De Winter综合征心电图改变3例

De Winter syndrome for three cases

1 病例资料例1,男,62岁,40min前因心前区疼痛伴有左臂及背部放射痛入院。体检:血压128/72 mmHg(1 mmHg=0.133 kPa),心率95次/min,心律齐,各瓣膜听诊区未闻及额外心音。心电图:Ⅱ、Ⅲ、avF导联ST段呈下斜型压低2 mV,V1~V3导联呈QS波,V4~V6导联ST呈上斜型压低,T波高尖对称。急检结果:肌红蛋白>500 ng/ml,肌钙蛋白I(cTnI)1.08 ng/ml,肌酸激酶同工酶(CK-MB)28.80ng/ml,钾离子4.05mmol/L,三酰甘油0.52mmol/L,胆固醇4.86mmol/L。冠状动脉造影示:前降支近段闭塞。给予血运重建后,复查心电图:V1~V4呈QS波,V4~V6其ST段明显回落接近基线。见图1~3。

Electrocardiogram manifestation of De Winter syndrome often indicates complete or subtotal occlusion of proximal left anterior descending branch.It is a fatal myocardial infarction that needs urgent treatment.It is easily misdiagnosed as reversible myocardial ischemia in clinic,which leads to delayed reperfusion time and even missed diagnosis.There were 3 cases reported De Winter syndrome in this article.