在aVR中ST升高:肺栓塞的非典型呈现
Bernard R Francis1, Nouman Arshad1, Mohammad El-Din1
1Department of Cardiology Kettering General Hospital Kettering UK.
Clinical case reports
|July 31, 2025
概括
在心电图上STaVR的升高可以模仿急性冠状动脉综合征,但可能表明肺栓塞. 这一案例凸显了在患有aVR变化和右心室张力迹象的患者中考虑PE的重要性.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 紧急医疗 紧急医疗
背景情况:
- 电心电图 (ECG) 上ST段领先aVR的升高通常意味着高风险的急性冠状动脉综合征 (ACS).
- 这种心电图发现很少与肺栓塞 (PE) 相关,这是一种可能危及生命的疾病.
研究的目的:
- 报告一个在aVR中ST升高是肺栓塞 (PE) 而不是急性冠状动脉综合征 (ACS) 的关键指标的病例.
- 在疑似心脏事件的背景下强调aVR ST升高的诊断挑战和临床影响.
主要方法:
- 一个47岁的女性病例介绍,她有PE病史和结性脊柱炎,胸痛.
- 电脑心电图分析显示ST升高在aVR和ST抑郁中,随后进行冠状动脉血管学,心声学和CT肺血管学 (CTPA).
主要成果:
- 冠状动脉扫描正常,排除了急性冠状动脉综合征.
- 心声图显示右心室 (RV) 扩张,CTPA证实了广泛的双边肺栓塞.
- 患者通过抗凝固疗法得到改善.
结论:
- 在aVR中ST的升高可能是PE等重大疾病的关键标志,特别是当与右心室应变相关时.
- 临床医生应在患者呈现VR变化和VR压力过载的心声学证据的情况下保持PE的高怀疑指数,以避免误诊.
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