- 期刊
ST Elevation in a Patient in the Early Phase of Exertional Heat Stroke: A Case Report and Literature Review
運動型中暑早期引發心電圖ST節段上升：病例報告及文獻回顧
摘要
儘管熱中暑已有不少文獻報告過，但是熱中暑引發心電圖ST節段上升及心肌酶升高在臨床上極少見。本文報告一位年輕男性在疑似中暑早期時立即給予降溫措施後被送至鄰近地區醫院求診，當時病患有意識改變及發燒等現象，檢驗報告意外發現有心肌酶升高，心電圖亦顯示ST節段上升，懷疑是急性心肌梗塞而轉診至本院。經由臨床表現及檢查報告診斷爲運動型中暑。在保守治療後，患者臨床狀況獲得改善。及時的降溫治療及支持性療法是此個案預後良好的關鍵因素。本文描述其一系列心電圖的變化，並回顧相關文獻，另外也提醒臨床醫師在過到此類情況時，應仔細詢問病史及觀察臨床表現，迅速做出正確的處理，才能使中暑的併發症降到最低！
並列摘要
Heat stroke has been reported, but elevation of serum cardiac enzymes and electrocardiogram (ECG) abnormalities can rarely be seen in the patients. Here, we describe a patient with an early phase of exertional heat stroke that was initially misdiagnosed as acute myocardial infarction (AMI). The case history is presented of one 22-year-old male recruit who was found to be disoriented, incoherent, and convulsive after a long military march on a hot summer day. Cooling measures were done immediately. He was first sent to a nearby community hospital, where his ear temperature was measured to be 38.8℃. The patient received intensive fluid resuscitation and was given supplemental oxygen. Evident ST elevation in leads V2-V6 of his ECG and raised serum cardiac enzymes were accidentally noted. Under the impression of AMI, he was referred to our hospital. His echocardiography and thallium-201 scan were unremarkable. During his stay in the hospital, ST elevation decreased and myocardial markers gradually normalized. After general condition was stable, he was discharged. We present this case to remind physicians that if ST-T elevation is found in the ECG of a heat stroke patient, AMI is not always the leading diagnosis. As in our case, rapid cooling and support of the organ systems are sufficient management in the early stage of heat stroke. This is because they are the key factors to prevent its progression and potential complications.
延伸閱讀
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- Ou, T. M., Huang, S. C., Shiang, J. C., & Wang, Y. C. (2011). 非持續性具症狀之心室心搏過速：病例報告及文獻回顧. 重症醫學雜誌, 12(4), 182-192. https://doi.org/10.30035/TCCM.201112.0005
- 楊宗茗、陳若佟、洪偉智、郭乃文、官大紳（2006）。中暑合併小腦運動失調之復健：案例報告。台灣復健醫學雜誌，34(3)，189-194。https://doi.org/10.6315/2006.34(3)08