Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, United States.
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, United States.
Am J Emerg Med. 2018 Apr;36(4):735.e5-735.e8. doi: 10.1016/j.ajem.2018.01.034. Epub 2018 Jan 11.
Acute Coronary Syndrome (ACS) is a common diagnosis in the emergency department (ED), the most severe manifestation of which is ST elevation on electrocardiogram (ECG). ST elevation reflects obstruction of flow through the coronary arteries, most commonly due to coronary atherosclerotic plaque rupture. However, alternative causes of coronary obstruction causing ST elevation are possible. Spontaneous coronary artery dissection (SCAD) is an unusual cause of ST elevation in ED patients which providers may encounter in patients without traditional atherosclerosis risk factors. Patients presenting with SCAD as a cause of ST elevation require unique management from traditional ACS. Here we report a case of a 43 year old female presenting with chest pain and unusual ECG findings including accelerated idioventricular rhythm followed by subtle ST segment elevation and resolution of abnormalities. This case illustrates subtle clinical and ECG findings suggestive of SCAD which emergency physicians should consider when evaluating patients for ACS in the absence of traditional clinical presentations. Such considerations may prompt physicians to avoid therapy for coronary plaque rupture which is not indicated in patients with SCAD.
急性冠状动脉综合征（ACS）是急诊科常见的诊断，其最严重的表现为心电图（ECG）上的 ST 段抬高。ST 段抬高反映了冠状动脉血流受阻，最常见的原因是冠状动脉粥样硬化斑块破裂。然而，导致 ST 段抬高的冠状动脉阻塞的其他原因也是可能的。自发性冠状动脉夹层（SCAD）是 ED 患者 ST 段抬高的不常见原因，提供者可能会在没有传统动脉粥样硬化危险因素的患者中遇到。由于 SCAD 导致 ST 段抬高的患者需要与传统 ACS 患者的独特管理。在这里，我们报告了一例 43 岁女性的病例，该患者表现为胸痛和不寻常的 ECG 表现，包括加速性室性自主节律，随后出现细微的 ST 段抬高和异常的恢复。该病例说明了提示 SCAD 的细微临床和 ECG 表现，在没有传统临床表现的情况下，急诊医生在评估 ACS 患者时应考虑到这一点。这种考虑可能会促使医生避免对冠状动脉斑块破裂进行治疗，因为这在 SCAD 患者中是不适用的。
