巨大冠状动脉瘤样扩张一例

患者男性,68岁。因心慌、胸闷3 h于2004年4月24日入院。9年前患急性下壁心肌梗死。查体:血压100/60mm Hg(1 mm Hg=0·133 kPa),双肺呼吸音粗,双肺底未闻及细湿音。心率160次/分,节律齐,心音低。心电图示室性心动过速(室速)、陈旧性下壁心肌梗死。入院后先给予利多卡因100 mg静脉注射,无效;后又给予胺碘酮150 mg静脉注射,然后以1 mg/min的速度静脉泵入。约一小时左右患者血压降到85/50 mm Hg,且双肺底可闻及细湿音。立即给予双向波直流电100 J转复心律,转复过程中患者出现呼吸停止,又给予气管插管抢救成功。后行冠状动脉造影检查,发现其左…     

肢端肥大症性心肌病伴冠状动脉瘤样扩张一例

<正>1临床资料患者女性,56岁,因"心悸、胸闷2个月,加重伴胸痛一天"入院。患者2个月前无诱因突然出现心悸发作,感心律不齐,伴有胸闷,无胸痛,无黑朦、晕厥,无畏寒、发热,无咳嗽、咳痰,休息约1 h左右症状逐渐缓解。2个月来反复出现心悸、胸闷发作,症状同前,持续数十分钟至数小时不     

冠状动脉瘤样扩张

本文介绍冠状动脉瘤样扩张的病因，诊断，临床意义和治疗方法。     

弥漫性巨大冠状动脉瘤样扩张并发心肌梗死一例

患者男性,64岁,因反复胸闷胸痛15 d入院.患者2009年10月29日于受凉后突发持续性胸前区疼痛,伴大汗淋漓,当地医院急诊心电图示急性前壁心肌梗死,肌酸激酶(CK):210 U/L(正常值:13～174 U/L),CK-MB:28.5 U/L(正常值:0～23 U/L),予尿激酶静脉溶栓后胸痛明显缓解.     

巨大冠状动脉瘤样扩张并发急性心肌梗死一例

正1临床资料患者男性,32岁,因"突发胸痛伴大汗6 h"入院。既往无胸闷、胸痛症状发作,无高血压、糖尿病病史,否认吸烟、饮酒史。入院查体:心界不大,心率70次/min,心律齐,各瓣膜听诊区未闻及病理性杂音。血压106/70 mm Hg(1 mm Hg=0.133 k Pa),双侧上肢血压无明显差别,双肺呼吸音清,未闻及干湿罗音。双下肢不肿,双足背动脉搏动对称。入院心电图示:窦性心律,V2~3导联T波高尖,Ⅱ、Ⅲ、a VF导     

药物洗脱支架术后冠状动脉瘤样扩张一例

<正>1病例介绍患者,男,65岁。因活动后胸闷心悸2年,加重1周于2015-06-18入住上海市普陀区中心医院心内科。患者否认既往高血压、糖尿病、慢性肾脏病等慢性病史。门诊查心电图示窦性心律、室性早搏;心超提示心脏多节段收缩活动异常,左室射血分数(LVEF)0. 40。入院查体无明显异常。实验室检查:血常规、尿常规、粪便常规、肝肾功能、凝血功能、血糖、血脂、肌钙蛋白等化验指标均正常。入院诊断:冠状动脉     

雷帕霉素洗脱支架远期致冠状动脉局部血管瘤样扩张四例报告

目的分析雷帕霉素洗脱支架远期发生冠状动脉局部血管瘤样扩张的特点及原因。方法2004年4—7月接受介入治疗的冠心病患者4例,男3例,女1例,造影显示7支病变血管共置入9个支架,其中前降支置入Cypher select支架5个,回旋支置入Firebird支架2个,Pixel支架1个,右冠状动脉置入Cypher select支架1个。术后口服氯吡格雷75mg／d持续1年。结果4例均成功置入支架,病变血管达TIMI Ⅲ级血流灌注,心绞痛症状消失,无急性／亚急性血栓形成。平均随访（24．8±1．8）个月,无主要心脏不良事件发生。术后12个月冠状动脉造影随访,无支架内再狭窄及新病变出现。停用氯吡格雷,继续门诊随访,病情稳定。4例患者分别于术后16、18、22个月因心绞痛症状复发而再次入院,入院后给予氯吡格雷75mg／d,静脉注射硝酸甘油及皮下注射低分子肝素治疗。冠状动脉造影显示：3例于前降支近段,1例右冠状动脉中段置入Cypher支架的部位冠状动脉呈血管瘤样扩张,扩张处血管直径明显大于临接正常冠状动脉,其他置入支架的血管无病变。术后即刻给予替罗非班（0．1μg·kg^-1·min^-1）连续3天治疗,症状消失。继续随访3—6个月,全部存活,无心绞痛发生。结论雷帕霉素支架远期发生支架贴壁不良,导致血管重构是造成局部血管瘤样扩张的可能原因。     

急性心肌梗死多支冠状动脉同时闭塞一例

<正>1临床资料患者男性,60岁。主因"突发胸痛17h"于2014年5月5日16:00入院。患者入院前17h于睡眠时突发胸骨后压榨样疼痛,向左肩及左上肢内侧放射,伴大汗、气短,症状持续不能缓解,5h后就诊当地县医院,行心电图示(图1):右束支传导阻滞,急性下壁、右心室心肌梗死,诊断急性下壁、     

巨大冠状动脉扩张一例

患者男 ,49岁。 2年前因突发持续性胸痛 5h就诊 ,诊断为急性广泛前壁心肌梗死 ,予组织型纤溶酶原激活剂 (r tPA) 10 0mg静脉溶栓后 90min行选择性冠状动脉造影(SCA) ,显示左前降支 (LAD)近段明显扩张 ,长度 18mm ,最大直径 9mm ,扩张远端 10 0 %关闭 ,可见血栓影像 ,其他冠状动脉均正常。经扩冠药物对症治疗后胸痛逐渐减轻出院。2年来又反复胸痛 ,近 2周加重 ,再次入院。既往健康。查体 :血压 13 5/ 80mmHg(1mmHg =0 13 3kPa) ,心率 62次 /min ,律齐 ,无杂音。实验室检查 :血尿常规、肝肾功能、血脂均正常。心电图示陈旧性广泛前壁心…     

年轻女性冠脉瘤样扩张伴狭窄介入治疗一例

患者,女,19岁,因间断胸闷、气短1周,加重2天,于2011年5月11日急诊入院。入院前1周无明显诱因间断出现胸闷气短,持续数分钟,休息后缓解。2天前胸闷气短加重,无胸痛,休息后不缓解,并伴有恶心呕吐,     

遗传性QT延长综合征研究新进展

遗传性QT延长综合征(LQTS)是一种家族遗传性电紊乱性心脏病,1957年由Jervell Lange-Nielsen首先发现并报道.临床主要表现为晕厥和猝死,心电图表现为QT间期延长、尖端扭转型室性心动过速(室速).     

抗高血压疫苗的研究现状

人类发明和使用疫苗已经超过200多年,在防治传染性疾病方面取得了优异成绩.然而时至今日,心血管疾病逐渐取代传染性疾病成为危害人类健康的主要杀手,高血压成为最常见的慢性心血管疾病.     

心肌肌钙蛋白测定在临床应用中的一些问题

心肌肌钙蛋白(cardiac troponin,cTn)在心肌损伤诊断中的重要作用已经得到了普遍认同[1-2],在急性冠状动脉综合征(ACS)中的其他方面如心电图(ECG)非ST段抬高的心肌梗死(NSTEMI)的应用也得到重视[3-4].     

药物洗脱支架极晚期血栓形成并自溶一例

患者男,49岁.无高血压病、糖尿病、血脂异常、吸烟史及冠心病家族史.2004年9月因"急性前壁心肌梗死"于当地医院行急诊冠状动脉造影,术中显示前降支(LAD)起始部闭塞,回旋支起始部轻度狭窄,于LAD置入Cypher支架(美国Cordis公司西罗莫司洗脱支架,具体型号不详)1枚,过程顺利.     

Recurrent episodes of deep vein thrombosis in a young man.

We present the case of a 32-year-old man suffering from recurrent episodes of deep vein thrombosis (DVT). He was heterozygous for the G1691A mutation in the Factor V gene. His father was heterozygous for the same mutation and had a unique episode of DVT after a fracture of the tibia. Genetic predisposition significantly influences the prevalence of thrombotic events, however, additional unknown factors may be involved in the initiation and recurrence of venous thromboembolism.     

Coronary thrombosis postpartum in a young woman with Still's disease.

A young woman with Still's disease sustained a small myocardial infarction 12 weeks after the delivery of a healthy male infant. This pregnancy was complicated by late onset proteinuric hypertension. Coronary angiography nine days after infarction revealed intracoronary thrombus which had resolved by 3 months with antithrombotic therapy. The angiographic appearances at 3 months suggested that a local vasculitis may have been the precipitating cause.     

Multiple, relapsing thrombosis in a young man with primary thrombocytosis

We report the case of a relatively young man with multiple and fatal thrombosis associated with essential thrombocythaemia. The clinical and laboratory examinations performed before his death were in agreement with the diagnostic criteria proposed by PVSG. The autopsy revealed myocardial infarction and pulmonary embolisms. This case suggests that young patients with primary thrombocytosis should be treated with antiplatelet agents in spite of the absence of other thrombotic risks.     

药物遗传学在心血管领域的研究进展

在美国,每年多于200万患因药物不良反应住院,其中因此死亡的高达10万人次。德国一项研究调查也表明,大约6％药物不良反应发生在新人院患。进行对药物反应的个体化研究已成为临床药物治疗的当务之急。为提高药物疗效及安全性,进一步认识药物的浓度分布和临床预后,两门新兴学科——药物遗传学（以单基因为靶目标）和药物基因组学（以多基因为靶目标）已快速发展起来。本就遗传变异在心血管药物治疗反应的影响作用以及目前药物遗传学在该领域的应用状况作一综述。     

Occurrence of pulmonary artery aneurysms and pulmonary artery thrombosis in a young man

Beh?et's disease (BD) is a multisystemic inflammatory disorder of unknown aetiology. Arterial involvement is uncommon but associated with important morbidity and mortality. We describe the clinical course of BD with severe pulmonary artery involvement in a 19-year-old man. He presented with massive haemoptysis related to pulmonary artery aneurysms. Initial treatment consisted in urgent right inferior lobectomy, corticosteroids and monthly intravenous cyclophosphamide. Subsequently, he developed pulmonary artery thrombosis at non-aneurysmatic sites. Corticosteroid therapy was intensified, monthly intravenous cyclophosphamide was continued and an anticoagulant was added to the treatment with a favourable clinical and radiological response. Our case illustrates that timely initiation of highly potent immunosuppressive therapy is critical to obtain a favourable outcome. At present, a consensus regarding optimal management of vascular BD is lacking. ALthough anticoagulation is not generally recommended, our report encourages a patient-based decision after carefully tailoring potential risks and benefits.