The Korean Journal of Emergency Medical Services (한국응급구조학회지)

The Korea Society of Emergency Medical Services (한국응급구조학회)
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Case Report: Cardiac tamponade in a patient with isolated posterior myocardial infarction presenting with syncope

실신으로 내원한 후벽 단독 심근경색 환자에서 발생한 심장눌림증 1례

  • Kang, Min Seong (Department of Preventive Medicine, College of Medicine, Hanyang University) ;
  • Oh, Seong Beom (Department of Emergency Medicine, College of Medicine, Dankook University) ;
  • Kim, Ji-Won (Department of Medicine, Graduate School, Dankook University)
  • 강민성 (한양대학교 의과대학 예방의학교실) ;
  • 오성범 (단국대학교 의과대학 응급의학교실) ;
  • 김지원 (단국대학교 대학원 의학과)
  • Received : 2021.02.28
  • Accepted : 2021.04.20
  • Published : 2021.04.30
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Abstract

Cardiogenic syncope occurs due to arrhythmia (bradycardia and tachycardia) or decreased cardiac output, and if proper treatment is not provided, it can lead to acute sudden death. A detailed medical history and physical examinations are required to determine the cause of syncope, and clinical approaches, including 12-lead ECG, are important. The 12-lead ECG does not have a chest lead in the posterior wall of the left ventricle; therefore, ECG of the isolated posterior wall myocardial infarction caused by left circumflex artery occlusion is not observed with ST elevation. Therefore, the significantly higher appearance of ST depression and R waves than S waves from V1 to V3 of the chest lead must be interpreted meaningfully. Isolated posterior wall myocardial infarction is small in the area of myocardial necrosis, and tension is increased in the necrotic area due to the contraction of the normal myocardial muscle, which can cause ventricular wall rupture. Therefore, it is necessary to additionally check Beck's triad, such as jugular venous distension and decreased heart sound, in patients with low blood pressure with an isolated posterior wall myocardial infarction on 12-lead ECG in patients with syncope.

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References

  1. Choi YY, Choi JI. Clinical approach and diagnosis of syncope. Korean J Med 2020;95(4):251-9. https://doi.org/10.3904/kjm.2020.95.4.251
  2. Dovgalyuk J, Holstege C, Mattu A, Brady WJ. The electrocardiogram in the patient with syncope. Am J Emerg Med 2007;25(6):688-701. https://doi.org/10.1016/j.ajem.2006.12.016
  3. Lee KW. Clinical analysis of direct medical oversight in a Korean metropolitan city. J Korean Soc Emerg Med 2017;28(4):362-73.
  4. Long BJ, Serrano LA, Cabanas JG, Bellolio MF. Opportunities for emergency medical services (EMS) care of syncope. Prehospital and Disaster Medicine 2016:31(4):349-52. https://doi.org/10.1017/S1049023X16000376
  5. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A et al. 2018 ESC Guidelines for the diagnosis and management of syncope. European Heart J 2018;39(21):1883 -948. https://doi.org/10.1093/eurheartj/ehy037
  6. Kim YH. Ventricular tachycardia of the coronary arterial diseases. Int J Arrhythm 2010:11(1);16-9.
  7. Bodson L, Bouferrache K, Vieillard-Baron A. Cardiac tamponade. Current Opinion in Critical Care 2011:17(5);416-24. https://doi.org/10.1097/MCC.0b013e3283491f27
  8. Chung JM. Advanced trauma life support. J Korean Med Assoc 2007:50(8);680-91. https://doi.org/10.5124/jkma.2007.50.8.680
  9. Pride YB, Tung P, Mohanavelu S, Zorkun C, Wiviott SD, Antman EM et al. Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depression: a TRITON-TIMI 38 (trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with Prasugrel-thrombolysis In myocardial infarction 38) substudy. JACC: Cardiovascular Interventions 2010:3(8);806-11. https://doi.org/10.1016/j.jcin.2010.05.012
  10. Matetzky S, Freimark D, Feinberg MS, Novikov I, Rath S, Rabinowitz B et al. Acute myocardial infarction with isolated ST-segment elevation in posterior chest leads V7-9: "hidden" ST-segment elevations revealing acute posterior infarction. J Am Coll Cardiology 1999:34(3);748-53. https://doi.org/10.1016/S0735-1097(99)00249-1
  11. Krishnaswamy A, Lincoff AM, Menon V. Magnitude and consequences of missing the acute infarct-related circumflex artery. American Heart J 2009:158(5);706-12. https://doi.org/10.1016/j.ahj.2009.08.024