Sudden Attack of Acute Myocardial Infarction in a Diabetic Patient Following Acute Tibial Fracture

脛骨骨折併發急性心肌梗塞

林豐彥(Feng-Yen Lin) ； 翁國昌(Kwo-Chang Ueng) ； 吳肇鑫(Chao-Hsin Wu) ； 周明智(Ming-Chih Chou)

《中華民國急救加護醫學會雜誌》 20卷4期 (2009/12) Pp. 226-230

https://doi.org/10.30018/JECCM.200912.0010

摘要

有許多的原因例如糖尿病、高血壓及壓力…等等可以引起急性的心肌梗塞。然而，在受到創傷之後進而引起的急性心肌梗塞案例則是少之又少。只有少數的案例曾經被報告過，而這些病人大部份都是經由胸腔的創傷所引起的。在此，我們要報告一例急性心肌梗塞併發心因性休克是因為車禍造成脛骨骨折所引起的。身為急診醫師，在繁忙的急診環境內照顧外傷病患必須時刻的警覺及關注傷患生命徵象的變化和病人的主訴並能做出快速反應及妥善治療。

關鍵字

急性心肌梗塞 ； 脛骨骨折

並列摘要

Acute myocardial infarction (AMI) is a potentially fatal and often unrecognized complication following acute non-thoracic trauma. We present a 50-year-old male patient who developed AMI after acute tibial fracture. He presented with chest pain and subsequent cardiogenic shock that began after being involved in a car accident. He had type 2 diabetes mellitus which was diagnosed 10 years prior to this admission. Cardiac enzymes were found elevated. His electrocardiogram (ECG) showed ST-segment elevation in leads V1-6. Coronary angiography showed multiple vessel disease. After percutaneous coronary intervention, intra-aortic balloon pump, and extracorporeal membrane oxygenation, his chest pain was relieved and ST elevations on ECG regressed. Acute extraordinary stress may have been responsible for AMI in this patient as a result of sympathetic hyperactivity and blood pressure elevation.

並列關鍵字

acute myocardial infarction AMI ； tibial fracture