Author/Editor		Podlesnikar, Tomaž; Gričar, Marko
Title		Zavajajoče EKG spremembe pri prsni bolečini: prikaz primera
Translated title		Misleading ECG changes in acute chest pain: case report
Type		članek
Source		In: Urgentna medicina: izbrana poglavja 2012 Ljubljana : Slovensko združenje za urgentno medicino
Publication year		2012
Volume		str. 280-282
Language		slv
Abstract		Bolniki z AKS imajo lahko povsem enake bolezenske simptome in znake. Pri obeh bolezenskih sindromih so navadno prisotne tudi spremembe v EKG. V pričujočem prispevku predstavljamo primer bolnice s PE, ki je tožila nad bolečinami v prsih in težkim dihanjem in pri kateri so bili prehodno v EKG prisotni negativni T valovi v odvodih V3-V6. Zlasti slednje je vodilo naše diferencialno diagnostično razmišljanje v smeri AKS. Po podatkih iz literature so namreč negativni T valovi v sklopu PE navadno omejeni na V1-V3/V4 in tudi po naših kliničnih izkušnjah se le redko razširijo na odvode stranske sten (V5-V6). Mnogo bolj pogosto srečamo tako jasno izražene in obsežne EKG spremembe v sklopu AKS, pri Wallensovem sindromu. Kadarkoli, po negativni koronarografiji smo postavili pravilno diagnozo in bolnico uspešno zdravili. Dejstvo, da lahko v sklopu PE nastanejo negativni T valovi v vseh prekordialnih odvodih, pomeni dodatno prekrivanje klinične slike z AKS, kar je potrebno imeti v mislih, ko imamo pred seboj bolnika z akutno nastalo prsno bolečino.ACS and PE may present with almost identical symptoms and signs, both are alsoassociated with EKG abnormalities. In the following article we present a clinical case of a patient with PE, who complained about chest pain and breathing difficulties and had transient negative T waves in ECG leads V3-V6. It was predominantly ECG that misled our diagnostic consideration in favour of ACS. Namely, according to the literature, T wave inversion in the setting of acute PE usually encompasses leads V1-V3/V4. Also according to our experience it seldom involves lateral precordial leads (V5-V6). Much more frequently such pronounced and widespread ECG changes develop during the course of ACS as a part of the Wellens syndrome. Nevertheless, after negative coronarography, a correct diagnosis of PE was established and patient was treated successfully. In conclusion. PE can cause widespread T wave inversion in all precordial ECG leads and thus mimic ACS. As such it poses additional diagnostic challenge in the setting of acute cardiac care.
Descriptors		Chest Pain Prsna bolečina Pulmonary Embolism Pljučna embolija Electrocardiography Elektrokardiografija Acute Coronary Syndrome Akutni koronarni sindrom