NSTEMI with Total Left Circumflex Occlusion: How the N-wave Might Help (case Report).

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Abstract

ABSTRACT A rise and/or fall in troponin level is an indication of type 1 or 2 myocardial infarct. A 62-year-old male physician presented to emergency room with chest discomfort followed by thought to be normal electrocardiogram (ECG) and normal echocardiography results. His serial hs-troponin test showed remarkable escalation three hours from the initial (107 ng/l into 4.978 ng/l), suggesting a high-risk non-ST-segment myocardial infarction (NSTEMI). An early invasive procedure was performed, showing acute total occlusion (TO) in the obtuse marginal 1 branch. We retrospectively reviewed our examination to diagnose better the presence of TO in NSTEMI patients presented with non-diagnostic examination. Our evaluation showed a minor change in the form of an ‘N-wave’ pattern on the ECG, which was not yet an established guideline criterion for prompt angiography. Although ECG pattern is often normal in LCx occlusion, recent study shows the presence of ‘N-wave’ ECG pattern in 10% of NSTEMI cases following TO at LCx.

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【要点】：本文通过病例报告发现，NSTEMI患者中，当左回旋支完全闭塞时，ECG上出现的“N波”模式可能作为早期诊断的指标。

【方法】：作者回顾性地分析了一位62岁男性医生的病例，通过连续的hs-troponin测试和早期侵入性手术，发现了左回旋支急性完全闭塞的情况。

【实验】：通过病例回顾，实验结果揭示了在非诊断性检查中，存在“N波”模式的ECG改变，而这一模式在当前指南中尚未作为紧急冠脉造影的标准指征。尽管LCx闭塞时ECG通常正常，但最近的研究显示，在LCx完全闭塞后的NSTEMI病例中，有10%出现了“N波”ECG模式。数据集为单一病例的ECG和troponin检测结果。