Hrycek Eugeniusz, Bońkowski Michał, Nowakowski Przemysław, Żurakowski Aleksander, Buszman Paweł
Polsko-Amerykańskie Kliniki Serca PAKS- Małopolskie Centrum Sercowo-Naczyniowe, ul.Topolowa 16, 32-500 Chrzanów; e-mail:
Polsko-Amerykańskie Kliniki Serca PAKS- Małopolskie Centrum Sercowo-Naczyniowe.
Wiad Lek. 2016;69(2 Pt 2):276-9.
The patient, a fifty nine year old male, was admitted to the ward with symptoms of inferior wall myocardial infarction with ST segment elevation combined with intermittent right side sight loss. Despite typical resting stenocardial chest pain, ST segment elevation in ECG, transient symptoms of acute heart failure and slightly elevated myocardial necrosis biomarkers, coronarography did not reveal obvious source of myocardial ischemia. Moreover, echocardiography did not confirm decreased ejection fraction. However further research confirmed critical stenosis of the left internal carotid artery and chronic occlusion of the right internal carotid artery. Several questions were raised during diagnostic process including: the cause of cardiac ischemia and the cause of cerebral ischemia. Clinical data analysis and available literature allowed authors to exclude cerebral ischemia as a source of ECG ischemic changes and to establish transient myocardial ischemia causing circulatory decompensation amplified by carotid arteries atherosclerosis as the source of neurological symptoms.
该患者为59岁男性，因下壁心肌梗死伴ST段抬高症状以及间歇性右侧视力丧失入院。尽管有典型的静息性心绞痛、心电图ST段抬高、急性心力衰竭的短暂症状以及心肌坏死生物标志物轻度升高，但冠状动脉造影未发现明显的心肌缺血源。此外，超声心动图未证实射血分数降低。然而，进一步检查证实左颈内动脉严重狭窄，右颈内动脉慢性闭塞。诊断过程中提出了几个问题，包括：心脏缺血的原因和脑缺血的原因。临床数据分析和现有文献使作者能够排除脑缺血作为心电图缺血性改变的来源，并确定短暂性心肌缺血导致循环失代偿，因颈动脉粥样硬化而加重，这是神经症状的来源。
