A 70-year-old woman with diabetes mellitus presented to the emergency department with a 3-day history of epigastric pain and vomiting. An electrocardiogram showed normal sinus rhythm with pathologic Q waves and T-wave inversions in the anterior leads. A high-sensitivity troponin test showed a troponin level of 686 ng per liter (reference value, <11). What finding is shown in these images from the patient’s left ventriculography and transthoracic echocardiography?
一位70岁糖尿病患者,有3天的上腹痛和呕吐史,来到急诊科。心电图显示正常的窦性心律,前导联有病理性Q波和T波倒置。高灵敏度肌钙蛋白测试显示肌钙蛋白水平为每升686纳克(参考值:<11)。请问从患者左心室造影和经胸超声心动图的这些图像中显示了什么发现?
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A. Mural thrombus壁血栓
B. Rhabdomyoma横纹肌瘤
C. Ruptured papillary muscle断裂的乳头肌
D. Sarcoma肉瘤
E. Vegetation赘生物
答案解析:
正确答案是壁血栓。冠状动脉造影发现了左前降支(LAD)动脉中段的完全闭塞。左心室造影显示与LAD动脉供血区域相对应的局部壁运动异常,以及心尖部的充盈缺损。经胸超声心动图显示左心室射血分数为37%,并且发现壁血栓。诊断为透壁前间壁心肌梗死并发左心室血栓。由于患者就诊延迟、症状已经缓解,以及随后确认LAD动脉供血区域的心肌无存活可能,因此没有进行血管再通。开始实施指南指导的药物治疗和治疗性抗凝。
正确答案:A
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