一个常见问题的罕见表现：运动平板试验中的静息ST段压低：病例报告
A rare manifestation of a common problem: resting ST-segment depression on the exercise treadmill test: Case report.
作者信息
Tan Yan, Lai Dandan, Jing Qifeng
机构信息
Department of Cardiology, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
Department of Radiology, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
出版信息
Medicine (Baltimore). 2025 May 9;104(19):e41981. doi: 10.1097/MD.0000000000041981.
RATIONALE
Myocardial bridge (MB), where a coronary artery segment is overlaid by myocardium, is often asymptomatic but can lead to serious complications. This case highlights a rare electrocardiographic manifestation of MB: resting ST-segment depression when transitioning from a supine to a standing position.
PATIENT CONCERNS
A 39-year-old male with no significant medical history presented with intermittent, nonexertional chest pain. His resting electrocardiogram was normal in the supine position but showed ST-segment depression in leads II, III, aVF, and V5-V6 when standing.
DIAGNOSES
Coronary angiography confirmed a MB in the left anterior descending artery.
INTERVENTIONS
The patient was managed with beta-blockers, aspirin, and rosuvastatin therapy.
OUTCOMES
After 8 months of follow-up, no complications or cardiac symptoms were observed.
LESSONS
This case underscores the importance of recognizing positional ST-segment changes as a potential indicator of MB, offering valuable insights into the diagnosis and management of this condition.
理论依据
心肌桥（MB）是指冠状动脉的一段被心肌覆盖，通常无症状，但可导致严重并发症。本病例突出了心肌桥一种罕见的心电图表现：从仰卧位转为站立位时静息ST段压低。
患者情况
一名39岁男性，无重大病史，出现间歇性非劳力性胸痛。他仰卧位时静息心电图正常，但站立时II、III、aVF及V5-V6导联显示ST段压低。
诊断
冠状动脉造影证实左前降支存在心肌桥。
干预措施
患者接受β受体阻滞剂、阿司匹林和瑞舒伐他汀治疗。
结果
经过8个月的随访，未观察到并发症或心脏症状。
经验教训
本病例强调了认识到体位性ST段改变作为心肌桥潜在指标的重要性，为该疾病的诊断和管理提供了有价值的见解。
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