亚急性左心室游离壁破裂的一种意外心电图征象：早期识别可能挽救生命。
An unexpected electrocardiogram sign of subacute left ventricular free wall rupture: Its early awareness may be lifesaving.
作者信息
Wu Hong-Yi, Qian Ju-Ying, Wang Qi-Bing, Ge Jun-Bo
机构信息
Shanghai Institute of Cardiovascular Diseases; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
出版信息
World J Emerg Med. 2020;11(2):117-119. doi: 10.5847/wjem.j.1920-8642.2020.02.009.
BACKGROUND
Post-infarct left ventricular free wall rupture (LVFWR) is not always an immediately catastrophic complication. The rupture can be subacute, allowing time for diagnosis and intervention. Accordingly, early recognition of the entity may be lifesaving.
METHODS
We present an electrocardiogram (ECG) change pattern in two cases, which was erroneously attributed to ischemia. Two women in their 80s were admitted to our institute after experiencing the sudden onset of chest pain. They were managed as anterior ST-segment elevation myocardial infarction without reperfusion treatment. Unfortunately, they experienced a recurrence of severe chest pain with cardiogenic shock during hospitalisation. The ECG recorded at that time showed a ST-segment re-elevation in infract-related leads.
RESULTS
The two cases were regrettably received a misjudgement of reinfarction at first, and one of the patients even was administrated with tirofiban. Afterwards the diagnosis of subacute LVFWR was made through antemortem echocardiography.
CONCLUSION
New ST-segment elevation (STE) in infarct-associated leads, coupled with recurrence of chest pain and new-onset hypotension, may constitute the premonitory signs of a subacute LVFWR.
背景
心肌梗死后左心室游离壁破裂（LVFWR）并非总是立即导致灾难性并发症。破裂可能是亚急性的，从而有时间进行诊断和干预。因此，早期识别该病症可能挽救生命。
方法
我们展示了两例心电图（ECG）变化模式，最初被错误地归因于缺血。两名80多岁的女性在突发胸痛后入住我院。她们被诊断为前壁ST段抬高型心肌梗死，但未接受再灌注治疗。不幸的是，她们在住院期间出现了伴有心源性休克的严重胸痛复发。当时记录的心电图显示梗死相关导联ST段再次抬高。
结果
遗憾的是，这两例最初都被误诊为再梗死，其中一名患者甚至接受了替罗非班治疗。之后通过生前超声心动图诊断为亚急性LVFWR。
结论
梗死相关导联新出现的ST段抬高（STE），伴有胸痛复发和新发低血压，可能构成亚急性LVFWR的先兆症状。
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