以急性左心衰竭为主要表现的急性心肌梗死24例临床分析

Acute myocardial infarction accompanied by acute pulmonary edema:a clinical report of 24 cases

目的 分析以急性左心衰竭为主要表现的老年人急性心肌梗死 (AMI)的临床特点 ,探讨其心力衰竭的发生机制。 方法 回顾性分析 2 4例以急性左心衰竭为主要表现的AMI老年患者的临床特点 ,根据NYHA心功能分级及超声心动图所示左室射血分数 (LVEF)探讨AMI时发生急性左心衰竭的机制。随访了 14例患者的预后。 结果 2 4例中 ,18例 (75 0 % )为无痛性梗死 ;19例(90 5 % )为急性非透壁性梗死 ,3例并发完全性左束支传导阻滞 ;超声心动图LVEF <40 % 8例 ,≥ 40 %14例。随访 14例 ,半年内死亡 5例 (35 7% )。 结论 以急性左心衰竭为主要表现的AMI多为无痛性梗死 ,心电图表现多为急性非透壁性梗死。AMI时发生急性左心衰竭的机制为左室收缩功能及舒张功能的严重损害。

Objective To analyze the clinical features of acute myocardial infarction(AMI) with acute pulmonary edema and the mechanisms of acute pulmonary edema in these patients. Methods Twenty four AMI cases 〔15 males, 9 females, mean age (71 5±8 1) years〕 with acute pulmonary edema were retrospectively studied with respect to clinical features, ECG and serum myocardial enzyme. Results Of the 24 AMI cases, 18(75 0 %) had no pain; 19 (90 5 %) had non Q wave AMI ;3 had complete left bundle branch block; with echocardiography, left ventricular ejection fraction (LVEF) was<40% in 8 cases and ≥40% in 14 cases. Mortality was 35 7% after six months. Conclusions Most of the AMI with acute pulmonary edema are painless and non Q wave AMI .Heart failure was caused by systolic and diastolic function impairment.