无T波高尖的De Winter综合征三例诊治分析  

Diagnosis and Treatment of De Winter Syndrome without Tall T-wave:Three Cases Analysis

作　　者：刘东升 刘娜 张书研 李彬 LIU Dongsheng;LIU Na;ZHANG Shuyan;LI Bin(Department of Cardiology,Cangzhou People's Hospital,Cangzhou 061001,China)

机构地区：[1]河北省沧州市人民医院心内科,061001

出　　处：《实用心脑肺血管病杂志》2021年第1期114-118,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景De Winter综合征患者冠状动脉造影检查显示罪犯血管为前降支,与传统的急性心肌梗死不同,心电图表现以胸前导联ST段压低及T波高尖为主要特点。目的探讨无T波高尖的De Winter综合征患者的临床表现、心电图特点、诊断方法及治疗策略。方法分析2019-04-07至2019-09-29沧州市人民医院心内科收治的3例无T波高尖的De Winter综合征患者的一般资料、发病时间、心电图特点、动态演变规律、罪犯血管特点、治疗方法等。结果患者均为男性,急性起病,临床表现为突发胸痛,发病时间为1~4 h,初始心电图除无T波高尖外,余均符合De Winter综合征特点,术后心电图均有动态演变,罪犯血管均为左前降支近段,病变性质为完全闭塞或次全闭塞,患者均成功行经皮冠状动脉介入术后顺利出院。结论前降支近段急性闭塞患者除传统的ST段抬高和经典De Winter综合征心电图特点外,也可表现为T波不高尖的De Winter综合征,该类患者临床表现符合急性冠脉综合征特点,心电图表现更隐匿,易被漏诊;诊断方法及治疗策略与急性ST段抬高型心肌梗死及经典De Winter综合征相同。Background Coronary angiography in patients with De Winter syndrome showed that the culprit vessel was the anterior descending artery.Unlike traditional acute myocardial infarction,the electrocardiogram(ECG)was mainly characterized by ST-segment depression and tall T wave in the front of the chest.Objective To investigate the clinical manifestations,ECG characteristics,diagnostic methods and treatment strategies of De Winter syndrome without tall T-wave.Methods The general data,onset time,ECG characteristics,law of dynamic evolution,culprit vessel characteristics and treatment methods of 3 patients with De Winter syndrome without tall T-wave admitted to the Department of Cardiology,Cangzhou People's Hospital from April 7,2019 to September 29,2019 were analyzed.Results All cases were male,with acute onset.The clinical manifestations were sudden chest pain,lasting from 1 h to 4 h.Except for the absence of tall T-wave,the initial ECG were consistent with the characteristics of De Winter syndrome.There were dynamic changes in ECG after operation.The culprit vessels were proximal of LAD,and the nature of the lesion were total occlusion or subtotal occlusion.All patients were discharged successfully after PCI.Conclusion In addition to the traditional ST segment elevation and classic De Winter syndrome ECG characteristics,patients with acute proximal occlusion of the anterior descending artery can also present as De Winter syndrome without tall T-wave,and the clinical manifestations of these patients are consistent with the characteristics of acute coronary syndrome,the ECG is more insidious,which is easy to be missed diagnosis.The diagnostic methods and treatment strategies are the same as those of acute ST-segment elevation myocardial infarction and classic De Winter syndrome.

关 键 词：De Winter综合征 急性心肌梗死 心电描记术 前降支 T波高尖 

分 类 号：R541.4[医药卫生—心血管疾病]