PDF(Pubmed)
Abstract：
Wolff-Parkinson-White (WPW) syndrome, known for episodes of tachycardia and distinctive electrocardiographic (ECG) patterns, often makes it harder to diagnose myocardial infarction (MI) because it can hide the usual ECG signs of MI. Early use of high-sensitivity troponin levels and echocardiography to detect myocardial injury in WPW is important, facilitates timely intervention and improves patient outcomes. This report presents the case of a 39-year-old Caucasian male with no chronic disease history who presented to a family health center with intermittent mild chest pain localized to the left side, characterized by a burning and dull ache, for one week. On the day of presentation, the patient experienced increased pain accompanied by palpitations and mild sweating. An ECG at the family health center showed findings of WPW. Due to the presence of typical chest pain and WPW pattern on the ECG, the patient was referred to a tertiary hospital emergency department. At the tertiary hospital, repeat ECGs showed no changes, but blood tests revealed elevated troponin T levels (495 ng/ml initially, 485 ng/ml after 4 hours). The patient was admitted to the cardiology critical care ward. Echocardiography indicated regional wall motion abnormalities in specific segments. Coronary angiography revealed ectasia in vessels with slow flow but no obstructed vessels. This case underscores the diagnostic challenges posed by WPW syndrome in the context of MI and highlights the importance of using high-sensitivity troponin levels and echocardiography for early diagnosis to improve patient outcomes.
摘要：
Wolff-Parkinson-White(WPW)综合征,以心动过速发作和独特的心电图（ECG）模式而闻名，通常会使诊断心肌梗塞（MI）变得更加困难，因为它可以隐藏通常的MI心电图征象。早期使用高敏肌钙蛋白水平和超声心动图检测WPW心肌损伤是重要的，促进及时干预并改善患者预后。本报告介绍了一名39岁的白人男性，没有慢性病史，他被送到家庭保健中心，间歇性轻度胸痛局限于左侧，以灼热和沉闷的疼痛为特征，一周。在演讲当天，患者疼痛加重，伴有心悸和轻度出汗。家庭保健中心的心电图显示了WPW的发现。由于心电图上存在典型的胸痛和WPW模式，病人被转诊到三级医院急诊科。在三级医院，重复心电图显示没有变化，但是血液检查显示肌钙蛋白T水平升高（最初是495ng/ml，485ng/ml后4小时)。患者被送进心脏病重症监护病房。超声心动图提示特定节段局部室壁运动异常。冠状动脉造影显示血管扩张，血流缓慢，但没有阻塞的血管。该病例强调了在MI背景下WPW综合征带来的诊断挑战，并强调了使用高灵敏度肌钙蛋白水平和超声心动图进行早期诊断以改善患者预后的重要性。
