Kürkciyan I, Schirmaier E, Frossard M, Schreiber W, Längle F, Huemer G, Sterz F
Abteilung für Notfallmedizin, Allgemeines Krankenhaus, Wien.
Wien Klin Wochenschr. 1994;106(20):660-3.
Clinical differentiation between acute myocardial infarction and peptic ulcer perforation may sometimes be difficult. We report on a sixty-five year-old patient who presented at the Emergency Department with upper abdominal pain and local tenderness suggestive of acute perforation of a gastric ulcer. However, the initial electrocardiogram (ECG) showed acute inferior wall myocardial infarction. Although abdominal pain is a major symptom of acute inferior wall myocardial infarction the history of gastritis and abdominal findings on admission of our patient required further exploration. The first plain abdominal radiograph was inconspicuous, therefore we performed a gastroscopy, which showed a prepyloric gastric ulcer. The second plain abdominal radiograph revealed air in the peritoneal cavity as sign of perforation. Echocardiography, ECG and the increase of heart enzymes confirmed acute inferior wall infarction. After successful surgical treatment of the perforated ulcer the patient recovered and progressed satisfactorily at the intensive care unit. He was discharged after three weeks and remains in good health. This case shows that rapid diagnosis and good interdisciplinary therapeutic management prevented a fatal outcome of acute myocardial infarction and concomitant gastric ulcer perforation in an elderly patient.
急性心肌梗死与消化性溃疡穿孔之间的临床鉴别有时可能会很困难。我们报告了一名65岁的患者，该患者因上腹部疼痛和局部压痛到急诊科就诊，提示胃溃疡急性穿孔。然而，最初的心电图（ECG）显示急性下壁心肌梗死。虽然腹痛是急性下壁心肌梗死的主要症状，但我们患者的胃炎病史和入院时的腹部检查结果需要进一步探究。第一张腹部平片未见明显异常，因此我们进行了胃镜检查，结果显示为幽门前胃溃疡。第二张腹部平片显示腹腔内有气体，提示穿孔。超声心动图、心电图以及心肌酶升高证实了急性下壁梗死。在成功进行穿孔性溃疡的手术治疗后，患者康复，在重症监护病房情况进展良好。三周后他出院，目前健康状况良好。该病例表明，快速诊断和良好的多学科治疗管理避免了一名老年患者急性心肌梗死合并胃溃疡穿孔的致命后果。
