Yu Han-Hua, Jeng Jing-Ren
Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Department of Cardiology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2017 Jan-Mar;29(1):50-54. doi: 10.4103/tcmj.tcmj_7_17.
We report a case of acute pulmonary embolism with hemodynamic instability diagnosed by a computed tomography pulmonary angiogram. The patient developed pulseless electrical activity during systemic thrombolytic therapy with recombinant tissue plasminogen activator. Successful return of spontaneous circulation was achieved after immediate cardiopulmonary resuscitation with chest compressions for 6 min. His electrocardiogram (ECG) on arrival in the emergency department displayed sinus tachycardia, an S wave in lead I, a Q wave in lead III, incomplete right bundle branch block (RBBB), T-wave inversion (TWI) in leads V1-V3, ST elevation in leads aVR and V1, and ST depression in leads I, II, III, aVF, and V4-V6. These characteristic ECG changes might have prognostic value for clinical deterioration. He recovered after treatment. After discharge, the ECG showed resolution of TWI in leads V1-V3 and incomplete RBBB, suggesting recovery from right ventricular dysfunction, which was confirmed by an echocardiogram on follow in the outpatient department.
我们报告一例经计算机断层扫描肺动脉造影诊断为急性肺栓塞伴血流动力学不稳定的病例。该患者在使用重组组织型纤溶酶原激活剂进行全身溶栓治疗期间出现无脉电活动。在立即进行胸外按压心肺复苏6分钟后成功恢复自主循环。他抵达急诊科时的心电图显示窦性心动过速、I导联S波、III导联Q波、不完全性右束支传导阻滞（RBBB）、V1-V3导联T波倒置（TWI）、aVR和V1导联ST段抬高以及I、II、III、aVF和V4-V6导联ST段压低。这些特征性心电图改变可能对临床病情恶化具有预后价值。他经治疗后康复。出院后，心电图显示V1-V3导联TWI和不完全性RBBB消失，提示右心室功能障碍已恢复，这在门诊随访时经超声心动图证实。
