CAJ | 학술논문

目的：探讨心电图酷似急性心肌梗死的病毒性心肌炎的临床识别及处理。方法回顾性分析5例急性心肌梗死样心电图改变的病毒性心肌炎患者的临床资料。结果5例明确诊断为病毒性心肌炎的患者,均有心肌酶谱的升高,但心脏超声提示室壁运动普遍减低。5例患者中均出现了程度不等的心功能不全,3例出现心源性休克,其中1例死亡。1例出现不可逆的Ⅲ度房室传导而植入了永久起搏器。4例进行了冠状动脉造影,其中3例接受了急诊冠状动脉造影,均未发现严重冠状动脉病变及痉挛。结论部分病毒性心肌炎患者可表现出类似急性心肌梗死样ST段抬高的心电图改变,需与急性心肌梗死相鉴别。冠状动脉造影,尤其是急诊冠状动脉造影,可能有助于早期鉴别。
목적：탐토심전도혹사급성심기경사적병독성심기염적림상식별급처리。방법회고성분석5례급성심기경사양심전도개변적병독성심기염환자적림상자료。결과5례명학진단위병독성심기염적환자,균유심기매보적승고,단심장초성제시실벽운동보편감저。5례환자중균출현료정도불등적심공능불전,3례출현심원성휴극,기중1례사망。1례출현불가역적Ⅲ도방실전도이식입료영구기박기。4례진행료관상동맥조영,기중3례접수료급진관상동맥조영,균미발현엄중관상동맥병변급경련。결론부분병독성심기염환자가표현출유사급성심기경사양ST단태고적심전도개변,수여급성심기경사상감별。관상동맥조영,우기시급진관상동맥조영,가능유조우조기감별。
Objective To investigate the clinical diagnosis and treatment of viral myocarditis with ST-segment elevat-ed electrocardiogram ( ECG) similar to acute myocardial infarction. Method Retrospective analysis of clinical data of 5 viral myocarditis patients with ST-segment elevated ECG. Result All of the 5 cases showed increased levels of myo-cardial enzymes but diffused ventricular wall motion decrease in cardiac ultrasound. Five patients demonstrated im-paired cardiac function, including 3 cases of cardiogenic shock with one death. A patient with irreversibleⅢdegree atrioventricular block had received implantation of permanent pacemaker. Coronary angiography conducted in 4 ca-ses, with 3 cases of primary angiography, had reveled neither serious lesions nor spasm of the vessels. Conclusion Some viral myocarditis patients with ST-segment elevated ECG should be differentiated from acute myocardial infarc-tion. early coronary angiography, especially primary coronary angiography, early administration of hormone cortisol may be useful.