尖顶军盔征心电图改变1例并文献复习

doi:10.3969/j.issn.1004-583X.2023.05.010

摘要/Abstract

摘要：

目的识别尖顶军盔征心电图表现并探讨其临床意义。方法回顾性分析湘西自治州人民医院心内科收治的1例尖顶军盔征心电图改变患者的临床资料,并结合相关文献进行分析。结果患者女性,48岁。因“腹胀、腹痛9天,加重伴胸闷、气促8小时”入院,完善相关化验检查,心电图检查结果提示:急性前壁抬高型心肌梗死? 尖顶军盔征? 心电图V3~V5导联呈尖顶军盔征,但患者肌钙蛋白升高,心电图ST段抬高,临床不能排除急性心肌梗死可能,进一步行冠状动脉造影检查后除外急性心肌梗死。诊断:肠梗阻并急性腹膜炎;心肌损伤并心功能不全;心电图尖顶军盔征表现。结论临床医师应及时识别尖顶军盔征心电图改变,尽快发现原发病,避免延误诊治。

关键词: 尖顶军盔征, 急性ST段抬高型心肌梗死, 心电描记术

Abstract:

Objective To identify the electrocardiographic (ECG) findings of the spiked helmet sign and to explore its clinical significance. Methods The clinical data of one patient with ECG findings of the spiked helmet sign who was admitted to the Department of Cardiology of Xiangxi Autonomous Prefecture People's Hospital were retrospectively analyzed. Relevant literatures reporting the spiked helmet sign were reviewed. Results A 48-year-old female patient presented with 9 days of abdominal distension and pain and aggravation with chest tightness and shortness of breath for 8 h. Laboratory tests were performed after admission. ECG showed acute anterior wall elevation myocardial infarction, and Spiked helmet sign. A pointed helmet sign on V3-V5 leads. The patient also had an elevated troponin and ST elevation, and therefore, the possibility of acute myocardial infarction could not be ruled out, which was finally ruled out by the coronary angiography examination. The patient was then diagnosed as intestinal obstruction with acute peritonitis, myocardial injury with cardiac dysfunction and Spiked helmet sign. Conclusion ECG findings of the spiked helmet sign should be timely recognized, and primary disease needs to be diagnosed to prevent delays in diagnosis and treatment.

Key words: spiked helmet sign, acute ST- elevation myocardial infarction, electrocardiography

中图分类号:

R542.22

张粲那, 向露, 罗亚雄. 尖顶军盔征心电图改变1例并文献复习[J]. 临床荟萃, 2023, 38(5): 444-447.

Zhang Canna, Xiang Lu, Luo Yaxiong. Electrocardiographic findings of the spiked helmet sign: A case report and literature review[J]. Clinical Focus, 2023, 38(5): 444-447.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.05.010

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I5/444

图/表 4

图1 入院时心电图

Fig.1 Electrocardiogram at admission

图2 胸部正侧位X线 :双侧胸腔无气胸、积液注:白色箭头提示扩张的主动脉

Fig.2 Chest lateral position and lateral X-ray: No pneumothorax or effusion in both sides of the chest cavity Note: The white arrow indicates dilated aorta

图3 腹部立位X线:胃和肠管大量积气扩张,膈肌受压上抬

Fig.3 Abdominal standing X-ray: Massive gas accumulation and dilation in the stomach and intestines, compression and lifting of the diaphragm

图4 冠状动脉造影 a.右冠状动脉(RCA),近中段狭窄40%~50%;b.左前降支(LAD),未见明显狭窄;c.左主干(LM)和左回旋支(LCX),未见明显狭窄

Fig.4 Coronary angiography a. Right coronary artery (RCA) with proximal to middle segment stenosis of 40% to 50%; b. Left anterior descending branch (LAD), no obvious stenosis observed; c. Left main artery (LM) and left circumflex branch (LCX), no obvious stenosis observed

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