心电图酷似心肌梗死的病毒性心肌炎的临床识别及处理

Clinical diagnosis and treatment of viral myocarditis with ST-segment elevated electrocardiogram( ECG) similar to acute myocardial infarction

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。

Objective To investigate the clinical diagnosis and treatment of viral myocarditis with ST-segment elevated electrocardiogram（ ECG） similar to acute myocardial infarction. Method Retrospective analysis of clinical data of5 viral myocarditis patients with ST-segment elevated ECG. Result All of the 5 cases showed increased levels of myocardial enzymes but diffused ventricular wall motion decrease in cardiac ultrasound. Five patients demonstrated impaired cardiac function,including 3 cases of cardiogenic shock with one death. A patient with irreversible Ⅲ degree atrioventricular block had received implantation of permanent pacemaker. Coronary angiography conducted in 4 cases,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 infarction. early coronary angiography,especially primary coronary angiography,early administration of hormone cortisol may be useful.