病例报告:疼痛的左捆分支阻塞综合征复杂的血管综合症
Jiangying Luo1, Yajun Xue1, Fang Liu1
1Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Frontiers in cardiovascular medicine
|January 23, 2025
概括
疼痛的左捆分支阻塞 (LBBB) 综合征,胸痛的罕见原因,可以由血管 (VVS) 复杂化. 这一案例凸显了准确诊断的重要性,以避免错误诊断和不当治疗.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 临床医学 临床医学
背景情况:
- 疼痛的左捆分支阻塞 (LBBB) 综合征的特征是心痛发作与同时的心电图变化,不包括阻塞性冠状动脉疾病.
- 血管 (VVS) 是的常见原因,有时由舌下甘 (NTG) 触发.
- 这份报告详细介绍了一种罕见的,由VVS复杂的痛苦LBBB综合征病例,最初被误诊为急性冠状动脉综合征和心脏性休克.
研究的目的:
- 为了呈现一个痛苦的LBBB综合征的病例,并与VVS复杂.
- 为了强调诊断挑战和痛苦的LBBB综合征的潜在误诊.
- 为了说明疼痛LBBB综合征患者中NTG诱导的VVS的风险.
主要方法:
- 一位62岁的女性有间歇性胸痛史,出现症状恶化.
- 诊断工作包括心电图,心声图,运动跑步机测试,冠状动脉图,异上腺素应激心声图和头向上倾斜测试.
- 治疗涉及延长释放的美托普罗罗尔糖酸盐.
主要成果:
- 运动跑步机测试引起胸痛和新发的LBBB.
- 在测试后,用舌下NTG给药诱导了VVS,其特征是心率和血压的快速下降,对亚特罗宾有反应.
- 冠状动脉扫描显示没有阻塞性病变;异上腺素应激心声扫描证实了速度依赖的LBBB和异步. 头向上倾斜测试证实了混合的VVS.
结论:
- 疼痛性LBBB综合征是胸痛的一个未被确诊的原因.
- 痛苦的LBBB综合征的错误诊断可能导致不适当的治疗和二次并发症,如NTG诱导的VVS.
- 准确的诊断和适当的管理,如贝塔抑制剂,对于患有疼痛LBBB综合征的患者至关重要.
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