心脏永久起搏器植入合并急性心肌梗死患者1例

Permanent pacemaker implantation complicated with acute myocardial infarction: a case report

本文报道1例心脏永久起搏器植入合并急性心肌梗死患者,因“突发颈背部疼痛半小时”就诊。查心电图提示VVI模式起搏心律,心室率60次/min,查心肌酶学未见异常。考虑到起搏心电图形会掩盖急性心肌梗死心电图形,心肌酶因时间窗原因难以早期诊断。遂以阿托品0.5 mg静脉推注后,自主心室率可升至约80次/min,心电图示下壁导联ST段弓背抬高,考虑急性下壁心肌梗死。行急诊冠状动脉造影提示右冠状动脉近段闭塞,支架植入后症状缓解。对植入起搏器患者怀疑冠心病时,可采用起搏器程控或使用提高心率药物等方法观察患者自主心律心电图图形,有助于明确诊断指导治疗。

This paper reported a case of acute myocardial infarction after permanent pacemaker implantation. Electrocardiogram showed VVI mode pacing rhythm, ventricular rate 60 beats/min, myocardial enzymology showed no abnormalities. Considering that pacing ECG pattern can obscure the ECG pattern of acute myocardial infarction,early diagnosis of myocardial enzymes is difficult because of the time window. After intravenous infusion of atropine 0.5mg, the spontaneous ventricular rate increased to approximately 80 beats per minute, and the ST segment of the inferior lead was raised in the arch. Acute inferior myocardial infarction was considered. Emergency coronary angiography showed occlusion of the proximal segment of the right coronary artery, and the symptoms relieved after stenting. When coronary heart disease is suspected in patients with pacemaker implantation, the ECG pattern of patients with spontaneous rhythm can be observed by pacemaker program control or using drugs to increase heart rate, which is helpful to clarify the diagnosis and guide the treatment.