风湿性心脏病合并急性心肌梗死临床病例分析

目的分析风湿性心脏瓣膜病患者合并急性心肌梗死的临床特点及造影表现。方法回顾性分析5例风湿性心脏瓣膜病合并急性心肌梗死患者的临床资料。结果5例患者均为二尖瓣病变,其中4例合并心房纤颤。心电图显示前壁心肌梗死3例,下壁心肌梗死2例。合并其他部位栓塞者1(脑栓塞)。4例患者进行了冠状动脉造影检查,其中1例提示为冠脉栓塞,3例提示为粥样硬化性冠脉病变。结论风湿性心脏病合并急性心肌梗死的病因可为冠状动脉粥样硬化性心脏病,也可为血栓栓塞。血栓栓塞导致急性心肌梗死者常有心房纤颤等血栓好发因素,急性期造影常表现为冠脉闭塞,有时可见栓塞征象。冠心病急性心肌梗死造影则多显示多支病变。

Acute myocardial infarction complicated in rheumatic heart disease: clinical analysis of 5 cases

Objective To investigate the clinical and angiographic features of acute myocardial infarction (AMI) in patients with chronic rheumatic heart disease (RHD).Methods Data of 5 patients were analyzed retrospectively.Results All patients had mitral valve disease, 4 of them had atrial fibrillation. ECG showed anterior wall infarction in 3 patients and inferior wall infarction in 2 patients. 1 patient also had cerebral infarction. In 4 patients who took coronary angiography examination, coronary embolism was found in one patient and atherosclerotic stenosis was found in the other 3 patients.Conclusion In RHD patients, AMI caused by embolism usually happens in patients with atrial fibrillation. AMI caused by atherosclerotic stenosis usually has multiple-vessel stenosis.