Strand Adam Orville, Aung Thein Tun, Agarwal Ajay
Department of Internal Medicine, Wright State University, Dayton, Ohio, USA.
Department of Internal Medicine, Division of Cardiology, Wright State University, Dayton, Ohio, USA.
BMJ Case Rep. 2015 Oct 13;2015:bcr2015211214. doi: 10.1136/bcr-2015-211214.
ST-segment elevation myocardial infarction is an important, life-threatening diagnosis that requires quick diagnosis and management. We describe the case of an 83-year-old man with coronary artery disease, ischaemic cardiomyopathy with left ventricular ejection fraction of 15%, newly diagnosed multiple myeloma that had an initial ECG showing ST-segment elevation in anterior leads V1-3 and ST-segment depression in lateral leads concerning for an ST-segment elevation myocardial infarction. Troponins were negative and his calcium was 3.55 mmol/L. It was thought that the ECG changes were not indicative of cardiac ischaemia but, rather, hypercalcaemia. He was treated with fluids, diuretics and zolendronic acid, with subsequent resolution of ST-segment changes. This case demonstrates that one must consider disease other than myocardial ischaemia as the culprit of ST-segment changes if physical examination and history do not point towards myocardial injury, as unnecessary invasive revascularisation procedures have inherent risks.
ST段抬高型心肌梗死是一种重要的、危及生命的诊断，需要快速诊断和处理。我们描述了一名83岁男性的病例，该患者患有冠状动脉疾病、缺血性心肌病，左心室射血分数为15%，新诊断为多发性骨髓瘤，其初始心电图显示前壁导联V1 - 3 ST段抬高，侧壁导联ST段压低，考虑为ST段抬高型心肌梗死。肌钙蛋白为阴性，其血钙为3.55 mmol/L。认为心电图改变并非提示心肌缺血，而是高钙血症所致。给予其补液、利尿剂和唑来膦酸治疗后，ST段改变随后消失。该病例表明，如果体格检查和病史未指向心肌损伤，那么必须考虑除心肌缺血以外的其他疾病作为ST段改变的原因，因为不必要的有创血管重建手术存在固有风险。
