Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 101
5. A patient presents with chest pain that started 4 hours previously and inferior ST elevation. Both his pain and ST elevation resolve after aspirin and nitroglycerin administration. Should he undergo emergent reperfusion?
ОглавлениеFigure 2.2 The patient presents with chest discomfort that has lasted 3 hours and resolved 2 hours ago. Subtle ST elevation is seen in leads II and aVF, and in leads V5 and V6, with subtle ST depression in V1–V2. Three features suggest that this mild ST elevation is actually STEMI: (i) Q waves; (ii) ST depression in reciprocal leads (V1–V2); (iii) wide T-wave morphology and fused ST-T segments in leads I, II, V5, and V6 (arrows). This patient qualifies for emergent catheterization since his discomfort occurred in the last 24 hours. He is found to have an acutely occluded large obtuse marginal branch.
Chest pain and ST elevation may both resolve spontaneously or with the acute therapies. This often indicates spontaneous thrombolysis and occurs in ~15% of STEMIs, leading to a much lower mortality and a smaller infarct size.8,9 Occasionally, this may represent resolution
of a coronary spasm. Coronary angiography may be performed emergently, but this is not mandatory: delayed angiography (mean 23 hours) was associated with a similarly low event rate and infarct size in TRANSIENT-STEMI trial.9 Full ACS therapy and early coronary angiography, within the next day, are indicated.
