Sohara H, Miyahara K, Kakura H, Miyanohara H, Kukihara T, Sanada J, Arima T
Division of Cardiology, Shinkyo Hospital, Kagoshima, Japan.
Jpn Heart J. 1994 Jan;35(1):81-6. doi: 10.1536/ihj.35.81.
We observed a case of acute myocardial infarction induced by second diagonal branch occlusion. Electrocardiogram (ECG) on admission showed ST elevation in leads I, aVL and V2-6. Since emergency coronary angiography disclosed complete occlusion of the second diagonal branch, intra-coronary thrombolysis (ICT) was performed, superselectively. Transient coronary reperfusion was obtained, however, reocclusion occurred after several minutes. Rescue percutaneous transluminal coronary angioplasty (PTCA) was then performed immediately and blood flow was improved to TIMI grade 2. During these processes, the ST-segment on the ECG changed in leads I, aVL and V2-6 always corresponding to the blood flow of the second diagonal branch. We have not seen a report hitherto in which occlusion of only the second diagonal branch could be a cause of extensive anterior infarction-like ECG changes. Although the mechanism of ECG changes in this patient cannot be clearly explained by conventional concepts, we report this case because it is considered to be very rare.
我们观察到一例由第二对角支闭塞诱发的急性心肌梗死病例。入院时心电图显示I、aVL及V2 - 6导联ST段抬高。由于急诊冠状动脉造影显示第二对角支完全闭塞，遂进行了超选择性冠状动脉内溶栓治疗（ICT）。获得了短暂的冠状动脉再灌注，但数分钟后又发生了再闭塞。随后立即进行了补救性经皮冠状动脉腔内血管成形术（PTCA），血流改善至TIMI 2级。在这些过程中，I、aVL及V2 - 6导联心电图上的ST段变化始终与第二对角支的血流情况相对应。迄今为止，我们尚未见到仅第二对角支闭塞可导致类似广泛前壁梗死心电图改变的报道。尽管该患者心电图变化的机制无法用传统概念清楚解释，但鉴于其极为罕见，我们报告了此病例。
