Acute myocardial infarction in a young man with ankylosing spondylitis: A case report

BACKGROUNDAnkylosing spondylitis (AS) is a chronic progressive inflammatory disease that mainly affects the spine and sacroiliac joints. To the best of our knowledge, AS with acute myocardial infarction (AMI) has rarely been reported. Here, we report an unusual case of AS with AMI in a young patient.CASE SUMMARYA 37-year-old man was admitted to the Department of Rheumatology and Immunology of our hospital on March 14, 2020, for low back pain. Further evaluation with clinical examinations, laboratory tests, and imaging resulted in a diagnosis of AS. Treatment with a non-steroidal anti-inflammatory drug and a tumor necrosis factor inhibitor partially improved his symptoms. However, his back pain persisted. After 6 wk of treatment, he was admitted to the emergency room of another hospital in this city for sudden-onset severe chest pain consistent with a diagnosis of AMI. Angiography revealed severe narrowing of the coronary arteries. Surgical placement of two coronary stents completely relieved his back pain.CONCLUSIONAS can cause cardiovascular diseases, including AMI. It is important to consider the cardiovascular risks in the management of AS.     

Acute inferior myocardial infarction in a young man with testicular seminoma: A case report

BACKGROUNDAtherosclerosis represents the main cause of myocardial infarction (MI); other causes such as coronary embolism, vasospasm, coronary-dissection or drug use are much rarely encountered, but should be considered in less common clinical scenarios. In young individuals without cardiovascular risk factors, the identification of the cause of MI can sometimes be found in the medical history and previous treatments undertaken. CASE SUMMARYWe present the case of a 34-year-old man presenting acute inferior ST-elevation MI without classic cardiac risk factors. Seven years ago, he suffered from orchidopexy for bilateral cryptorchidism, and was recently diagnosed with right testicular seminoma for which he had to undergo surgical resection and chemotherapy with bleomycin, etoposide and cisplatin. Shortly after the first chemotherapy treatment, namely on day five, he suffered an acute MI. Angiography revealed a mild stenotic lesion at the level of the right coronary artery with suprajacent thrombus and vasospasm, with no other significant lesions on the other coronary arteries. A conservative treatment was decided upon by the cardiac team, including dual antiplatelets therapy and anticoagulants with good further evolution. The patient continued the chemotherapy treatment according to the initial plan without other cardiovascular events. CONCLUSIONIn young individuals with no cardiovascular risk factors undergoing aggressive chemotherapy, an acute MI can be caused by vascular toxicity of several anti-cancer drugs.     

25岁急性心肌梗死1例

急性心肌梗死是一种冠状动脉粥样硬化性心脏病,是心血管疾病中的危急重症疾病,多发生于40岁以上的中、老年人.本例患者年龄25岁,既往无家族史、高血压等危险因素,仅有长期吸烟史.提示急性心肌梗死发病年龄有年轻化趋势,吸烟是中青年患者发生急性心肌梗死最突出、最普遍的危险因素.     

Acute myocardial infarction in a young man caused by centipede sting

It is known that insects can cause various clinical effects such as myocardial ischaemia and hypotension from vasospasm and the myocardial toxic effects of the venom and anaphylaxis. Although myocardial ischaemia resulting from centipede sting has been reported once before, myocardial injury has not. In this report, the authors present the case of a 20 year old male patient bitten by a centipede and admitted to the emergency room with chest pain, abnormal electrocardiographic findings, and increased cardiac enzymes (cardiac troponin T) suggesting acute myocardial infarction.     

青年女性自发冠状动脉夹层导致急性心肌梗死1例并文献复习

目的 探讨自发性冠状动脉夹层的临床特点,以期提高对该病的诊治与认识。方法 回顾性分析1例青年女性自发性冠状动脉夹层导致急性心肌梗死患者的临床资料,并以“自发性冠状动脉夹层”、“急性心肌梗死”以及“青年女性”等关键词,通过检索中国知网、PubMed及万方数据库,筛选公开发表的相关中英文文献,以分析自发性冠状动脉夹层的临床特点。结果 本例为青年女性,35岁,因间断胸痛就诊,心电图检查提示I、aVL及V2-V5导联ST段抬高,肌钙蛋白T升高(>2 000 ng/L),冠状动脉造影结果示左主干(LM)自开口可见夹层,延伸至左前降支(LAD)远段及回旋支(LCX)中段,管腔全程受压,近段血管部分不能显影,经血管内超声(intravenous ultrasound, IVUS)指导下行经皮冠状动脉介入(percutaneous coronary intervention, PCI)治疗,随访1个月并复查冠状动脉造影(coronary angiography, CAG)患者治疗效果良好。结论 自发性冠状动脉夹层是导致急性冠脉综合征的罕见病因,其疾病特点及治疗方法与冠状动脉粥样硬化不同,诊断具有...     

Acute coronary artery stent thrombosis caused by a spasm: A case report

BACKGROUNDAcute stent thrombosis (AST) is a serious complication of percutaneous coronary intervention (PCI). The causes of AST include the use of stents of inappropriate diameters, multiple overlapping stents, or excessively long stents; incomplete stent expansion; poor stent adhesion; incomplete coverage of dissection; formation of thrombosis or intramural hematomas; vascular injury secondary to intraoperative mechanical manipulation; insufficient dose administration of postoperative antiplatelet medications; and resistance to antiplatelet drugs. Cases of AST secondary to coronary artery spasms are rare, with only a few reports in the literature.CASE SUMMARYA 55-year-old man was admitted to the hospital with a chief complaint of back pain for 2 d. He was diagnosed with coronary heart disease and acute myocardial infarction (AMI) based on electrocardiography results and creatinine kinase myocardial band, troponin I, and troponin T levels. A 2.5 mm × 33.0 mm drug-eluting stent was inserted into the occluded portion of the right coronary artery. Aspirin, clopidogrel, and atorvastatin were started. Six days later, the patient developed AST after taking a bath in the morning. Repeat coronary angiography showed occlusion of the proximal stent, and intravascular ultrasound showed severe coronary artery spasms. The patient’s AST was thought to be caused by coronary artery spasms and treated with percutaneous transluminal coronary angioplasty. Postoperatively, he was administered diltiazem to inhibit coronary artery spasms and prevent future episodes of AST. He survived and reported no discomfort at the 2-mo follow-up after the operation and initiation of drug treatment. CONCLUSIONCoronary spasms can cause both AMI and AST. For patients who exhibit coronary spasms during PCI, diltiazem administration could reduce spasms and prevent future AST.     

右冠状动脉瘘并发心肌梗死1例

患者男,61岁.2年前患心肌梗死.心电图:广泛性前壁陈旧性心肌梗死.彩超检查:左室、左房轻度增大,左室前壁及前间隔室壁回声增强,左室前间隔及前壁中间段至心尖段运动消失,收缩期增厚率减低,收缩功能减低EF 39%.在大动脉短轴切面可观察到右冠状动脉破入右心房,彩色多普勒血流显示右冠状动脉内鲜亮的红色血流信号,瘘口处可见红色五彩血流从右冠状动脉至右心房(图1),瘘口内径2 mm,频谱多普勒显示双期连续高速射流,最高流速2 m/s(图2),右室压力45 mmHg.超声诊断:右冠状动脉瘘入右心房;缺血性心脏病(陈旧性心肌梗死)、左室收缩功能减低,肺动脉高压(轻度).     

超声造影诊断副肾动脉通畅主肾动脉栓塞伴肾段梗死1例

患者男，38岁，风湿性心脏病，因下肢疼痛5h急诊入院．住院后行下肢动脉彩超检查诊断为双侧股动脉栓塞，取栓术后5天，出现右肾区疼痛、血尿及尿量减少，肌酐及尿素氮增高，临床怀疑右肾动脉栓塞。超声检查发现右肾实质回声不均匀，肾动脉阻力指数高，左肾未见异常，遂于肘静脉内团注SonoVue2．4ml行超声造影检查，     

急性心肌梗死并发右房巨大血栓1例

患者男,60岁,突发急性前间壁心肌梗死入院,既往有糖尿病史.入院后6天出现右下肢肿胀,腓肠肌压痛.     

酷似AMI的恙虫病感染致急性心肌炎一例

急性心肌炎是由各种原因引起的心肌急性炎症性病变。部分急性心肌炎可引起胸痛、心肌酶及心电图的动态改变,与AMI临床症状类似。恙虫病是由恙虫病立克次体引起的一种急性疫源性传染病,恙虫病感染可引起心肌弥漫间质性炎症病变。恙虫病感染致病的临床表现多样,易出现漏诊误诊。该文报道了1例酷似AMI的恙虫病感染致急性心肌炎患者的诊治过...     

A young man with myocardial infarction and a calcified coronary artery aneurysm on chest radiography

Kawasaki disease (mucocutaneous lymph node syndrome) is a syndrome of generalised vasculitis and is the leading cause of acquired heart disease in children. Coronary arterial abnormalties occur in 20% of cases, with coronary artery aneurysms being the most predominant vascular abnormality in this condition. Although death may occur secondary to thrombotic coronary artery occlusion usually within the first year of the illness, myocardial infarction may occur several years after the onset of the disease. Here, we report a case of a young man presenting with ischaemic chest pain, an ECG suggestive of an anteroseptal infarction and a childhood illness consistent with Kawasaki disease.     

Acute myocardial infarction in a young man with sickle cell disease

Sickle cell disease is considered protective against large vessel coronary artery disease. Although sickle cell patients do develop myocardial degeneration and fibrosis at a higher rate than age-matched controls, they rarely suffer from an acute myocardial infarction. We present a case of a 29-year-old man with sickle cell disease who presented with an acute non-ST segment myocardial infarction. In sickle cell patients who present with chest pain as an element of their sickle cell crisis, the clinician must consider acute myocardial infarction in the differential along with more common entities like acute chest syndrome.     

主动脉夹层累及颈动脉导致脑梗死1例

病例女,49岁,工人.因发作性胸闷、气短1年,加重1周入院.患者剧烈咳嗽后突然昏迷,持续10min左右,醒来后发现左侧肢体偏瘫就诊.否认梅毒病史,无家族遗传病史.     

肺动脉瘤血栓形成致右下肺动脉闭塞1例

患者男,42岁,患者10多年前开始出现慢性咳嗽,胸闷,活动后加重,无咯血。2年前开始偶尔痰中带血,曾作胸部CT(图1)及CR检查发现右肺门肿块,考虑肺癌可能。纤支镜检查未见异常。本次因咳嗽、胸痛4天就诊。查体:慢性病容,呼吸急促,P2>A2,未闻及明显心脏杂音。超声心动图:右心室肥厚,肺动脉扩张,右肺动脉栓子,肺动脉中重度反流,重度肺动脉高压。并行胸部CT及MRI检查。影像学表现:胸部CT平扫(采用SOMATOM欢悦双排螺旋CT机,层厚5mm,连续扫描)显示肺动脉主干、右肺动脉及右下肺动脉明显扩张,其直径分别为4.1cm、5.7cm及5.5cm(图2),右下肺动…     

Liver abscess caused by Burkholderia pseudomallei in a young man: A case report and review of literature

Pyogenic liver abscess is a common entity in Indian subcontinent and is mostly caused by gram negative bacteria. Melioidosis is not commonly seen in India and only a few cases are reported. It can give rise to multiple abscesses at different sites including liver. We report a case of isolated liver abscess caused by Burkholderia pseudomallei (B. pseudomallei) in a 29-year-old recently diagnosed diabetic, immunocompetent male. Diagnosis was made by imaging and culture of pus aspirated from the abscess and he was treated with percutaneous pigtail catheter drainage followed by antibiotics (meropenem and trimethoprim-sulphmethoxazole). Melioidosis is an emerging infection in India and has high mortality rate, so early diagnosis and prompt management is warranted which requires clinical vigilance and an intensive microbiological workup. Clinicians should be aware of isolated liver abscess caused by B. pseudomallei in appropriate clinical settings.