后壁心肌梗死PosteriorWal

一名仍未戒烟的60岁妇女因急性胸痛急诊就诊。Hs-TnI测定为51ng/L。心电图示窦性心律、V1至V4导联ST段压低，V2和V3导联显示正向T波和R波，提示后壁缺血。心脏后壁导联V7、V8和V9示ST段抬高。急诊冠状动脉造影示左旋支冠状动脉近端和第一钝角边缘动脉闭塞，放置药物洗脱支架予以治疗。标准12导联ECG没有ST段抬高，诊断后壁心肌梗塞是很大的挑战。如果怀疑心脏后壁缺血，诊断性的后壁导联很重要。随后患者平稳，出院时接受药物治疗进行二级预防。三个月的随访时，患者情况良好。

A60-year-oldwomanwhowasacurrentsmokerpresentedtotheemergencydepartmentwithacutechestpain.ThetroponinIlevelwas51ngperliteronahigh-sensitivityassay.Anelectrocardiogram(ECG)showedsinusrhythmwithST-segmentdepressionsinleadsV1throughV4,withapositiveterminalTwaveandalargeRwaveinleadsV2andV3,anappearancesuggestiveofposterior-wallischemia.AnECGperformedwiththeuseofposteriorleadsrevealedST-segmentelevationinleadsV7,V8,andV9.Emergencycoronaryangiographywasperformed.Occlusionoftheproximalleftcircumflexcoronaryarteryandthefirstobtusemarginalarterywasvisualizedandtreatedwiththeplacementofadrug-elutingstent.Posterior-wallmyocardialinfarctioncanbechallengingtodiagnosebecauseoftheabsenceofST-segmentelevationonastandard12-leadECG.Posterior-leadplacementisanimportantdiagnostictoolifischemiaissuspectedintheposteriorwall.Thepatientssubsequentclinicalcoursewasuneventful,andshewasdischargedwhilereceivingmedicaltherapyforsecondaryprevention.Atthe3-monthfollow-up,thepatientremainedwell.

听写：邵杰

审核：贾晓孜

参考文献

AndreBriosaeGalaandJohnRawlins.NEnglJMed;:e32

每天推送的资料选自新英格兰杂志NEJM、JAMA、Lancet、《哈里森内科学》、世界卫生组织WHO、美国CDC、NIH旗下的MedlinePlus、MayoClinic等，建议大家利用这些音频及文字资料，将医学单词、词组、句子和段落一起学习，“听说读写译”一样也不能少的。

多学+勤用是高效学习英语的法宝!

预览时标签不可点收录于话题#个上一篇下一篇

转载请注明：http://www.shhongrui.net/xjgyf/8352.html