Ischemické a neischemické příčiny elevace ST segmentu u pacientů s bolestí na hrudi: Systematický přehled literatury

English version

Authors: M. Levine; Y. Kanei; M. Rachko; P. Schweitzer
Authors‘ workplace: Beth Israel Medical Center, New York, NY, USA
Published in: Vnitř Lék 2012; 58(7 a 8): 54-59
Category: 80th Birthday MUDr. Miroslav Mydlík, DrSc.

Overview

Elektrokardiogram zůstává nejdůležitějším nástrojem v diagnóze infarktu myokardu s elevací ST segmentu. Je okamžitě k dispozici, je snadné jej opakovat a ekonomicky je velice výhodný. Pro trénovaného odborníka je rovněž vysoce citlivý a specifický. Časná diagnóza a následná léčba infarktu myokardu s elevací ST segmentu závisí na rychlém provedení a správné interpretaci EKG. Mimo akutního infarktu myokardu existuje u pacienta s probíhající bolestí na hrudi mnoho dalších příčin elevace ST segmentu. Lékař musí mít tyto diferenciální diagnózy na zřeteli a musí být schopen rychle potvrdit nebo vyvrátit alternativní příčiny elevace ST segmentu. Cílem tohoto článku je přezkoumání nálezů na EKG u akutního infarktu myokardu v porovnání s ostatními alternativními diagnózami, u kterých může docházet k elevaci ST segmentu. Tato diskuse je ukončena třemi kazuistickými příklady atypických příčin elevace ST segmentu u pacienta s bolestí na hrudi.

Klíčová slova:
elektrokardiogram – elevace ST segmentu – infarkt myokardu – diferenciální diagnóza

Sources

1. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet 2003; 361: 13–20.

2. Keeley EC, Boura JA, Grines CL. Comparison of primary and facilitated percutaneous intervention for ST-elevation myocardial infarction: quantitative review of randomized trials. Lancet 2006; 364: 579–588.

3. Andersen HR, Nielsen TT, Rasmussen K et al. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med 2003; 349: 733–742.

4. De Luca G, Suryapranata H, Ottervagner JP et al. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004; 109: 1223–1225.

5. Antman EM. Time is muscle. J Am Coll Cardiol 2008; 52: 1216–1221.

6. Thygesen K, Alpert JS, White HD. Joint ESC/ACC/AHA/WHF task force for redefinition of myocardial infarction. Universal definition of myocardial infarction. Eur Heart J 2007; 28: 2525–2538.

7. Wang K, Asinger RW, Marriott HJL. St-segment elevation in condition other than acute myocardial infarction. N Engl J Med 2003; 349: 2128–2135.

8. Widimsky P, Budesinsky T, Vorac D et al. Long distance transport for primary angioplasty vs immediate thrombolytic in acute myocardial infarction. Final results of the randomized national multicenter tria-Prague-2. Eur Hear J 2003; 24: 94–104.

9. Le May MR, Dionne R, Maloney J et al. Paramedics in a primary PCI program for ST-elevation myocardial infarction. Prog Cardiovas Disease 2010; 53: 183–187.

10. Larson DM, Menssen KM, Sharkey SW et al. “False-Positive” cardiac catheterization laboratory activation among patients with suspected ST-segment elevation myocardial infarction. JAMA 2007; 298: 2754–2760.

11. Gu YL, Svilaas T, van der Horst ICC et al. Conditions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous coronary intervention. Neth Hear J 2008; 16: 325–331.

12. Perugini E, Di Pasquale G, Di Diodoro L et al. What is the acceptable rate of false positives for STEMI within a primary PCI network? Insight from a metropolitan system with direct ambulance-based access. Int J Cardiol 2012; 154: 356–358.

13. Nfor T, Kostopoulos L, Hashim H et al. Identifying false-positive ST-elevation myocardial infarction in emergency department patients. J Emerg Med 2012; http://dx.doi.org/10.1016.jemermed.2011.09.027.

14. Brady WJ, Perron A, Ullman E. Error in emergency physician interpretation of ST-segment elevation in emergency department chest pain patients. Acad Emerg Med 2000; 7: 1256–1260.

15. Erling BF, Perron AD, Brady WJ. Disagreement in the interpretation of electrocardiographic ST segment elevation: A source of error for emergency physician? Am J Emerg Med 2004; 22: 65–70.

16. Jayroe JB, Spodick DH, Nikus K et al. Differentiating ST elevation myocardial infarction and nonischemic causes of ST elevation by analyzing the presenting electrocardiogram. Am J Cardiol 2009; 103: 301–306.

17. Tran V, Huang HD, Diez JG et al. Differentiating ST elevation myocardial infarction from nonischemic ST elevation in patients with chest pain. Am J Cardiol 2011; 108: 1096–1101.

18. Widimsky P, Stellova B, Groch L et al. Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial inarction: Experience from the PRAGUE study. Can J Cardiol 2006; 22: 1147–1152.

19. Prasad SB, Richards DAB, Sadick N et al. Clinical and electrocardiographic correlates of normal coronary artery angiography in patients referred for primary precutaneous coronary intervention. Am J Cardiol 2008; 102: 155–159.

20. Larsen AI, Galbraith D, Ghali WA et al. Characteristics and outcomes of patients with acute myocardial infarction and agiographically normal coronary arteries. Am J Cardiol 2005; 95: 261–263.

21. Agewall S, Eurenius L, Hofman-Bang C et al. Myocardial infarction with agiographically normal coronary arteries. Atherosclerosis 2011; 219: 10–14.

22. Stensaeth HK, Fossum E, Hoffman P et al. Clinical characteristics and role of early cardiac magnetic resonance imaging in patients with suspected ST-elevation myocardial infarction and normal coronary arteries. Int J Cardiovas Imaging 2011; 27: 355–365.

23. Yamaji H, Iwasaki K, KusachiS et al. Prediction of acute left main Coronary artery obstruction by 12-lead electrocardiography. J Am Coll Cardiol 2001; 38: 1348–1354.

24. de Zwaan C, Bar FW, Wellens HJJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J 1982; 103: 730–764.

25. Migliore F, Zorzi A, Perazzolo M et al. Myocardial edema underlies dynamic T-wave inversion (Wellens’ ECG pattern) in patients with reversible left ventricular dysfunction. Heart Rhythm 2011; 8: 1629–1634.

26. Sagie A, Sclarovsky S, Strasberg B et al. Acute anterior wall myocardial infarction presenting with positive T waves and without ST segment shift: Electrocardiographic features and angiographic correlation. Chest1989; 95: 1211–1215.

27. de Winter RJ, Verouden NJW, Wellens HJJ et al. A new ECG sign of proximal LAD occlusion. N Engl J Med 2008; 359: 2071–2073.

28. Verouden NJ, Koch KT, Peters RJ et al. Persistent precordial hyperacute T-waves signify proximal left anterior descending occlusion. Heart 2009; 95: 1701–1706.

29. Pride YB, Tung P, Mohanavelu S et al. Angiographic and clinical outcome among patients with acute coronary syndrome presenting with isolated anterior ST-segment depression: A TRITON-TIMI 38 (Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction 38) Sub study. J Am Coll Cardiol Intv 2010; 3: 806–811.