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患者,男,42岁,饮酒后出现腹痛、恶心呕吐、胸闷气促、大汗、心悸、胸骨后压榨痛,持续约3小时,静息不能缓解而就诊。既往有类似症状反复发作史5个月。就诊时急查心电图示:陈旧性下壁心肌梗塞、急性冠状动脉供血不足,以“冠心病”、“心绞痛”收治入院。次日心电图示:再发下壁、前间壁梗塞。化验检查心肌酶谱均显著异常。入院第3天梗塞范围进一步扩大,心电图示:下壁、前壁梗塞,加做V_(3R)～V_(5R)导联,V_(4R)的ST段抬高不明显,入院第4天心电图示:除以上异常外,又出现完全性有束支传导阻滞图形,同时,患者一般情况差;查体:肝肋下3cm;血压下降,升压效果不理想,病情进一步加重,血压从9/6kPa降至6/4kPa,直至血压为0;患者出现心源性休克,神志丧失,双目凝视等一系列右室梗塞症状,经抢救病情趋稳定。第5天心电图示:右束支阻滞图形消失。
Patients, male, 42 years old, abdominal pain after drinking, nausea and vomiting, chest tightness, shortness of breath, sweating, heart palpitations, chest pain after pressing for about 3 hours, rest can not be alleviated and treatment. Past history of recurrent episodes of similar symptoms for 5 months. Emergency ECG check: Old inferior wall myocardial infarction, acute coronary insufficiency, “coronary heart disease”, “angina” admitted to hospital. The next day ECG shows: the next wall, the anterior infarction wall. Laboratory tests were significantly abnormal myocardial enzymes. On the third day of hospital admission, infarct size was further enlarged. The electrocardiogram showed that the lower wall and the anterior wall infarction were not significantly evoked by the V 3R V 5R lead and ST segment elevation of V 4R. Show: In addition to the above anomalies, there is complete bundle branch block graphics, at the same time, patients in general poor; examination: liver ribs 3cm; blood pressure, blood pressure is not satisfactory, the condition worsened, blood pressure from 9 / 6kPa down to 6 / 4kPa, until the blood pressure is 0; patients with cardiogenic shock, loss of consciousness, binocular gaze and a series of symptoms of right ventricular infarction, the disease tends to be stabilized. Day 5 ECG shows: Right bundle branch block graphics disappear.