无症状性ST段抬高型心肌梗死
Asymptomatic ST elevation myocardial infarction.
作者信息
Anderson Kenton L, Shah Neel A, Gallegos Moises, Chiang I-Hui
机构信息
Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Palo Alto, CA 94304, USA.
Department of Emergency Medicine, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030, USA.
出版信息
Heart Lung. 2018 Jul-Aug;47(4):363-365. doi: 10.1016/j.hrtlng.2018.04.012. Epub 2018 May 31.
BACKGROUND
A 71-year-old non-smoking female with a history of diabetes, hypertension, hyperlipidemia and end-stage renal disease presented to the emergency department for right leg pain due to an ankle fracture.
CASE
The patient's initial electrocardiogram (ECG) revealed ST segment elevations in the anterior leads. She denied any chest pain, shortness of breath, fatigue, lightheadedness, palpitations, nausea or diaphoresis. Her initial laboratory Troponin I resulted 35.9 ng/mL. Coronary catheterization demonstrated 99% occlusion of the left anterior descending (LAD) coronary artery. The patient had 2 drug eluting stents placed in the LAD with 10% residual stenosis.
CONCLUSION
Although witnessing an ongoing asymptomatic ST elevation myocardial infarction (STEMI) is rare, this case highlights the importance of early revascularization when the ECG demonstrates a STEMI, even in the absence of symptoms for patients at risk for silent myocardial infarctions.
背景
一名71岁的非吸烟女性，有糖尿病、高血压、高脂血症和终末期肾病病史，因踝关节骨折导致右腿疼痛而就诊于急诊科。
病例
患者最初的心电图（ECG）显示前壁导联ST段抬高。她否认有任何胸痛、气短、疲劳、头晕、心悸、恶心或出汗。她最初的实验室肌钙蛋白I结果为35.9 ng/mL。冠状动脉造影显示左前降支（LAD）冠状动脉闭塞99%。患者在LAD置入了2个药物洗脱支架，残余狭窄10%。
结论
虽然目睹正在发生的无症状ST段抬高型心肌梗死（STEMI）很罕见，但该病例强调了在心电图显示STEMI时早期血运重建的重要性，即使对于有沉默性心肌梗死风险的无症状患者也是如此。
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