Koci Florian, Eltibi Rami, Hadley Michelle, Kumar Deepti
Tex Heart Inst J. 2014 Dec 1;41(6):638-40. doi: 10.14503/THIJ-13-3500. eCollection 2014 Dec.
Although chest pain in association with ST-segment electrocardiographic deviation is often indicative of cardiac ischemia, it has also been associated with noncardiac conditions. The case of a 63-year-old woman that we report here is extraordinary because her presentation of "acute abdomen" did not appear severe enough to warrant urgent surgical intervention, whereas the chest pain and electrocardiographic changes (supported by rising troponin levels) created strong clinical suspicion of acute coronary syndrome. Was the evidence of cardiac ischemia a primary event, or was it a sequela of an acute surgical condition? Noncardiac surgical cases associated with evidence of myocardial injury can be extremely challenging from a diagnostic and management perspective. We believe that the accuracy of the clinical diagnosis is crucial to a well-considered approach.
尽管与心电图ST段偏移相关的胸痛通常提示心肌缺血，但它也与非心脏疾病有关。我们在此报告的一名63岁女性病例非同寻常，因为她表现出的“急腹症”看似并不严重到需要紧急手术干预，然而胸痛和心电图变化（肌钙蛋白水平升高佐证）引发了对急性冠状动脉综合征的强烈临床怀疑。心肌缺血的证据是原发性事件，还是急性外科疾病的后遗症？从诊断和管理角度来看，伴有心肌损伤证据的非心脏外科病例极具挑战性。我们认为临床诊断的准确性对于深思熟虑的治疗方法至关重要。
