실신으로 내원한 후벽 단독 심근경색 환자에서 발생한 심장눌림증 1례
Case Report: Cardiac tamponade in a patient with isolated posterior myocardial infarction presenting with syncope
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Cardiogenic syncope occurs due to arrhythmia (bradycardia and tachycardia) or decreased cardiac output, and if proper treatment is not provided, it can lead to acute sudden death. A detailed medical history and physical examinations are required to determine the cause of syncope, and clinical approaches, including 12-lead ECG, are important. The 12-lead ECG does not have a chest lead in the posterior wall of the left ventricle; therefore, ECG of the isolated posterior wall myocardial infarction caused by left circumflex artery occlusion is not observed with ST elevation. Therefore, the significantly higher appearance of ST depression and R waves than S waves from V1 to V3 of the chest lead must be interpreted meaningfully. Isolated posterior wall myocardial infarction is small in the area of myocardial necrosis, and tension is increased in the necrotic area due to the contraction of the normal myocardial muscle, which can cause ventricular wall rupture. Therefore, it is necessary to additionally check Beck’s triad, such as jugular venous distension and decreased heart sound, in patients with low blood pressure with an isolated posterior wall myocardial infarction on 12-lead ECG in patients with syncope.
Abstract
Cardiogenic syncope occurs due to arrhythmia (bradycardia and tachycardia) or decreased cardiac output, and if proper treatment is not provided, it can lead to acute sudden death. A detailed medical history and physical examinations are required to determine the cause of syncope, and clinical approaches, including 12-lead ECG, are important. The 12-lead ECG does not have a chest lead in the posterior wall of the left ventricle; therefore, ECG of the isolated posterior wall myocardial infarction caused by left circumflex artery occlusion is not observed with ST elevation. Therefore, the significantly higher appearance of ST depression and R waves than S waves from V1 to V3 of the chest lead must be interpreted meaningfully. Isolated posterior wall myocardial infarction is small in the area of myocardial necrosis, and tension is increased in the necrotic area due to the contraction of the normal myocardial muscle, which can cause ventricular wall rupture. Therefore, it is necessary to additionally check Beck’s triad, such as jugular venous distension and decreased heart sound, in patients with low blood pressure with an isolated posterior wall myocardial infarction on 12-lead ECG in patients with syncope.
참고문헌 (11)
- 최윤영, "실신의 임상적 접근 및 진단", 대한내과학회지, 95(4), pp.251~259 (2020), 대한내과학회[DOI]
- Jennifer L. White, "Electrocardiogram and cardiac testing among patients in the emergency department with seizure versus syncope", Clinical and Experimental Emergency Medicine, 6(2), pp.106~112 (2019), 대한응급의학회[DOI]
- 이경원, "일개 광역시 지역에서 직접의료지도의 임상적 고찰", 대한응급의학회지, 28(4), pp.362~373 (2017), 대한응급의학회
- Brit J. Long, "Opportunities for Emergency Medical Services (EMS) Care of Syncope", Prehospital and Disaster Medicine, 31(4), pp.349~352 (2016), Cambridge University Press (CUP)[DOI]
- Brignole M, "2018 ESC Guidelines for the diagnosis and management of syncope", European Heart J, 39(21), pp.1883~1948 (2018)[DOI]
- Kim YH, "Ventricular tachycardia of the coro-nary arterial diseases", Int J Arrhythm, 11(1), pp.16~19 (2010)
- Laurent Bodson, "Cardiac tamponade", Current Opinion in Critical Care, 17(5), pp.416~424 (2011), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Jae Myung Chung, "Advanced Trauma Life Support", Journal of the Korean Medical Association, 50(8), pp.680~691 (2007), Korean Medical Association (KAMJE)[DOI]
- Yuri B. Pride, "Angiographic and Clinical Outcomes Among Patients With Acute Coronary Syndromes Presenting With Isolated Anterior ST-Segment Depression", JACC: Cardiovascular Interventions, 3(8), pp.806~811 (2010), Elsevier BV[DOI]
- Shlomi Matetzky, "Acute myocardial infarction with isolated ST-segment elevation in posterior chest leads V7–9", Journal of the American College of Cardiology, 34(3), pp.748~753 (1999), Elsevier BV[DOI]
- Amar Krishnaswamy, "Magnitude and consequences of missing the acute infarct-related circumflex artery", American Heart Journal, 158(5), pp.706~712 (2009), Elsevier BV[DOI]