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本文报道4例死于急性心肌梗死心脏破裂,经尸解证实的病人。心肌梗死已存在一天以上,但临床表现不明显,直至心脏破裂出现明显心绞痛症状及心源性休克时,才诊断为急性心肌梗死。抢救无效死亡。这可称为“隐匿性破裂”。病例1 女性,61岁。患高血压已7年。主诉左臂疼痛,前此只稍有不适。2天后,发展为胸部隐痛,第5天,突感胸部剧痛,并出现虚脱。当即入院。收缩压70毫米汞柱,心率110次/分。心电图示近期急性前侧壁心肌梗死。用利多卡因治疗。于入院16 小时突然死亡。尸检发现,左室前间壁穿透性心肌梗死,中心破裂导致心包填塞,有400毫升血液。前降支及左旋支动脉有近期完全性阻塞。镜检坏死心肌处有大量白细胞浸润。说明实际梗死时间比临床病史提供的(24小期)要早。病例2 男性,63岁。主诉间歇性胸痛几星期,
This article reports 4 patients died of acute myocardial infarction heart rupture, confirmed by autopsy patients. Myocardial infarction has existed for more than a day, but the clinical manifestations are not obvious until the heart rupture obvious angina symptoms and cardiogenic shock, was diagnosed with acute myocardial infarction. Rescue invalid death. This can be called “occult rupture.” Case 1 Female, 61 years old. Hypertension has been 7 years. Chief complaint left arm pain, before this only a little discomfort. 2 days later developed chest pain, the first 5 days, suddenly felt chest pain, and collapse. Immediately admitted to hospital. Systolic blood pressure 70 mm Hg, heart rate 110 beats / min. ECG shows the recent acute anterior myocardial infarction. Treatment with lidocaine. Sudden death 16 hours after admission. Autopsy found that left anterior wall transmural myocardial infarction, central rupture leads to pericardial packing, with 400 ml of blood. Anterior descending artery and left circumflex artery have recent complete obstruction. Microscopic necrotic myocardium at a large number of leukocyte infiltration. That the actual infarction time than the clinical history provided (24 small) earlier. Case 2 male, 63 years old. Chief complaint intermittent chest pain for a few weeks,