急性心肌梗死患者心电图正常12例分析  

Analysis of 12 cases in acute myocardidl infarction patients with normal electrocardiogram

作　　者：刘雅丽 尚万松 王勇 杨芬 郭新胜 LIU Ya-li;SHANG Wan-song;WANG Yong;YANG Fen;GUO Xin-sheng(Department cardiology,Lankao the First Hospital,Lankao,Henan 475300,China)

机构地区：[1]兰考第一医院心内科,河南兰考475300

出　　处：《医药论坛杂志》2023年第1期71-73,共3页Journal of Medical Forum

摘　　要：目的 对心电图正常的急性持续性胸痛患者要高度重视。随时观察患者心电图和心肌酶学的动态变化,尽快排除危及患者生命的疾病,包括主动脉夹层,肺栓塞和自发性气胸等疾病。及时做冠脉造影和相关检查,以便及时抢救治疗。方法 回顾兰考第一医院2021年3月至2022年10月间12例以急性持续性胸痛就诊的病例,其心电图正常,没有动态演变,心肌酶有动态变化。结果 急诊时冠脉造影结果显示,11例LCX完全闭塞,TIMI 0级,1例LAD次全闭塞,TIMI 1级;11例患者开通后进行了支架植入,4例患者为单支病变,7例为多支病变,住院5~7天后病情稳定出院,1例拒绝进一步治疗,要求转上级医院。12例患者出院前做心脏超声检查,除1例LAD病变EF值40%降低外,其余11例EF值均正常。结论 对急性持续性胸痛的高危患者,即使心电图正常,也要尽快进行冠脉造影检查,及时开通罪犯血管,挽救濒死心肌。Objective The purpose of the esaay is to raise awareness of clinical medical workers to pay close attention to the acute persistent chest pain patients with normal electrocardiogram. The dynamic changes of the patient’s electrocardiogram and myocardial enzymes should be observed at any time. The life-threatening diseases, including aortic dissection, pulmonary embolism, and spontaneous pneumothorax, should be excluded as soon as possible. Do coronary angiography and related examinations in time for timely rescue and treatment. Methods Twelve cases with acute persistent chest pain from March 2021 to October 2022 were retrospectively reviewed. Their electrocardiograms were normal without dynamic evolution, and there were dynamic changes in myocardial enzymes. Results The results of coronary angiography at the time of emergency showed that 11 patients had LCX total occlusion, TIMI grade 0, and 1 case had LAD subtotal occlusion, TIMI grade 1;11 patients underwent stent implantation after opening, 4 patients had single-vessel disease, and 7 patients had multivessel disease. They were discharged in stable condition after being hospitalized for 5-7 days. One patient refused further treatment and was required to be transferred to a higher-level hospital. 12 patients underwent cardiac ultrasonography before discharge. Except for 1 patient with a 40% decrease in the EF value of LAD lesions, the remaining 11 patients had normal EF values. Conclusion For high-risk patients with acute persistent chest pain, even if the electrocardiogram is normal, coronary angiography should be performed as soon as possible, and the culprit blood vessels should be opened in time to save the dying myocardium.

关 键 词：急性持续性胸痛 正常心电图 冠脉造影 心肌酶升高 左回旋支 

分 类 号：R541.4[医药卫生—心血管疾病]