除颤器导线穿孔导致令人担忧的心电图表现：病例报告
Defibrillator Lead Perforation Leading to Concerning Electrocardiogram Findings: Case Report.
作者信息
Rosenberg Bryan, Hockstein Max, Hadadi Cyrus
机构信息
Medstar Washington Hospital Center; Department of Emergency Medicine; Washington, District of Columbia.
Medstar Washington Hospital Center; Department of Cardiology; Washington, District of Columbia.
出版信息
Clin Pract Cases Emerg Med. 2024 May;8(2):107-110. doi: 10.5811/cpcem.1466.
INTRODUCTION
Implantable cardioverter-defibrillator (ICD) lead perforation through the myocardium may result in chest pain and electrocardiogram (ECG) changes concerning for ST-segment elevation myocardial infarction. The clinical context of the ECG aids in appropriate management.
CASE REPORT
We report the case of a 71-year-old woman experiencing chest pain after an ICD placement two weeks earlier. On presentation, she exhibited ST-segment elevation on her ECG. Computed tomography confirmed ICD lead migration. The patient's hemodynamics were normal, and she was discharged home after a five-day hospital stay following a lead revision.
CONCLUSION
Although rare, ICD lead perforation is a potential cause of chest pain and ischemic ECG changes. Emergency physicians should consider lead perforation as a potential differential diagnosis when evaluating chest pain in patients with ICDs, taking into account the potential complications of coronary angiography.
引言
植入式心脏复律除颤器（ICD）导线穿破心肌可导致胸痛以及提示ST段抬高型心肌梗死的心电图变化。心电图的临床背景有助于进行恰当的处理。
病例报告
我们报告一例71岁女性病例，该患者在两周前植入ICD后出现胸痛。就诊时，她的心电图显示ST段抬高。计算机断层扫描证实ICD导线移位。患者血流动力学正常，在导线修复术后住院五天后出院回家。
结论
尽管罕见，但ICD导线穿孔是胸痛和缺血性心电图改变的一个潜在原因。在评估植入ICD患者的胸痛时，急诊医生应考虑导线穿孔作为一种潜在的鉴别诊断，同时要考虑到冠状动脉造影的潜在并发症。
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