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中华心脏与心律电子杂志 ›› 2024, Vol. 12 ›› Issue (04) : 249 -252. doi: 10.3877/cma.j.issn.2095-6568.2024.04.010

所属专题: 经典病例

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Graves病合并冠状动脉痉挛致心肌梗死和心律失常一例
罗艳婷1, 朱洁明1, 谢旭晶1, 黄卓山1, 董睿敏1,()   
  1. 1.510665 广州,中山大学附属第三医院心血管内科
  • 收稿日期:2024-06-03 出版日期:2024-12-25
  • 通信作者: 董睿敏

Graves disease complicating coronary vasospasm-induced myocardial infarction and malig‐nant arrhythmias: a case report

Yanting Luo1, Jieming Zhu1, Xujing Xie1, Zhuoshan Huang1, Ruimin Dong1,()   

  1. 1.Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510665,China
  • Received:2024-06-03 Published:2024-12-25
  • Corresponding author: Ruimin Dong
引用本文:

罗艳婷, 朱洁明, 谢旭晶, 黄卓山, 董睿敏. Graves病合并冠状动脉痉挛致心肌梗死和心律失常一例[J/OL]. 中华心脏与心律电子杂志, 2024, 12(04): 249-252.

Yanting Luo, Jieming Zhu, Xujing Xie, Zhuoshan Huang, Ruimin Dong. Graves disease complicating coronary vasospasm-induced myocardial infarction and malig‐nant arrhythmias: a case report[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2024, 12(04): 249-252.

Graves 病合并冠状动脉(冠脉)痉挛致急性心肌梗死和恶性心律失常的病例报道较少见。本例患者为短期反复发作冠脉痉挛性心绞痛并致急性心肌梗死,冠脉造影确诊为急性冠脉非梗塞性心肌梗死。心肌梗死后24 h内发作数次恶性心律失常,分别为严重窦性心动过缓、窦性停搏和心室颤动。住院期间发现存在甲状腺功能亢进症(甲亢),最终确诊为Graves 病。患者经过抗甲亢治疗和冠心病规范化治疗后无再发胸闷和心律失常。是否需要植入心律转复除颤器预防心脏性猝死尚值商榷。

图1 患者急性胸痛时首份心电图(心电图示V1~V3导联QS 型,V2~V3导联ST 段弓背向上抬高0.2 mV,V4导联rS型,J点抬高0.15 mV)
图2 患者窦性心动过缓发作时心电图(2A为20:16复查床边心电图;2B为20:50出现突发窦性心动过缓,心电监护记录可见最长RR间期达3.2 s,自行恢复窦性心律)
图3 患者冠状动脉痉挛发作并导致心室颤动心电图[3A 为患者23:58发作胸闷,心电图示Ⅱ、Ⅲ、aVF 导联和V1~V4导联ST 段迅速动态抬高,T 波高耸,同时Ⅱ、Ⅲ、avF导联R 波振幅增高和S 波变浅(急性损伤阻滞图形);Ⅰ、aVL 导联ST 段压低0.1~0.2 mV;3B为心电监护记录其后出现心室颤动]
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