Rusoja Evan, Singh Amandeep
Acute Care Health Outcomes, Alameda Health System, Highland Hospital, Oakland, California (Dr Rusoja); and Department of Emergency Medicine, Highland Hospital, Oakland, California (Drs Rusoja and Singh).
Adv Emerg Nurs J. 2023;45(3):217-221. doi: 10.1097/TME.0000000000000471.
Acute neurologic injury and increased intracranial pressure are associated with electrocardiographic (ECG) changes that include rhythm disturbances as well as ECG mimics of myocardial ischemia, such as focal or diffuse ST-segment or T-wave abnormalities. Both the mechanism and significance of these ECG changes are not clear. The authors report a case of a patient with a complex medical history who became hypotensive after he presented with acute intracranial hemorrhage. A subsequent ECG showing ST-segment elevation in the inferior and lateral leads was concerning for acute myocardial infarction. ST-segment elevation in the setting of acute intracranial hemorrhage can lead to diagnostic confusion and/or premature narrowing of the differential diagnosis. This case report starts with an example of this exact scenario, provides a concise overview of potential mechanisms, and concludes with several possible strategies that the emergency provider can use to identify this effect in an undifferentiated patient.
急性神经损伤和颅内压升高与心电图（ECG）改变有关，这些改变包括节律紊乱以及心肌缺血的心电图模拟表现，如局灶性或弥漫性ST段或T波异常。这些心电图改变的机制和意义尚不清楚。作者报告了一例病史复杂的患者，该患者在出现急性颅内出血后出现低血压。随后的心电图显示下壁和侧壁导联ST段抬高，这让人担心急性心肌梗死。急性颅内出血情况下的ST段抬高可导致诊断混淆和/或过早缩小鉴别诊断范围。本病例报告首先举了一个确切场景的例子，简要概述了潜在机制，并以急诊医生可用于在未分化患者中识别这种效应的几种可能策略作为结尾。
