肺栓塞中交替双边阻塞的第一个心电图文档
Santiago Obregón-Rosas1, Jessica Michelle Flores-Guerra2, Ángel Antonio Montañez-Aguirre3
1Subdirectorate of Teaching Coordination, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; Mexican Faculty of Medicine, La Salle University, Mexico City, Mexico.
大规模的肺栓塞 (PE) 可以导致心律变化. 这种病例在心电图上显示出一种罕见的,交替的带阻塞模式,这表明PE患者可能出现血液动力学崩.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 肺部医学 肺部医学
背景情况:
- 大规模的肺栓塞 (PE) 经典呈现与鼻高心力衰竭或右捆-分支阻塞 (RBBB).
- 带块,特别是双边模式,在PE的背景下不常被描述.
- 在PE中早期发现血液动力学损害至关重要.
研究的目的:
- 报告在一个患有大量PE的患者中,与左侧后侧块 (LPFB) 交替进行双边前侧块RBBB的第一个已记录的病例.
- 突出交替带块模式的潜力,作为大规模PE中的早期心电图警告信号.
- 探索在PE中扩散的His-Purkinje损伤和血液动力学不稳定性之间的关联.
主要方法:
- 一个46岁的女性患者的病例报告,患有巨大的PE.
- 对连续心电图 (ECG) 结果的分析.
- 电图变化与临床表现和手术内事件的相关性.
主要成果:
- 最初的心电图显示了同时出现左侧和右侧前侧带阻塞,这是一个新发现,被称为双边前侧带阻塞.
- 随后的ECG显示转换为完整的RBBB与LPFB,这是已知的双边模式.
- 这一序列代表了从双边前筋块到RBBB + LPFB组合的首次记录的交替.
- 患者经历了血液动力学崩,并在手术期间死亡.
结论:
- 交替的双边筋膜块模式可能表明大规模PE中的分散的,压力诱导的His-Purkinje损伤.
- 这些心电图发现可以作为即将发生的血液动力学崩的关键早期警告.
- 这个案例扩大了对大规模PE中心电图表现的理解.
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