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急性脑血管意外引起心肌梗塞或心内膜下心肌梗塞的心电图改变,临床上称之为“脑心卒中”。我科自1989年1月～1992年6月,共收治256例脑梗塞患者,其中有8例并发急性心肌梗塞,约占3.1％。 本组8例心肌梗塞的病人,均发生在脑梗塞的急性期,经心电图检查发现,并有典型的急性心肌梗塞的心电图特点和演变过程,血清酶学增高均支持心肌梗塞的存在。现将典型病例报告如下。 1 典型病例 例1:男,54岁。右利,左侧肢体活动失灵1天入院。查体:神志清楚,言语自如,双侧瞳孔3mm,等大正圆,对光反射正常,无高颅压征,左侧上下肢肌力Ⅱ级,肌张力低,病理征(-)。头颅CT、右基底节区大片状低密度影。EKG:窦速。次日上午突感胸闷,大汗,自述心前区疼痛。急查EKG提示,急性下壁心肌梗塞。CPK804u,LDH275u(37.5℃),SGOT445u。诊断:脑血栓形成(右基底节),急性下壁心肌梗塞。
Acute cerebrovascular accident caused by myocardial infarction or subendocardial myocardial infarction ECG changes, clinically called “brain stroke.” Our department from January 1989 to June 1992, a total of 256 patients with cerebral infarction, including 8 cases of acute myocardial infarction, accounting for about 3.1%. The group of 8 patients with myocardial infarction, all occurred in the acute stage of cerebral infarction, found by electrocardiogram, ECG and typical characteristics of acute myocardial infarction and evolution, increased serum enzyme support the existence of myocardial infarction. The typical case report is as follows. A typical case example 1: male, 54 years old. Right Lee, left limb activity failure 1 day admission. Physical examination: conscious, speech freely, bilateral pupil 3mm, and other large round, normal light reflex, no intracranial hypertension, left upper limb muscle strength Ⅱ, low muscle tension, pathological sign (-). Head CT, large basal ganglia low density film. EKG: sinus speed. The next morning suddenly felt chest tightness, sweating, self-report of pain in the area before. Emergency check EKG tips, acute inferior wall myocardial infarction. CPK804u, LDH275u (37.5 ° C), SGOT445u. Diagnosis: Cerebral thrombosis (right basal ganglia), acute inferior wall myocardial infarction.