Agnese Marco Antônio Vinciprova Dall, Copetti Alana Sangalli, de Ferreira Filho Sérgio Ferreira, de Ferreira Pedro Rotta, Leiria Tiago Luiz Luz
Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC-FUC), Brazil.
Universidade Luterana do Brazil (ULBRA), Brazil.
J Electrocardiol. 2024 Nov-Dec;87:153807. doi: 10.1016/j.jelectrocard.2024.153807. Epub 2024 Sep 15.
Acute Coronary Syndrome (ACS) is characterized by the suspicion or confirmation of acute ischemia or acute myocardial infarction (MI). The presence of ST segment elevation (STE) consists in the main criterion for indication of immediate reperfusion therapy due to acute coronary occlusion, although significant part of the acute coronary occlusion cases do not fit the ST-segment elevation myocardial infarction (STEMI) criteria. A case report of a 50 year-old male presenting typical anginal pain, whose electrocardiogram (EKG) presented Aslanger's pattern. The patient had severe lesion of the left anterior descending artery (ADA) and chronic occlusion of the right coronary artery on cardiac catheterization, with important collateral flow from branches of the left coronary artery to the right coronary artery. The dichotomy between STEMI and Non-ST segment elevation myocardial infarction (NSTEMI) must be contested, owing to the evidence that one third of the NSTEMI patients presents a total coronary occlusion. There are other electrocardiographic patterns which must be considered to diagnose ACS. Our case report outlines a different clinical presentation of Aslanger pattern, that shows a ADA acute occlusion, instead of the lesion being in the right coronary system. There is evidence that, in addition to the STEMI vs NSTEMI criteria, the Aslanger pattern and other electrocardiographic patterns characterize occlusive ACS. Recognizing those patterns in clinical practice is essential to improve the diagnosis and early treatment of patients with ACS.
急性冠状动脉综合征（ACS）的特征是怀疑或确诊为急性缺血或急性心肌梗死（MI）。ST段抬高（STE）的存在是因急性冠状动脉闭塞而立即进行再灌注治疗的主要指征标准，尽管相当一部分急性冠状动脉闭塞病例不符合ST段抬高型心肌梗死（STEMI）标准。本文报告了一名50岁男性出现典型心绞痛症状的病例，其心电图（EKG）呈现阿斯朗格氏图形。该患者心脏导管检查显示左前降支动脉（ADA）有严重病变，右冠状动脉慢性闭塞，左冠状动脉分支向右冠状动脉有重要的侧支血流。由于有证据表明三分之一的非ST段抬高型心肌梗死（NSTEMI）患者存在冠状动脉完全闭塞，因此STEMI和NSTEMI之间的二分法必须受到质疑。诊断ACS时还必须考虑其他心电图图形。我们的病例报告概述了阿斯朗格氏图形的一种不同临床表现，即显示ADA急性闭塞，而非病变位于右冠状动脉系统。有证据表明，除了STEMI与NSTEMI标准外，阿斯朗格氏图形和其他心电图图形也是闭塞性ACS的特征。在临床实践中识别这些图形对于改善ACS患者的诊断和早期治疗至关重要。
