急性心肌梗死表现为突发剧烈头痛和呕吐一例报道并文献复习

Sudden Severe Headache and Vomit as the Sole Presenting Symptoms of Acute Myocardial Infarction: A Case Report and Literature Review

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。

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.