AAI临时起搏控制急性心肌梗死后电风暴1例

<正>1病例资料患者,女,78岁,因胸痛2 d于2013-06-0601:17时急诊入院。曾在当地县人民医院因心电图和心肌肌酶谱改变确诊为"急性前壁ST段抬高型心肌梗死",但未行再灌注治疗。患者高血压史10年,服用氯沙坦50 mg,1次/d,自诉血压控制在150/90mmHg(1mmHg=0.133kPa)。3个月前体检血肌酐180μmol/L,诉"胃溃疡"史,否认糖尿病、浮肿、乏力、贫血史,无慢性咳嗽史。无吸烟、长期饮酒史。入院体检:体温36.5℃,心率89次/min,呼吸18次/min,血压144/71mmHg,体重38     

扩张型心肌病患者反复心室扑动心室颤动成功救治1例

1.临床资料患者女性,37岁,主因劳累性胸闷、心悸、气短50 d,加重1周,于2009年2月20日以扩张型心肌病(DCM),心功能Ⅳ级,肺部感染诊断入院。给予卧床休息、吸氧、稳定生命体征及强心、营养心肌、扩血管、抗感染等治疗,5 d后心衰症状缓解。2月25日09∶50,患者情绪激动后突然意识丧失,四肢抽搐,颈动脉搏动消失,心电监护示心室扑动。立即     

超速起搏救治急性心肌梗死合并电风暴1例

<正>患者：男性,73岁,2013年7月因突发上腹痛伴胸闷3 h就诊于我院急诊科。既往有高血压病史10余年,血压控制可,无家族遗传病史。急诊测血压90/55 mm Hg (1 mm Hg=0.133 k Pa),氧饱和度95%。候诊中突然出现意识丧失,伴四肢抽搐,无口吐白沫、角弓反张、大小便失禁等。立即予胸外心脏按压、气管插管、呼吸机辅助呼吸、建立静脉通道,迅速转运至监护室,床边心电监护提示室性心动过速（室速）,     

急性心肌梗死合并心动过速风暴8例抢救体会

2006年室性心动过速（室速）治疗的指南中,将心室电风暴或称交感风暴定义为24h内患者自发1〉2次的心室颤动（室颤）或快速室速需要电复律紧急处理的症候群。冠心病急性心肌梗死导致拘心室电风暴是心脏性猝死的重要原因。     

急性心肌梗死首诊表现癫痫发作1例

患者,男,35岁.因间断发作呼之不应、上肢抽搐1 h入院.患者在休息状态下突觉心慌、头晕,继而发作头后仰,双目向上凝视、口吐白沫,双上肢屈曲抽搐,呼之不应.即测脉搏约100次/min,约5 s后自行缓解.诉乏力、胸闷,此后15 min及40 min各发作1次,持续时间分别是12 s、15 s.     

冠心病急性心肌梗死并室速风暴1例分析

2006年ACC／AHA／ESC“室性心律失常的诊疗和心源性猝死预防指南”给“室速风暴／电风暴／交感风暴”做出明确的定义，24h内室性心动过速（室速）和／或心室颤动（室颤）发作2次或2次以上称为室速风暴。     

急性ST段抬高型心肌梗死并心室颤动12例临床救治分析

目的总结基层医院急性ST段抬高型心肌梗死(STEMI)并心室颤动患者的救治体会。方法回顾性分析抢救12例符合溶栓条件的急性SFEMI心室颤动患者的临床资料。结果在无直接经皮冠状动脉介入治疗(PCI)条件下,12例患者均采用及时的心脏电除颤和静脉溶栓治疗,11例获得成功,1例死亡。结论急性STEMI患者在无PCI条件的基层医院应及时积极采用静脉溶栓疗法,心室颤动时应首选电击除颤,以提高抢救效果。     

急性心肌梗死后心室电风暴6例临床分析

目的通过对6例急性心肌梗死后心室电风暴（VES）抢救治疗患者的资料分析,总结早期识别和抢救VES的经验。方法6例均为急性心肌梗死后反复室速／室颤的患者,6例均多次给予同步月#同步心脏电击复律／除颤、应用胺碘酮及倍他乐克联合抗心律失常、补钾、降压、抗冠状动脉炎症等改善心肌缺血综合治疗。结果其中5例转复成功;1例不能维持窦性节律,在主动脉球囊反搏下行急诊冠状动脉支架置入治疗后心室电风暴终止发作。6例患者长期服用胺碘酮、倍他乐克维持,门诊随访,1例因心力衰竭于18个月后死亡,其余5例至今存活。结论心脏同步月E同步电复律／除颤、胺碘酮及美托洛尔联合抗心律失常治疗急性心肌梗死后心室电风暴安全有效,但要注意基础病因治疗,转复后长期服用胺碘酮、倍他乐克预防复发。     

T波电交替预测老年急性心肌梗死患者早期室颤的作用

目的 探讨基于动态心电图记录的时域法T波电交替（TWA）检测方法及其对老年急性心肌梗死（AMI）患者住院期间心室颤动的预测价值。方法 1998～1999年来自北京朝阳医院的72例老年AMI患者，依据住院期间有无心室颤动分为室颤组（12例）和非室颤组（60例）。应用时域法测量TWA指标，分析TWA预测室颤的敏感性、特异性及预测值。结果 非室颤和室颤两组之间的TWA有显著性差异（P〈0．05），TWA〉60μV预测老年AMI患者室颤的敏感性为83％、特异性81％、阳性预测值63％、阴性预测值93％。结论 时域法测量的老年AMI患者的早期TWA对住院期间室颤有预测价值。     

年轻人急性心肌梗死一例

急性心肌梗死多见于40岁以上中老年人,30岁以下急性心肌梗死很罕见,且临床中多易考虑非动脉粥样硬化病因所致的心肌梗死,本文报道一例经冠状动脉造影证实由动脉粥样硬化病变导致急性心肌梗死的28岁青年患者,并结合相关文献分析这类患者危险因素、冠状动脉造影特点及长期预后.1临床资料患者男,28岁,身高183 cm,体重98 kg,剧烈胸痛20min来诊,既往无胸痛史,否认高血压、糖尿病、高血脂、胸部外伤、吸毒史,有吸烟史10余年,每日1包,稍饮酒,父亲有心肌梗死病史,母亲有高血压、冠心病病史,外婆因心肌梗死去世,有早发的心血管病家族史.查体:血压90/5…     

Coronary artery aneurysms in a young patient with acute myocardial infarction: a case report

Coronary artery aneurysms are not uncommon. They are usually arteriosclerotic in origin, and may be congenital or secondary to injury, dissection, infection, inflammation, or Kawasaki disease (KD). Herein, we report a case involving a 25-year-old male smoker with acute myocardial infarction (AMI). Coronary angiography showed triple-vessel disease, coronary artery aneurysms, and diffuse ectasia. Coronary artery bypass grafting was performed without complications. Based on his history, serologic examinations, and angiographic findings, we suspected that his coronary artery aneurysms and ectasia were the adult sequelae of KD. This case is a good reminder that KD victims may suffer from young-onset AMI.     

Rare survival in a patient with severe complications of acute myocardial infarction: a case report

A 50-year-old man presented with acute myocardial infarction. Coronary angiography showed the left anterior descending artery (segment 6) was totally occluded. Direct percutaneous transluminal coronary angioplasty was performed, but a distal embolism occurred by the procedure. Consequently, he suffered cardiogenic shock and sustained ventricular tachycardia/fibrillation which exacerbated his condition. Finally, the patient was successfully treated with catheter ablation and cryosurgery to control the incessant ventricular arrhythmias, and partial left ventricular volume reduction and coronary artery bypass grafting to improve contractile performance. His left ventricular contractility did not improve, but the incessant ventricular arrhythmias could be controlled. His condition remarkably improved and he was discharged on foot. This patient with severe complications of acute myocardial infarction showed unusually good response and recovery.     

St-segment elevation acute myocardial infarction in a patient with acromegaly: a case report and literature review

Acromegaly is a disorder caused by the excess production of pituitary growth hormone and is characterized by the enlargement of the hands, feet and head. Increased morbidity and mortality with acromegaly is associated with cardiovascular complications, hypertension, glucose intolerance, cardiomyopathy and coronary artery disease. We report a case of acromegaly, which presented with ST-segment elevation acute myocardial infarction. The patient received successful primary transluminal coronary angioplasty with stent implantation. Acromegaly was suspected from typical appearance, and confirmed with hormonal examination and imaging of the pituitary mass. We discuss this case in comparison with previous literature.     

Single coronary artery in a patient with acute myocardial infarction and supraventricular tachycardia--a case report

A case of a 66-year-old patient with a history of paroxysmal supraventricular tachycardia, hypertension and chronic obturatory pulmonary disease is presented. The patient was admitted to the hospital due to acute myocardial infarction. Coronary angiography revealed a single coronary artery originating from the right sinus of Valsalva without any significant lesions. Literature concerning this rare coronary anomaly is discussed.     

抗磷脂综合征伴急性心肌梗死一例

患者男性,29岁,因间断腹痛2 d,胸痛1 d于2008年11月26日入院.患者入院前2 d餐后出现左侧腹部隐痛,阵发性加重,来我院急诊,腹部平片提示不完全性肠梗阻,予禁食、胃肠减压后症状减轻.人院前1 d静息时出现轻度胸部闷痛,不伴放射痛、出汗、呼吸困难等,持续1 h自行减轻,未告知医生.     

Acute myocardial infarction in a patient with iatrogenic thyrotoxicosis--a case report

We present a patient with myocardial infarction and normal coronary angiogram. The patient had no classical coronary risk factors, but had thyrotoxicosis, which was taken into consideration as a possible cause of myocardial infarction.     

Multiple coronary aneurysms and acute myocardial infarction in a female patient with rhupus: case report and literature review

Clinical Rheumatology - Coronary artery aneurysms (CAA) are an infrequent cause of coronary artery disease in both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), most occurring...     

冠状动脉前降支心肌桥致急性心肌梗死一例

<正>1病例资料患者男性,47岁。主因"间断胸痛12 d"入院。患者入院前12 d,于夜间睡眠中突发胸痛,位于心前区,手掌大小范围,无放射痛,持续不缓解。5 h后于当地医院就诊,诊断"急性前壁心肌梗死",负荷剂量阿司匹林及氯吡格雷口服,并予"尿激酶150万U"溶栓。此后,患者于日常体力活动时仍间断出现胸痛,位于心前区,手掌大小范围,无放射痛,每     

Terlipressin-related acute myocardial infarction: a case report and literature review

Acute ST-segment elevation myocardial infarction after the administration of terlipressin in patients with hemorrhagic esophageal varices is a rare but life-threatening complication. We report the case of a 73-year-old female patient with esophageal variceal bleeding complicated with acute ST-segment elevation myocardial infarction after intravenous injection of terlipressin. We discuss the underlying mechanisms of terlipressin-related acute myocardial infarction and review the literature.