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患者,男,58岁,因活动后胸闷1周,心电图运动试验阳性,于1998年6月18日入院。入院时常规心电图正常。查体:T 36℃,呼吸20次/min,血压130/76 mmHg,心率64次/min,律齐,心脏各瓣膜区未闻及病理性杂音,双肺呼吸音清晰无湿罗音。入院次日下午4时许,心电图示:窦性心律,心率73次/min。V_(1-3)呈rS型,V_4呈QS型,ST段V_(1-4)呈弓背上抬0.1～0.5 mV,T波V_(2-4)与ST段融合。心肌酶谱:CK 5371 u/L,CK-MB 274.2 u/L,LDH 1608 u/L,LDH-1496 u/L,α-HBO 550 u/L,AST 259 u/L。临床诊断:急性前壁心肌梗死,虽给予尿激酶150万u溶栓治疗,但心电图心肌酶谱连续监测以及临床观察均提示溶栓不成功。患者病情继续恶化,梗死面积扩大。6月23日心电图报告:急性广泛前壁、下壁心肌梗死。患者出现急性左心衰竭,心源性休克。由于病情恶化迅速,患者最终死于心源性休克。
The patient, male, aged 58, was admitted to hospital on June 18, 1998 because of a chest tightness episode of 1 week after exercise and a positive ECG exercise test. Conventional ECG normal admission. Examination: T 36 ℃, breathing 20 times / min, blood pressure 130/76 mmHg, heart rate 64 beats / min, law Qi, the heart valve area was not known and pathological murmur, lungs breath sounds clear no wet rales. Admission the next day at 4 pm, ECG showed: sinus rhythm, heart rate 73 beats / min. V_ (1-3) was rS type, V_4 was QS type. V_ (1-4) of ST segment showed a dorsal elevation of 0.1-0.5 mV, and V_ (2-4) of T wave fused with ST segment. Myocardial enzymes: CK 5371 u / L, CK-MB 274.2 u / L, LDH 1608 u / L, LDH-1496 u / L, α-HBO 550 u / L, AST 259 u / Clinical diagnosis: acute anterior myocardial infarction, although giving urokinase 1.5 million u thrombolytic therapy, but continuous monitoring of ECG myocardial enzymes and clinical observations suggest that thrombolysis was unsuccessful. Patients continue to worsen the condition, infarct size expanded. June 23 ECG report: Acute wide anterior wall, inferior wall myocardial infarction. Patients with acute left heart failure, cardiogenic shock. The patient eventually dies of cardiogenic shock due to the rapid deterioration of his condition.