Alsagaff Mochamad Yusuf, Wardhani Louisa Fadjri Kusuma, Pratanu Iswanto, Kartikasari Dian Paramita, Doevendans Pieter A
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr Soetomo General Hospital Surabaya, Surabaya, Indonesia.
Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherland.
Oxf Med Case Reports. 2022 Feb 19;2022(2):omac010. doi: 10.1093/omcr/omac010. eCollection 2022 Feb.
A rise and/or fall in troponin level is an indication of type 1 or 2 myocardial infarct. A 62-year-old male physician presented to emergency room with chest discomfort followed by thought to be normal electrocardiogram (ECG) and normal echocardiography results. His serial hs-troponin test showed remarkable escalation three hours from the initial (107 ng/l into 4.978 ng/l), suggesting a high-risk non-ST-segment myocardial infarction (NSTEMI). An early invasive procedure was performed, showing acute total occlusion (TO) in the obtuse marginal 1 branch. We retrospectively reviewed our examination to diagnose better the presence of TO in NSTEMI patients presented with non-diagnostic examination. Our evaluation showed a minor change in the form of an 'N-wave' pattern on the ECG, which was not yet an established guideline criterion for prompt angiography. Although ECG pattern is often normal in LCx occlusion, recent study shows the presence of 'N-wave' ECG pattern in 10% of NSTEMI cases following TO at LCx.
肌钙蛋白水平的升高和/或降低表明1型或2型心肌梗死。一名62岁的男性医生因胸部不适前往急诊室，随后心电图（ECG）和超声心动图结果被认为正常。他的系列高敏肌钙蛋白检测显示，从最初的检测结果（107纳克/升升至4978纳克/升）开始，三小时内显著升高，提示高危非ST段心肌梗死（NSTEMI）。进行了早期侵入性检查，显示钝缘支1急性完全闭塞（TO）。我们回顾性地检查了我们的检查情况，以便更好地诊断在检查未明确诊断的NSTEMI患者中TO的存在情况。我们的评估显示，心电图上出现了一种轻微变化，表现为“N波”模式，但这尚未成为提示进行血管造影的既定指南标准。尽管在左回旋支闭塞时心电图模式通常正常，但最近的研究表明，在左回旋支发生TO后的NSTEMI病例中，有10%出现“N波”心电图模式。
