We described an 82-year-old man who was taken to our emergency department after being found unconscious. His electrocardiogram (ECG) showed ST-segment elevation in leads V4-V6 and cardiac troponin I (cTnI) was abnormally elevated. In addition to ECG and cTnI changes, this patient was combined with unconsciousness, high fever, abnormal liver function, acute renal failure, and rhabdomyolysis. The initial diagnosis was heat stroke, so cooling measures were initiated immediately, but a concurrent myocardial infarction was suspected. Meanwhile, emergency coronary angiography was performed, but no severe coronary stenosis or thrombosis was found. We first evaluated quantitative flow ratio (QFR) and coronary angiography-derived index of microvascular resistance (ca-IMR) in patients with heat stroke. Ca-IMR was 260 mmHg*s/m in the left circumflex artery, indicating the presence of coronary microvascular dysfunction (CMD). After several days of treatment, the patient recovered from multiple organ damage. Therefore, ECG and troponin results should be interpreted carefully in patients with high fever and coma during high temperature seasons.

目的 部分阵发性室上速(PVST)患者伴随肌钙蛋白(cTn I)水平升高,本研究旨在探讨PVST导致cTnI升高是否与冠脉狭窄程度存在相关性.方法 回顾性分析本院2018年至2022年,因PVST急诊入院,后经心脏电生理检查证实,并完成射频消融术的成年患者共224例,其中cTn I水平正常者142例,设为对照组,cTn I水平升高者82例,设为观察组.住院期间均完成冠脉CT或冠脉造影检查.结果 观察组室上速发作时心室率较对照组快[(164.8±14.8)VS.(156.6±20.1)],观察组心衰指数、纤溶指数更高,且房室结双径路人数占比更多,两组差异有统计学意义(P<0.05).但两组冠脉狭窄程度方面差异无统计学意义(P>0.05).结论 室上速发作伴随cTn I水平升高者,若心电图无明显ST-T动态演变或症状上无典型胸痛,cTn I水平升高一般考虑快心室率导致心肌损伤可能性大,与冠脉狭窄不一定存在相关性,临床上应减少误诊为急性冠脉综合征.

Objective To compare the value and influencing factors of esophageal atrial pacing(TEAP)and intracardiac electrophysiological examination(EPS)in the diagnosis of parparal ventricular hypervelocity(PSVT).Methods A retrospective analysis was performed on 436 patients who underwent TEAP,EPS and radiofrequency ablation due to PSVT from January 2017 to March 2022.According to whether intravenous antiarrhythmic drugs had been used in the short time(2.17±1.63)d before the examination,the patients were divided into the medication group and the non-medication group,among which medication group had stopped more than 5 half-lives before examination.PSVT was divided into two atrioventricular node paths,left side bypass and right side bypass.According to the stimulation method,they were divided into TEAP and EPS.The final successful ablation target was used as the gold standard for PSVT typing.Results There was a statistically significant difference in TEAP induction rate between the untreated group(72%)and the treated group(56.5%)(P<0.05).There was a statistically significant difference(P<0.05)in the induction of TEAP on dual pathway,left side pathway,and right side pathway.The difference in TEAP induction rate compared to EPS was statistically significant(P<0.05).The accuracy of TEAP in diagnosing PSVT was 83.9%.Isoprenephrine can increase the induction rate of EPS from 76.8%to 94.7%.Conclusion TEAP is an effective method for preoperative diagnosis of PSVT.Withdrawal of intravenous antiarrhythmic drugs over 5 half-life periods still has a certain effect on TEAP induction.Isoproterenol can improve the induction rate of EPS.

目的 阵发性室上性心动过速(PSVT)在不同年龄段皆可发生,本研究旨在探讨成人PSVT类型是否与年龄、性别存在相关性.方法 回顾性分析2017年1月至2022年3月因PSVT入院成年患者共726例.按手术时年龄分为四组:<20岁,20～40岁,41～60岁,>60岁;按类型分为房室结折返性心动过速(AVNRT)和房室折返性心动过速(AVRT);AVRT按位置进一步细分为左侧、右侧、心外膜三种类型旁道.结果 ①AVNRT较AVRT发生率高(63.1％?VS.?36.9％),女性AVNRT发生率是男性的1.7倍,男性AVRT发生率是女性的1.26倍;②随着年龄的增长,AVNRT发生率逐渐增高(37.9％、48.1％、61.7％、72.5％),AVRT发生率逐渐降低(62.1％、51.8％、38.3％、27.5％);③<20岁和20～40岁年龄组男性AVRT比AVNRT发生率高,41～60岁和>60岁年龄组女性AVNRT比AVRT发生率高;④41～60岁是射频消融手术的高峰年龄,占总人数51.1％.结论 成人室上速类型与性别、年龄在某些方面存在一定的相关性.

Acute myocardial infarction (AMI) and acute ischemic stroke (AIS) are the main causes of disability and mortality worldwide. Although reperfusion therapy is the most effective treatment for the two diseases, it is still a great challenge for treating the two diseases at the same time. Here we share 2 cases: one patient was hospitalized for AMI, developed AIS after receiving percutaneous coronary intervention (PCI), and suffered from cardiac rupture after alteplase thrombolytic therapy. The other patient was admitted for AIS, who had sudden chest pain during the thrombolytic process of alteplase. Considering AMI, emergency PCI was performed, and he was finally discharged.

本文报道浙江大学医学院附属金华医院2019年9月25日收治的1例患儿,运动后诱发心肌损伤、心源性休克、泵衰竭,接受呼吸机、体外膜氧合器支持治疗.冠状动脉(下称冠脉)计算机断层扫描血管成像和冠脉造影显示左冠脉起源右冠状窦,行左冠脉起源异常矫治术治疗.术后随访,该患儿进行性心脏扩大、左心室收缩功能减退,临床预后差.

目的:观察利心丸联合缬沙坦治疗慢性心力衰竭的疗效及对明尼苏达心功能不全生活量表(MLHFQ)评分、6 min步行试验(6MWT)的影响.方法:回顾性分析85例慢性心力衰竭患者的临床资料,按治疗方式将其分为对照组与观察组.对照组43例给予缬沙坦胶囊口服,观察组42例在对照组基础上加服利心丸.比较2组临床疗效,并比较2组治疗前后心功能指标、MLHFQ评分、6MWT与血清炎性因子水平.结果:与同组治疗前比较,治疗后2组左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、MLHFQ评分及血清白细胞介素-6 (IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)水平均降低(P＜0.05),左心室射血分数(LVEF)、6MWT升高(P＜0.05);与对照组治疗后比较,观察组治疗后LVEDD、LVESD、MLHFQ评分及血清IL-6、hs-CRP、TNF-α水平更低(P＜0.05),LVEF、6MWT更高(P＜0.05).观察组总有效率92.85％,高于对照组76.74％ (P＜ 0.05).结论:利心丸联合缬沙坦治疗慢性心力衰竭,可有效提高临床疗效,改善心功能,降低血清炎性因子水平,增加6MWT,降低MLHFQ评分.

Objective:To investigate the application value of combined detection of hypoxia-inducible factor-1α (HIF-1α), N-terminal proBNP (NT-proBNP) and thromboxane B 2 (TXB 2) in the prediction of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction. Methods:The clinical data of 136 patients with acute ST-elevation myocardial infarction who received treatment in Jinhua Municipal Central Hospital, China between February 2018 and September 2019 were retrospectively analyzed. These patients were assigned to MACE group ( n = 33) and no MACE group ( n = 103) according to whether MACE occurred. The basic data was compared between the two groups. Serum levels of HIF-1α, NT-proBNP and TXB 2 prior to PCI were analyzed. The receiver operating characteristic (ROC) curve was plotted to investigate the application value of combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels in the prediction of acute ST-elevation myocardial infarction after PCI. Results:At 6 months after PCI, MACE occurred in 33 out of 136 patients with acute ST-elevation myocardial infarction, with the incidence of 24.26%. There were no significant differences in age, sex and accompanied diseases between MACE and no MACE groups (all P > 0.05). Serum HIF-1α level in the MACE group was significantly lower than that in the no MACE group [(31.54 ± 5.26) ng/L vs. (37.18 ± 6.94) ng/L, t = 4.286, P < 0.05]. Serum levels of NT-proBNP and TXB 2 in the MACE group were (1 246.83 ± 243.71) μg/L and (125.13 ± 20.16) ng/L, respectively, which were significantly higher than those in the no MACE group [(876.92 ± 173.04) μg/L, (95.73 ± 18.24) ng/L, t = 9.617, 7.835, both P < 0.05]. ROC curve analysis showed that the optimal cutoff values of serum HIF-1α, NT-proBNP and TXB 2 levels in the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI were 32.67 ng/L, 1 018.27 μg/L and 112.19 ng/L, respectively. The sensitivity and specificity of combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels in the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI were 69.70% (23/33) and 98.06% (101/103), respectively. The specificity of the combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels was higher than that of detection of serum HIF-1α, NT-proBNP or TXB 2 level alone. The area under the curve (AUC) plotted regarding the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI by combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels was 0.901, which was significantly higher than the AUC obtained for detection of serum HIF-1α, NT-proBNP or TXB2 level alone ( Z = 2.007, 1.991 and 2.217, all P < 0.05). Conclusion:Combined detection of serum HIF-1α, NT-proBNP and TXB 2 levels exhibits a higher value in the prediction of MACE occurrence in patients with acute ST-elevation myocardial infarction after PCI than detection of serum HIF-1α, NT-proBNP or TXB 2 level alone.

目的:探讨非勺型血压与冠状动脉病变严重程度的相关性.方法:2017年1月-2018年1月收治冠心病患者212例,根据住院期间动态血压监测结果分为非勺型血压组157例及勺型血压组55例.比较两组冠状动脉病变的严重程度.结果:非勺型血压组多支病变率、Gensini积分高于勺型血压组,差异均有统计学意义(P<0.001).多元线性回归分析,年龄、男性及非勺型血压与Gensini积分呈正相关(P<0.05).结论:非勺型血压与冠状动脉病变严重程度具有密切相关性.