症例 心筋梗塞様心電図波形を呈した心筋挫傷の1例
症例は17歳,女性.道路を歩行中に対向してきたバスと接触し,全身打撲のため緊急入院した.胸部に擦過傷および皮下出血がみられたが,胸郭の変形はなかった.心電図上完全右脚ブロックに加えてII・III・aVF・V1・V2・V3に異常Q波があり,CK-MB ,GOT,LDHなど心筋逸脱酵素の上昇を伴ったので,心筋梗塞との鑑別が問題になった.しかし,心エコー図・心筋シンチグラム・心血管造影では異常が認められず,経過とあわせて臨床的に外傷性心筋挫傷による変化と診断した. 近年,交通事故時の鈍的胸部外傷による心筋挫傷が増加しているが,特異的な所見はなく,その診断は必ずしも容易でない.本報告では,心筋挫傷の発...
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| Published in | 心臓 Vol. 21; no. 5; pp. 611 - 617 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
1989
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo1969.21.5_611 |
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| Abstract | 症例は17歳,女性.道路を歩行中に対向してきたバスと接触し,全身打撲のため緊急入院した.胸部に擦過傷および皮下出血がみられたが,胸郭の変形はなかった.心電図上完全右脚ブロックに加えてII・III・aVF・V1・V2・V3に異常Q波があり,CK-MB ,GOT,LDHなど心筋逸脱酵素の上昇を伴ったので,心筋梗塞との鑑別が問題になった.しかし,心エコー図・心筋シンチグラム・心血管造影では異常が認められず,経過とあわせて臨床的に外傷性心筋挫傷による変化と診断した. 近年,交通事故時の鈍的胸部外傷による心筋挫傷が増加しているが,特異的な所見はなく,その診断は必ずしも容易でない.本報告では,心筋挫傷の発生頻度,診断,本例における心筋梗塞様心電図波形・右脚ブロックの成因について考察を加えた. |
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| AbstractList | 症例は17歳,女性.道路を歩行中に対向してきたバスと接触し,全身打撲のため緊急入院した.胸部に擦過傷および皮下出血がみられたが,胸郭の変形はなかった.心電図上完全右脚ブロックに加えてII・III・aVF・V1・V2・V3に異常Q波があり,CK-MB ,GOT,LDHなど心筋逸脱酵素の上昇を伴ったので,心筋梗塞との鑑別が問題になった.しかし,心エコー図・心筋シンチグラム・心血管造影では異常が認められず,経過とあわせて臨床的に外傷性心筋挫傷による変化と診断した. 近年,交通事故時の鈍的胸部外傷による心筋挫傷が増加しているが,特異的な所見はなく,その診断は必ずしも容易でない.本報告では,心筋挫傷の発生頻度,診断,本例における心筋梗塞様心電図波形・右脚ブロックの成因について考察を加えた. |
| Author | 籠島, 忠 大塚, 文明 上田, 一也 西田, 育功 梅原, 雅樹 葛本, 雅之 石川, 兵衛 土井, 康司 船谷, 泰嗣 青山, 信房 |
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| References | 8) Chou, J. H.: Pseudo-infarction; noninfarction Q waves. Cardio. Vasc. Clin., 5: 1 99, 1973. 1) Reid, J. M. and Baird, W. L. M.: Crushed chest injury: Some physiological disturbances and their correction. Br. Med. J., 1: 1105, 1965. 3) Sigler, L. H.: Traumatic injury to the heart; incidence of its occurrence in 42 cases of sever accidental bodily injury. Am. Heart J., 30: 459, 1945. 5) Kissane, R. W.: Traumatic heart disease. Circulation, 6: 421, 1952. 9) Lindsey, D., Navin, T. R. and Finley, P. R.: Transient evaluation of serum activity of MB phosphokinase in drivers involved in automobile accidents. Chest, 74: 15, 1978. 15) Hartrowitz, P. A. and Dinsmor, RE.: Traumatic myocardial infarction. Report of a case with normal coronary angiogram. Ann. Intern. Med., 66: 341, 1967. 2) Parmley, L. F., Manion, W. C. and Mattingly, T. W.: Nonpenetrating traumatic injury to th e heart. Circulation, 18: 371, 1958. 17) Depasquale, N. P., Burch, G. E. and Phillips, J. H.: Electrocardiographic alterations associated with electrically silent areas of myoca r dium. Am. Heart J., 68: 697, 1964. 14) Leinhoff, H. D.: Acute coronary thrombosis in industry; direct nonpenetrating injuries with report cases. Arch. Intern. Med., 70: 33, 1943. 4) De Muth, W. E. and Zinsser, H. F.: Myocardial contusion. Arch. Intern. Med., 115: 434, 1965. 12) Kennedy, W. J., Sridharan, M. R. and Flowers, N. C.: Nonpenetrating traumatic complete heart block and myocardial infarctio n with normal coronaries. Cathet. Cardiovasc. Diagn., 9: 63, 1983. 16) Gambetta, M. and Childers, R. W.: Rate-dependent right precordial Q waves; septal focal block. Am. J. Cardiol., 32: 196, 1973. 11) Anto, M. J., Cokinos, S. G. and Jonas, E.: Acute anterior wall myocardial infarction secondary to blunt chest trauma. Angiology, 35: 802, 1984. 6) Zinsser, H. F. and Thind, G. S.: Right bundle brunch block after nonpenetrating injury to the chest wall. J. A. M. A., 207: 1913, 1969. 7) Bharati, S., Chervony, A., Gruhun, J., Rosen, K. M. and Lev, M.: Atrial arrhythmias related t o trauma to sinoatrial node. Chest, 61: 331, 197 2. 13) Watt, A. H. and Stephens, M. R.: Myocardial infarction after blunt chest trum a incurred during rugby football that later required cardiac transplantation. Br. Heart J., 55: 408, 1986. 10) Watson, J. H. and Bartholomae, W. M.: Cardiac injury due to nonpenetrating chest traum a. Ann. Intern. Med., 52: 871, 1960. |
| References_xml | – reference: 5) Kissane, R. W.: Traumatic heart disease. Circulation, 6: 421, 1952. – reference: 8) Chou, J. H.: Pseudo-infarction; noninfarction Q waves. Cardio. Vasc. Clin., 5: 1 99, 1973. – reference: 7) Bharati, S., Chervony, A., Gruhun, J., Rosen, K. M. and Lev, M.: Atrial arrhythmias related t o trauma to sinoatrial node. Chest, 61: 331, 197 2. – reference: 10) Watson, J. H. and Bartholomae, W. M.: Cardiac injury due to nonpenetrating chest traum a. Ann. Intern. Med., 52: 871, 1960. – reference: 16) Gambetta, M. and Childers, R. W.: Rate-dependent right precordial Q waves; septal focal block. Am. J. Cardiol., 32: 196, 1973. – reference: 6) Zinsser, H. F. and Thind, G. S.: Right bundle brunch block after nonpenetrating injury to the chest wall. J. A. M. A., 207: 1913, 1969. – reference: 11) Anto, M. J., Cokinos, S. G. and Jonas, E.: Acute anterior wall myocardial infarction secondary to blunt chest trauma. Angiology, 35: 802, 1984. – reference: 1) Reid, J. M. and Baird, W. L. M.: Crushed chest injury: Some physiological disturbances and their correction. Br. Med. J., 1: 1105, 1965. – reference: 2) Parmley, L. F., Manion, W. C. and Mattingly, T. W.: Nonpenetrating traumatic injury to th e heart. Circulation, 18: 371, 1958. – reference: 9) Lindsey, D., Navin, T. R. and Finley, P. R.: Transient evaluation of serum activity of MB phosphokinase in drivers involved in automobile accidents. Chest, 74: 15, 1978. – reference: 12) Kennedy, W. J., Sridharan, M. R. and Flowers, N. C.: Nonpenetrating traumatic complete heart block and myocardial infarctio n with normal coronaries. Cathet. Cardiovasc. Diagn., 9: 63, 1983. – reference: 13) Watt, A. H. and Stephens, M. R.: Myocardial infarction after blunt chest trum a incurred during rugby football that later required cardiac transplantation. Br. Heart J., 55: 408, 1986. – reference: 17) Depasquale, N. P., Burch, G. E. and Phillips, J. H.: Electrocardiographic alterations associated with electrically silent areas of myoca r dium. Am. Heart J., 68: 697, 1964. – reference: 14) Leinhoff, H. D.: Acute coronary thrombosis in industry; direct nonpenetrating injuries with report cases. Arch. Intern. Med., 70: 33, 1943. – reference: 15) Hartrowitz, P. A. and Dinsmor, RE.: Traumatic myocardial infarction. Report of a case with normal coronary angiogram. Ann. Intern. Med., 66: 341, 1967. – reference: 3) Sigler, L. H.: Traumatic injury to the heart; incidence of its occurrence in 42 cases of sever accidental bodily injury. Am. Heart J., 30: 459, 1945. – reference: 4) De Muth, W. E. and Zinsser, H. F.: Myocardial contusion. Arch. Intern. Med., 115: 434, 1965. |
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| Snippet | 症例は17歳,女性.道路を歩行中に対向してきたバスと接触し,全身打撲のため緊急入院した.胸部に擦過傷および皮下出血がみられたが,胸郭の変形はなかった.心電図上完全右... |
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| SubjectTerms | 心筋挫傷 心筋梗塞様心電図 胸部外傷 非梗塞性異常Q波 |
| Title | 症例 心筋梗塞様心電図波形を呈した心筋挫傷の1例 |
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