临床实践中的韦伦斯综合征

K. G. Pereverzeva, N. V. Dubova, S. A. Biryukov, G. V. Nozhov, S. S. Yakushi
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摘要

尽管心血管死亡率下降,但心肌梗死(MI)的发病率仍然很高,因此及时诊断的问题仍然非常重要。除了主要的诊断标准和典型的心电图征象外,还有许多提示心肌梗死的继发性模式。Wellens’s syndrome (WS)是其中的一种心电图模式,它表明患者是由前室间动脉(AIA)闭塞或其临界狭窄引起的左室前壁心肌梗死的高危人群。尽管WS的发病率相对较低,但为了预防心肌梗死并减少其可能产生的不良后果,有必要提高医生的认识。本文介绍WS的临床病例,说明WS的诊断在心绞痛患者治疗中的重要性。第一位患者43岁,诊断为III级外力性心绞痛,有心绞痛病史,V2-V3导联出现倒T波。住院第7天行AIA支架植入术。第二例患者67岁,诊断和病史相似,I、aVL、V1-V3和V5-V6双相T波导联,V4深度倒位T波。在最严重的心绞痛发作后5-6天以及心绞痛复发后,对AIA和右冠状动脉(RCA)进行支架植入术。在这两个病例中,WS都没有被诊断出来。第三例患者,57岁,II、III、aVF T波倒置,III导联ST段抬高小于1mm, aVL和V2-V3导联ST段降低,随后在不到2小时内II、III、aVF导联ST段升高。该患者及时诊断WS,紧急行冠状动脉造影,发现99% RCA狭窄,行RCA支架植入术。结果为左室下壁非q波心肌梗死。最后引用的WS病例表明,该综合征不仅发生于AIA损伤,也发生于其他冠状动脉损伤。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Wellens’ syndrome in clinical practice
Despite the declining cardiovascular mortality, the incidence of myocardial infarction (MI) is still high, and therefore the issues of its timely diagnosis remain extremely relevant. In addition to the main diagnostic criteria and typical electrocardiographic (ECG) signs, there are many secondary patterns that suggest MI. Wellens’ syndrome (WS) is one of these ECG patterns, which indicates that the patient is at high risk of left ventricular anterior wall MI, caused by occlusion of the anterior interventricular artery (AIA) or its critical stenosis. Despite the relatively low incidence of WS, it is necessary to increase physicians’ awareness in order to prevent MI and reduce its possible negative consequences.This article presents clinical cases of WS, which show the importance of its diagnosis in the management of patients with anginal pain. The first patient is 43-year-old with a diagnosis of class III exertional angina, a history of anginal pain, and the presence of inverted T waves in V2-V3 leads. AIA stenting was performed on the 7th day of hospitalization. The second patient is 67-year-old with a similar diagnosis and history, biphasic T waves in I, aVL, V1-V3 and V5-V6 leads, deeply inverted T waves in V4. Stenting of the AIA and right coronary artery (RCA) was performed on days 5-6 after the most severe episode of anginal pain and after the anginal pain became recurrent. In both cases, WS was not diagnosed. The third patient, 57-year-old, with T wave inversion in II, III, aVF, leads ST segment elevation of less than 1 mm in lead III, minimal ST segment depression in aVL and V2-V3 leads, followed in less than 2 hours by ST segment elevation in II, III, aVF leads. In this patient, WS was diagnosed in a timely manner, urgent coronary angiography was performed, 99% RCA stenosis was detected, and RCA stenting was performed. The outcome is left ventricular inferior wall non-Q wave MI. The last cited case of WS indicates that this syndrome develops not only with AIA damage, but also with damage to other coronary arteries.
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