急性非Q波心肌梗死合并多器官功能衰竭抢救成功一例

急性非Ｑ波心肌梗死合并多器官功能衰竭抢救成功一例梁岩章友华黄红袁贤奇朱俊宋有城１临床资料患者男性，７７岁，因急性前壁非Ｑ波心肌梗死、左心功能不全于１９９７年５月１日急诊入院。既往有陈旧性下后壁心肌梗死、糖尿病、高血压病史。入院后仍反复发作心绞痛。于入...     

心肌梗死亚急性期合并急性肠梗阻抢救成功一例

1　病例报告患者男 ,82岁 ,因阵发性胸闷、胸痛 3ｄ于 2 0 0 1年 1月 2日入院。患有陈旧性下壁、前壁心肌梗死病史 2 0余年。 9日患者出现剧烈胸骨后及心前区疼痛 ,心电图示 :急性高侧壁心肌梗死。 1月 11日心肌酶示 :肌酸磷酸激酶 472Ｕ Ｌ ,肌酸磷酸激酶同功酶 80Ｕ Ｌ ,乳酸脱氢酸 485Ｕ Ｌ。给予硝酸甘油、肝素、罂粟碱、杜冷丁等药物救治 ,2 0ｄ后患者突然出现左下腹痛伴有恶心、呕吐 ,查左腹部压痛及反跳痛 ,可触及一条索状包块 ,质硬。结肠镜检查 :进入结肠约 5 0ｃｍ见有粪块阻塞 ,诊断为“急性肠梗阻” ,在局麻下于床边行盲肠造瘘…     

高龄患者急性心肌梗死合并肺动脉栓塞抢救成功一例

1临床资料 患者男性,83岁,主因冠心病、急性前璧心肌梗死于2004年9月7日入院,既往患有陈旧性心肌梗死、阻塞性肺气肿、糖尿病、脑梗死后遗症等病史.患者入院时一般情况差,神志尚清楚,语言、智力障碍,呼吸18次/min,血压130/70mmHg(1 mm Hg=0.133 kPa),双肺呼吸音清晰,未闻及明显干湿哕音.心率96～108次/min,双足背动脉搏动弱.给予低流量吸氧,扩冠、抗凝及对症治疗,病情相对稳定.     

老年急性下壁心肌梗死合并右心室梗死抢救成功一例

<正> 1 临床资料患者男性,78岁,主因突发胸闷、憋喘3 h于2008年4月11日急诊入院。患者1970年确诊冠心病,长期服药,病情平稳。心电图提示新发Q波_(Ⅱ、Ⅲ、avF),ST段_1、V_3～V_5压低,乳酸脱氢酶277.6 U/L,肌钙蛋白I 0.84μg/L,余心肌酶未见异常,拟诊"急性心肌梗死",给予阿司匹林300 mg口服,硝酸异山梨酯10 mg静脉滴注。入院后给予药物对症     

急性心肌梗死合并急性肠系膜上动脉闭塞经介入抢救成功一例

急性肠系膜动脉闭塞临床表现极不典型,容易误诊漏诊,同时合并急性心肌梗死则更为罕见。该病诊断困难,死亡率高,抢救成功的关键在于早期诊断,及时处理。湖南师范大学第一附属医院2011年经多科合作抢救成功1例急性心肌梗死合并急性肠系膜上动脉闭塞的患者,现报道如下。     

急性心肌梗死合并心室电风暴成功抢救1例

<正>患者男,46岁,因胸闷伴大汗、呕吐2h就诊。既往有高血压病史。急诊科心电图提示:急性下壁心肌梗死,三度房室阻滞。患者继而出现意识障碍,心电图示室速、室颤(图1),予反复300J非同步电除颤和电复律,并在安装临时起搏器基     

急性心肌梗死合并过敏性及心源性休克抢救成功1例报告

患者男 ,60岁。因心前区、胸骨后针刺样疼痛 4ｈ于 1998年 10月 3日上午 10 :15急诊入院。查体 :Ｔ 3 5 5℃ ,Ｐ 60次 ｍｉｎ ,Ｒ 2 0次 ｍｉｎ ,ＢＰ 18 10ＫＰａ。神志清楚 ,急性重病容。头颅五官端正 ,双侧瞳孔等圆、等大 ,直径约 2 5ｍｍ ,对光反射存在。口唇无紫绀。颈软 ,气管居中 ,双肺呼吸音清 ,未闻及干湿性罗音。心前区无隆起 ,未触及震颤 ,心界不大 ,心音低沉 ,ＨＲ 60次 ｍｉｎ ,律整 ,各瓣膜听诊区未闻及病理性杂音。腹平软 ,肝脾肋下未及。四肢肌张力、肌力正常 ,生理性反射存在 ,病理征未引出。双下肢无浮肿。ＥＣＧ示窦缓…     

急性胰腺炎合并急性心肌梗死2例

急性胰腺炎(AP)合并急性心肌梗死(AMI)国内偶有报告,我们遇到病情凶险的2例,报告如下。 1 临床资料 例1 男性56岁,胸闷5d,持续性上腹痛阵发性加剧23h,以AMI于1993年4月7日住院。查体:T37.2℃,P132次/min,R25次/min,BP90/68     

急性播散性脑脊髓炎合并多器官功能衰竭救治成功一例

急性播散性脑脊髓炎合并多器官功能衰竭救治成功一例张宝和龙南展刘桂芳李惠芝石湘云患者男性，６２岁。因发热、咽痛１周于１９９５年３月７日入院。查体：体温３７．６℃，血压２２／１２ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），双侧扁桃体肿大、化脓，心、肺、腹部及神经...     

成功抢救中毒性菌痢合并急性心肌梗死1例报告

患者女 ,65岁 ,农民 ,因寒战高热并胸骨后不适 3小时 ,突发抽风 ,大小便失禁 ,神志丧失约 3 0分钟 ,于 2 0 0 1年 9月 1日入院。有高血压病史 5年 (最高达 180 /10 5 mm Hg) ,未进行正规降压治疗。发病前曾受凉及进食未清洁水果。入院后 ,T3 9.8℃ ,P12 0次 /分 ,R2 6次 /分 ,Bp60 /4 0 mm Hg。休克貌 ,躁动不安 ,劲略抵抗 ,颈静脉无怒张。胸廓无畸形 ,双肺可闻及细湿罗音 ,心界不大 ,心率 12 0次 /分 ,律齐 ,各瓣膜区未闻及病理性杂音 ,心音较弱。腹部平坦 ,肝脾未触及 ,腹部有无压痛不能表达 ,肠鸣音活跃 ,膝腱反射减弱 ,病理反射未引…     

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.     

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…     

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.     

Antiphospholipid syndrome with acute myocardial infarction and portal vein occlusion: a case report

A 62-year-old woman was admitted to hospital because of chest oppression and abdominal discomfort. Coronary arteriography revealed that the proximal left anterior descending artery had a large thrombus with TIMI (Thrombolysis in Myocardial Infarction) Grade 3 flow. On the second hospital day, she had sudden hematemesis because of esophageal varices. Her general condition became stable with conventional therapy. On the 20th hospital day, coronary arteriography and arterial portography showed that the thrombus had diminished. Arterial portography also revealed total occlusion of the portal vein as well as giant gastric varices. She was diagnosed as antiphospholipid syndrome, based on the presence of lupus anticoagulant. The treatment of this case was very complicated because of the bleeding from the esophageal varices induced by the anticoagulant therapy for the thrombus. Prednisolone was administered for 1 month, but no remarkable effects were observed. Therefore, she was treated with endoscopic sclerotherapy for the esophageal varices and anticoagulant therapy for prevention of thrombosis.     

急性心肌梗死后电风暴一例

<正>1病例资料患者男,79岁,主因"发热2周,加重伴嗜睡1 d"于2012年4月12日门诊入院。患者既往糖尿病史40年;慢性肾功能不全病史多年;脑梗死病史10年;老年性痴呆多年;长期卧床,生活不能自理;高血压病史30年;冠心病史10余年。入院诊断:重症肺炎,冠状动脉粥样硬化性心脏病,高血压,糖尿病,肾功能不全,脑梗死后遗症。入院时化验血钾4.3     

反复急性冠状动脉栓塞致心肌梗死一例

<正>1病例资料患者女性,57岁。因"突发胸痛2 h"于2008年8月16日入院。患者胸痛发作时正在步行上坡,胸痛部位位于前胸偏右侧,呈持续性胀痛,伴气短、心悸。既往史:30年前开始无诱因出现阵发性心悸、气短,左前胸点状疼痛,含服硝酸异     

A case of acute pancreatitis presenting with electrocardiographic signs of acute myocardial infarction

A 71-year-old man presented with left upper quadrant abdominal pain. Serial electrocardiograms (ECGs) demonstrated an evolving left bundle branch block, a sign of acute myocardial infarction (AMI). However, a coronary angiogram demonstrated minimal coronary artery disease, and serum troponin T was undetectable in serial serum measurements. Later, serum pancreatic enzyme levels were elevated and a computed tomography scan of the abdomen was consistent with pancreatitis. In patients presenting with acute pancreatitis and ECG changes suggesting AMI, measurement of serum troponin T concentrations can aid in differentiating ECG changes driven by acute pancreatitis from those of true myocardial ischemia or infarction.     

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.     

Cardiovascular syphilis-associated acute myocardial infarction: A case report

Rationale:In recent decades, the incidence of advanced syphilis has declined due to early recognition and the application of effective antibiotics. Advanced syphilis often manifests in the cardiovascular system as simple aortitis, aortic valve insufficiency, coronary artery stenosis or obstruction, Aortic aneurysm and mucinous myocarditis. In most case reports on the subject, acute myocardial infarction caused by syphilis was reported to be due to aortic valve insufficiency and coronary stenosis as a result of the involvement of the aorta.Patient concerns:The patient was a 48-year-old woman. She was admitted to our hospital because of intermittent upper abdominal pain with chest tightness for 3 hours. The patient reported a past syphilis infection, when she was hospitalized for hysteromyoma surgery four years ago, and had no related treatment.Diagnosis:According to the characteristics of coronary angiography and results of lab tests and echocardiography, she was finally diagnosed with myocardial infarction associated with syphilis.Interventions:At the first diagnosis of syphilis, the patient did not received antibiotics treatment. After the diagnosis of myocardial infarction, she received the percutaneous coronary intervention (PCI) operation assisted by extracorporeal membrane oxygenation (ECMO) technology, successfully got drug -eluted stents in right coronary artery ostium and left main ostium. Then the patient received penicillin to treat the syphilis infection.Outcomes:After coronary revascularization, the cardiac function of the patients was gradually improved, and the left ventricular ejection fraction was gradually improved after combined with optimized drug therapy.Lessons:The cardiovascular system is often involved in the stages of advanced syphilis with severe complications like myocardial infarction. Standard treatment should be given as soon as syphilis is diagnosis. For stenosis of coronary ostium, the PCI assisted by ECMO technology did not only ensure the effectiveness of the treatment, but also reduce the surgical risk of the patient. This case indicated the effectiveness of ECMO-assisted PCI, and thus may provide a reference for future patient treatment.