预激综合征并发阵发性房室折返性心动过速导致2型心肌梗死1例

doi:10.3969/j.issn.1004-583X.2026.09.009

摘要/Abstract

摘要：

目的探讨预激综合征并发阵发性房室折返性心动过速导致2型心肌梗死的临床表现及诊治策略。方法回顾性分析1例预激综合征并发阵发性房室折返性心动过速导致2型心肌梗死患者的临床资料、诊断、治疗,并复习相关文献。结果患者青年女性,31岁,既往无特殊病史,因“突发心悸、晕厥、心前区疼痛不适1小时”入院。经心脏电生理、临床表现、心电图、心肌酶学检查明确诊断为A型预激综合征、阵发性房室折返性心动过速、2型心肌梗死。结论预激综合征并发阵发性房室折返性心动过速,并出现胸痛、晕厥、心肌酶学等异常时,应考虑2型心肌梗死的存在,并及时作出诊断及治疗。

关键词: 预激综合征, 心动过速, 房室结折返性, 晕厥, 胸痛, 2型心肌梗死

Abstract:

Objective To discuss the clinical manifestations and diagnostic and therapeutic strategies of type 2 myocardial infarction (T2MI) caused by paroxysmal atrioventricular reentrant tachycardia complicating pre-excitation syndrome. Methods A retrospective analysis was conducted of the clinical data, diagnosis, and treatment of one patient with T2MI caused by paroxysmal atrioventricular reentrant tachycardia complicating pre-excitation syndrome, and relevant literature was reviewed. Results The patient was a 31-year-old young woman with no special past medical history. She was admitted due to “sudden palpitations, syncope, and chest discomfort/ache in the precordial area for 1 hour”. Based on cardiac electrophysiology, clinical manifestations, electrocardiogram, and myocardial enzyme testing, the diagnoses of A-type pre-excitation syndrome, paroxysmal atrioventricular reentrant tachycardia, and T2MI were established. Conclusion When pre-excitation syndrome is complicated by paroxysmal atrioventricular reentrant tachycardia and abnormalities such as chest pain, syncope, and myocardial enzyme elevations are present, T2MI should be considered. Prompt diagnosis and timely treatment are necessary.

Key words: pre-excitation syndrome, tachycardia, atrioventricular node reentry, fainting, chest pain, type 2 myocardial infarction

中图分类号:

R541.77

张鹏伟, 王智慧, 文乾灵, 陈博, 董小丽, 姚辰扬, 李文博, 党晓红. 预激综合征并发阵发性房室折返性心动过速导致2型心肌梗死1例[J]. 临床荟萃, 2026, 41(9): 837-841.

Zhang Pengwei, Wang Zhihui, Wen Qianling, Chen Bo, Dong Xiaoli, Yao Chenyang, Li Wenbo, Dang Xiaohong. A case of type 2 myocardial infarction caused by paroxysmal atrioventricular reentrant tachycardia complicating pre-excitation syndrome[J]. Clinical Focus, 2026, 41(9): 837-841.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.09.009

https://www.lchc.cn/CN/Y2026/V41/I9/837

图/表 4

图1 入院前心电图 P波难以确认,心室律205次/min,广泛导联ST段下移

Fig.1 Electrocardiogram before admission: P waves were difficult to identify; ventricular rate was 205 beats/min, with ST-segment depression across multiple leads

图2 入院后首份心电图入院后恢复窦律可见大部分导联QRS波起始处有明显的delta波

Fig.2 The first electrocardiogram after admission After restoration of sinus rhythm following admission, a prominent delta wave was observed at the onset of the QRS complex in most leads

图3 冠状动脉CT未见明显异常

Fig.3 Coronary artery CT showed no obvious abnormalities

图4 心脏电生理检查 a.S1S2 500,310ms旁道不应期;b.S1S2 500,290ms AVN不应期;c.RV S1S1 300ms VA 2∶1;d.消融后 S1S2 500, 320ms AVN不应期;e. 消融过程,前传已断开,旁道逆传断开。

Fig.4 Cardiac electrophysiology study a. S1S2 500, 310 ms; accessory pathway refractory period; b. S1S2 500, 290 ms; AVN refractory period; c. RV S1S1 300 ms; VA 2∶1; d. After ablation: S1S2 500, 320 ms; AVN refractory period; e. During ablation: antegrade conduction was interrupted, and retrograde conduction via the accessory pathway was interrupted.

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