，其在非穿透性前后胸部按压后因右冠状动脉夹层导致右心室心肌梗死。患者因右心衰竭入院，中心静脉压为17 cm H2O。V1至V3导联（V2：7mm）的ST段显著抬高。超声心动图显示右心房和右心室均扩张，室间隔偏移。急诊心脏血管造影证实右心室运动减弱，无其他异常发现。入院24小时后进行的冠状动脉造影显示右冠状动脉第二部分夹层，左冠状动脉系统正常，该系统使位于夹层远端的右冠状动脉区域再灌注。ST段抬高在第10小时停止。最初，患者病情恶化。此后，他在治疗下（5.5微克·千克-1·分钟-1多巴酚丁胺，并补液以维持肺楔压约15 mmHg）缓慢好转。由于创伤后心肌梗死罕见，对诊断和治疗策略进行了讨论。
