每日一题_2024.08.23

A 57-year-old man called emergency medical services to report a 1-hour history of chest pain. When he arrived at the hospital, his heart rate was 125 beats per minute, the blood pressure 128/84 mm Hg, and the oxygen saturation 99% while he was breathing ambient air. The physical examination was normal. An initial serum troponin I level was 35 ng per liter (reference range, 0 to 34). What does the electrocardiogram most likely represent?一名57岁男性拨打急救医疗服务报告了1小时的胸痛史。当他到达医院时，心率为每分钟125次，血压为128/84毫米汞柱，呼吸室内空气时的氧饱和度为99%。体格检查正常。初始血清肌钙蛋白I水平为每升35纳克（参考范围，0至34）。心电图最可能代表的是：

A. Anteroseptal ST-elevation myocardial infarction前间壁ST段抬高型心肌梗死

B. Diffuse subendocardial ischemia弥漫性心内膜下缺血

C. Pericarditis心包炎

D. Posterior myocardial infarction后壁心肌梗死

E. Wellens syndrome韦伦斯综合征

答案解析：

他的心电图显示窦性心动过速，V1导联和aVR导联st段升高，广泛的st段下降-表明弥漫性心内膜下缺血。这种模式可由多支或左主干冠状动脉疾病并发急性斑块破裂或心肌需氧量增加引起。本例患者急诊冠状动脉造影显示左主干近端狭窄90%以上，左主干分叉狭窄20%以上。冠状动脉内注射硝酸甘油显示左冠状动脉主干狭窄是固定的，不是由冠状动脉痉挛引起的。诊断为高危非st段抬高型心肌梗死。

正确答案：B