广泛的T波逆转与胸痛相关:阐明潜在的真相
Jing-Xiu Li1, Xin-Xin Di1, Min Gao1
1Department of Electrocardiogram, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
概括
本案例研究表明,超结瘤如何导致非典型的心电图 (ECG) 变化模仿心脏病发作. 早期识别这些心脏症状是诊断和治疗的关键.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
背景情况:
- 一名患者呈现症状,包括胸痛,腹,,头等症状.
- 电心电图 (ECG) 显示了aVR中的ST升高,分散的T波逆转和QTc延长,最初表明非ST升高心肌梗塞 (NSTEMI).
- 高血压是患者病史中的重要组成部分.
研究的目的:
- 在患有偶发性胸痛和其他症状的患者中调查非典型心电图发现的原因.
- 突出了分泌甲基胺的瘤与心脏表现之间的关联.
- 强调考虑非心脏病因子对缺血性类似心电图模式的重要性.
主要方法:
- 冠状动脉扫描以排除显著的冠状动脉狭窄.
- 心声图和心脏MRI评估心脏功能并排除缺血.
- 生物化学分析,包括血雷宁和尿中诺米他内的水平.
- 诊断成像检查,以确定一个 retroperitoneal质量.
- 确定瘤的腹腔镜切除.
主要成果:
- 冠状动脉扫描显示了心肌桥梁,但没有显著的狭窄.
- 心脏成像显示心脏功能保持不变,没有缺血的证据.
- 血内氨酸和尿中诺美甲尼林水平升高表明有一种分泌甲基荷胺的瘤.
- 切除了一种4.0 x 3.5厘米的逆皮质偏瘤.
- 手术后的康复没有任何事件.
结论:
- 非典型的心电图图案可以模仿心肌缺血,并由catecholamine分泌瘤引起,如 paraganglioma.
- 当初心脏检查没有确定性时,全面的诊断工作至关重要.
- 及时诊断和手术干预可解决相关的心血管症状.
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