中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
33期
4137-4140,4141
,共5页
季政%袁敏%许伟源%许富康%孟立平%周昌钻%刘龙斌%彭放%郭航远
季政%袁敏%許偉源%許富康%孟立平%週昌鑽%劉龍斌%彭放%郭航遠
계정%원민%허위원%허부강%맹립평%주창찬%류룡빈%팽방%곽항원
心肌梗死%头痛%呕吐
心肌梗死%頭痛%嘔吐
심기경사%두통%구토
Myocardial infarction%Headache%Vomiting
急性心肌梗死需要通过其典型的临床症状———胸痛尽早确诊。右心室心肌梗死可严重影响急性血流动力学过程,且是低血压或休克的主要原因,其处理原则不同于左心室功能障碍引起的心源性休克。下壁心肌梗死伴右心室心肌梗死较单纯下壁心肌梗死者预后更差。以头痛和呕吐为表现的急性下壁心肌梗死在临床上罕见,而以头痛和呕吐为表现起病的急性下壁心肌梗死合并右心室心肌梗死更为罕见。本文报道1例由绍兴市人民医院心内科收治,以严重后枕部疼痛和呕吐为主诉且无任何胸部不适症状的急性 ST 段抬高型心肌梗死的罕见患者,患者接受经皮冠状动脉介入术后头痛即刻得到缓解,并进一步详细探讨以头痛和呕吐作为急性心肌梗死唯一临床表现的病理生理学机制,旨在加强临床医师对该病的认识。
急性心肌梗死需要通過其典型的臨床癥狀———胸痛儘早確診。右心室心肌梗死可嚴重影響急性血流動力學過程,且是低血壓或休剋的主要原因,其處理原則不同于左心室功能障礙引起的心源性休剋。下壁心肌梗死伴右心室心肌梗死較單純下壁心肌梗死者預後更差。以頭痛和嘔吐為錶現的急性下壁心肌梗死在臨床上罕見,而以頭痛和嘔吐為錶現起病的急性下壁心肌梗死閤併右心室心肌梗死更為罕見。本文報道1例由紹興市人民醫院心內科收治,以嚴重後枕部疼痛和嘔吐為主訴且無任何胸部不適癥狀的急性 ST 段抬高型心肌梗死的罕見患者,患者接受經皮冠狀動脈介入術後頭痛即刻得到緩解,併進一步詳細探討以頭痛和嘔吐作為急性心肌梗死唯一臨床錶現的病理生理學機製,旨在加彊臨床醫師對該病的認識。
급성심기경사수요통과기전형적림상증상———흉통진조학진。우심실심기경사가엄중영향급성혈류동역학과정,차시저혈압혹휴극적주요원인,기처리원칙불동우좌심실공능장애인기적심원성휴극。하벽심기경사반우심실심기경사교단순하벽심기경사자예후경차。이두통화구토위표현적급성하벽심기경사재림상상한견,이이두통화구토위표현기병적급성하벽심기경사합병우심실심기경사경위한견。본문보도1례유소흥시인민의원심내과수치,이엄중후침부동통화구토위주소차무임하흉부불괄증상적급성 ST 단태고형심기경사적한견환자,환자접수경피관상동맥개입술후두통즉각득도완해,병진일보상세탐토이두통화구토작위급성심기경사유일림상표현적병리생이학궤제,지재가강림상의사대해병적인식。
Acute myocardial infarction should be diagnosed as early as possible based on typical symptoms. As is known to all,right ventricular myocardial infarction can seriously affect the acute hemodynamic process,and it is the major cause of hypotension or shock. Its treatment principle is very different from cardiogenic shock caused by left ventricular dysfunction. The patients with inferior myocardial infarction who have right ventricular myocardial involvement appear to have worse prognosis than those who only have inferior myocardial infarction. Headache and vomit are unusual symptoms in patients with acute myocardial infraction. Headache and vomit as the only presenting symptoms of acute inferior myocardial infarction complicating right ventricular infarction are extremely uncommon phenomenon. We reported a patient with ST - segment elevation acute myocardial infarction who was admitted into the cardiology department of Shaoxing People's Hospital and who complained of severe occipital headache and vomit without any chest discomfort. After the patient underwent primary percutaneous coronary intervention followed by drug - eluting stent implantation,the headache was immediately relieved. The pathophysiologic explanation of the occurrence of headache and vomit as the sole manifestation of AMI was further discussed,in order to enhance clinicians' understanding of the disease.