[雙語翻譯]醫(yī)學(xué)外文翻譯--肺栓塞并發(fā)急性冠脈綜合征伴動態(tài)心電圖變化（英文）

1、Case ReportConcurrent pulmonary embolism and acute coronary syndrome with dynamic electrocardiographic changesAbstractConcomitant occurrence of pulmonary embolism and acute coronary syndrome is rare. The early diagnosis

2、and treatment of acute coronary syndrome with right ventricular myocardial ischemia during acute pulmonary embolism (APE) are crucial. The irreversible right ventricular myocar- dial dysfunction is a major risk factor fo

3、r mortality from APE. In this case report, we present a 66-year-old female patient with APE who had a significant right coronary artery (RCA) lesion, which was successfully treated with angio- plasty and stent implantati

4、on.Acute pulmonary embolism (APE) is a relatively frequent cardiovascular emergency that generally appears with chest pain and shortness of breath. The overall inhospital mortality rate of APE has been reported to be 7%

5、to 11% and raises to 25% among those with shock and to 65% among those with cardiopulmonary arrest [1,2]. Life-threatening severe right ventricular dysfunction may develop because of acute obstruction of pulmonary arteri

6、al bed. Irreversible functional impairment of right ventricle is a major risk factor for mortality. Therefore, acute coronary syndromes (ACSs), which accompany APE and affect the right ventricle functions in particular,

7、should be determined and treated in the early period. In the present case, a patient diagnosed with APE was successfully treated by percutaneous intervention of the RCA for the concurrent ACS. A 66-year-old woman was adm

8、itted to our emergency department with complaints of shortness of breath and burning chest pain for 4 hours. She also described swelling and pain in her left leg that occurred after a 4-hour bus trip a week ago. She was

9、transferred to the coronary care unit for the differential diagnosis of the chest pain. On her physical examination, blood pressure was 180/100 mm Hg, and heart rate was 104 beats per minute and regular. The respiratory

10、rate was 30 per minute, and oxygen saturation was 90% in room air. Her electrocardiogram (ECG) revealed a sinus rhythm with incomplete right bundle- branch block, negative T waves, and 0.5-mm ST-segment depression in lea

11、ds V1 to V6 (Fig. 1). Bedside transthoracicechocardiographic examination revealed an enlarged right ventricle with akinetic mid and basal segments and hyperkinetic apical segment (McConell's sign). There was moderate

12、 tricuspid insufficiency, and the estimated pulmonary artery pressure was 45 mm Hg. Because of the absence of shock or resistant hypotension, fibrinolytic therapy for APE was not considered, and she was scheduled for ele

13、ctive multislice computed tomography (MSCT) imaging. She was treated initially with enoxapar- ine (0.1 mg/kg, BID), acetylsalicylic acid (300 mg/d), and metoprolol (50 mg/d). Biochemical analysis showed increased D-dimer

14、 (2500 ng/mL), troponin I levels (1.2 U/L), and normal creatinine kinase/creatinine kinase-MB levels. On the second day of her hospitalization, she had burning chest pain that impaired hemodynamic stability (systolic blo

15、od pressure, 80-90 mm Hg) and was accompanied by paroxysmal atrial fibrillation (PAF) (Fig. 2). Because the PAF episodes became frequent and impaired the hemodynamic stability, coronary angiography was performed to elimi

16、nate an acute coronary event. Coronary angiography revealed 60% to 70% tubular narrowing of the mid segment of the left anterior descending artery (LAD) and 95% to 99% narrowing of the mid proximal segment of the RCA (Fi

17、g. 3A). Percutaneous transluminal coronary angioplasty (PTCA) was performed for the severe obstruction in RCA. The obstruction in the RCA was dilated via a 2.0 × 14 mm mercury balloon (Abbott Laboratories, Abbott Pa

18、rk, IL), and a 2.75 × 16 mm bare metal stent (20 atm, 3.3 mm; Flexmaster [JoMed GmbH, Rangendirgen, Germany]) was implanted (Fig. 3-B). After the intervention, the patient was hemody- namically stable, and the MSCT

19、pulmonary angiography was performed 3 days after the procedure. Multislice computed tomography imaging showed diffuse thrombus in both of the main pulmonary arteries extending through to the distal segment (Fig. 4). Dopp

20、ler ultrasound examination also showed thrombus in the deep femoral vein of the left lower extremity. On the fifth day, PTCA was performed for the lesion in LAD. The patient was discharged on the eighth day with warfarin

21、, acetylsalicylic acid, clopidogrel, atorvastatin, metoprolol, and ramipril. Acute pulmonary embolism is an urgent clinical condi- tion resulting from acute obstruction of pulmonary artery and the branches as well. The p

22、atients with acute massive pul- monary embolism (PE) that progresses to shock and hypo- tension due to severe right heart failure die in a short timewww.elsevier.com/locate/ajem0735-6757/$ – see front matter. Crown Copyr

23、ight © 2012 Published by Elsevier Inc. All rights reserved.American Journal of Emergency Medicine (2012) 30, 637.e1–637.e4Fig. 2 Paroxysmal atrial fibrillation that accompanied chest pain and hypotension on the seco