Myint Thu Thaw, Hegazy Ahmed, Dancy Luke
Cardiology, Medway Maritime Hospital, Gillingham, GBR.
Acute Medicine, Medway Maritime Hospital, Gillingham, GBR.
Cureus. 2025 Jun 15;17(6):e86103. doi: 10.7759/cureus.86103. eCollection 2025 Jun.
A gentleman in his 80s presented to the hospital with several hours of ongoing, dull-aching chest pain radiating to his left arm. The initial electrocardiogram (ECG) showed atrial fibrillation (AF), bifascicular block (right bundle branch block (RBBB) and left anterior fascicular block), and concordant 0.5 mm ST-segment elevation in leads V1-V3. The repeated ECGs at one-hour and three-hour intervals showed similar findings. The initial high-sensitivity troponin (HS-troponin) level was 2672.7 ng/L. He was triaged as non-ST-segment elevation acute coronary syndrome (NSTE-ACS). However, his ECGs repeated on the next day showed AF, bifascicular block, and ST-segment elevation in leads V2-V4, I, and augmented vector left (aVL) alongside a significant troponin surge to 25,951 ng/L. The emergency coronary angiogram uncovered severe coronary artery disease that warranted percutaneous coronary intervention (PCI).
一位80多岁的男性因持续数小时的胸部隐痛并向左臂放射而入院。初始心电图（ECG）显示心房颤动（AF）、双分支阻滞（右束支传导阻滞（RBBB）和左前分支阻滞），以及V1-V3导联ST段抬高0.5mm且方向一致。每隔一小时和三小时重复进行的心电图显示类似结果。初始高敏肌钙蛋白（HS-肌钙蛋白）水平为2672.7ng/L。他被分诊为非ST段抬高型急性冠状动脉综合征（NSTE-ACS）。然而第二天重复进行的心电图显示AF、双分支阻滞，V2-V4导联、I导联和左上肢加压单极肢体导联（aVL）ST段抬高，同时肌钙蛋白显著升高至25951ng/L。急诊冠状动脉造影显示严重冠状动脉疾病，需要进行经皮冠状动脉介入治疗（PCI）。
