Yeh I-Jeng, Liu Kuan-Ting
Department of Emergency Medicine, Kaohsiung Medical University Hospital Institute of Clinical Medicine, College of Medicine School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Medicine (Baltimore). 2017 Nov;96(47):e8819. doi: 10.1097/MD.0000000000008819.
Electrocardiography (ECG) was used to diagnose acute coronary syndrome, but many other diseases may also result in ST segment change. We report one case of ingested hydrochloric acid present with ST segment elevation in the ECG. However, subsequent coronary angiography did not reveal significant coronary occlusion.
An 83-year-old female was transferred to our emergency department (ED) from the branch hospital due to ingestion of toilet bowl cleaner containing 9.5% hydrochloric acid. She complained about chest pain and 12-lead ECG showed ST segment elevation at lead II, III, and aVF. The blood examinations revealed elevation of aspartate transaminase (69 IU/L), thrombocytopenia (62,000/μL), and acidosis (pH 7.311, pCO2 27 mm Hg, HCO3 13.3 mmol/L). Creatine kinase-MB and troponin I did not elevate then.
After transferred to our ED, coronary angiography was done within 1 hour. Angiography showed 60% stenosis in the segment 7 of left anterior descending coronary artery and 30% nonsignificant stenosis in the segment 2 of right coronary artery, with no apical ballooning. No significant lesion consistent with ST segment elevation myocardial infarction was found.
Conservative treatment was chosen.
Bradycardia was followed by cardiac arrest that developed 4 hours later. Cardiopulmonary resuscitation was applied and the patient became shock status after return of spontaneous circulation. The patient was admitted to the intensive care unit and expired on next day.
Patients of ingested hydrochloric acid present with ST segment elevation in the ECG may not indicate coronary artery disease. This ECG finding may be a poor prognostic index in such patients.
心电图（ECG）曾用于诊断急性冠状动脉综合征，但许多其他疾病也可能导致ST段改变。我们报告1例因摄入盐酸而出现心电图ST段抬高的病例。然而，随后的冠状动脉造影未显示明显的冠状动脉闭塞。
一名83岁女性因误服含9.5%盐酸的马桶清洁剂从分院转至我院急诊科。她主诉胸痛，12导联心电图显示Ⅱ、Ⅲ和aVF导联ST段抬高。血液检查显示天冬氨酸转氨酶升高（69 IU/L）、血小板减少（62,000/μL）和酸中毒（pH 7.311，pCO2 27 mmHg，HCO3 13.3 mmol/L）。当时肌酸激酶同工酶和肌钙蛋白I未升高。
转至我院急诊科后，1小时内进行了冠状动脉造影。造影显示左前降支冠状动脉第7段狭窄60%，右冠状动脉第2段有30%的非显著性狭窄，无心尖气球样变。未发现与ST段抬高型心肌梗死一致的明显病变。
选择保守治疗。
患者出现心动过缓，4小时后发生心脏骤停。进行了心肺复苏，自主循环恢复后患者进入休克状态。患者被收入重症监护病房，次日死亡。
摄入盐酸的患者心电图出现ST段抬高可能并不提示冠状动脉疾病。在这类患者中，这一心电图表现可能是预后不良的指标。
