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...     

冠状动脉痉挛致急性心肌梗死1例并文献复习

患者,男,43岁,因胸闷、胸痛5小时于2010年12月3日09:07入院.既往史:高血压病史3年,否认糖尿病史.吸烟史15年,20～30支/d.入院查体:体温36.5℃,呼吸19次/min,血压140/100 mmHg(1 mmHg=0.133 kPa),意识清楚,精神略萎,体形中等,颜面无水肿,口唇无发绀,颈静脉无怒张,两肺叩诊呈清音,呼吸音粗,两肺未闻及干湿哕音;心前区未触及震颤,未触及心包摩擦感,心浊音界正常,心率74次/min,律齐,各瓣膜听诊区未闻及杂音,腹平软,无压痛、反跳痛,肝脾肋缘下未触及,双下肢无水肿.急查心电图示:Ⅱ、Ⅲ、aVF导联,V1～V6导联ST段弓背向上抬高0.1～0.3mV,提示急性下壁+前壁心肌梗死.入院后完善相关检查:粪、尿常规、肝功能、电解质、血糖未见明显异常.血常规:白细胞12.9×109/L,中性粒细胞0.852,淋巴细胞0.102,血红蛋白146 g/L,血小板273×109/L.     

升主动脉夹层压迫左主干开口误诊急性冠状动脉综合征1例

患者,女,62岁,因＂间断活动后胸痛6年,加重3小时＂入院。每次发作后经休息数分钟症状可缓解。入院前3小时患者再次出现劳累后胸痛,无肩背放散痛,无晕厥及咯血。心电图：窦性心律,ST-T轻度改变。以＂冠心病、心绞痛＂收入院。高血压病史15年,血压最高可达200/110 mmHg（1 mmHg=0.133 kPa）,规律口服复方降压片治疗,未定期监测血压。入院查体：血压105/70 mmHg,意识清楚;     

多支冠状动脉同时急性闭塞1例并文献复习

正急性心肌梗死(AMI)是由冠状动脉粥样硬化斑块破裂、痉挛及血栓形成导致血管闭塞引起的一组急性临床综合征。通常,一支冠状动脉闭塞引起心肌梗死很常见,两支及以上冠状动脉同时闭塞很少见。我们观察到经冠状动脉造影证实的1例两支冠状动脉血管同时闭塞导致AMI的患者,并对该患者进行经皮冠状动脉介入治疗(PCI)。1临床资料患者,男,37岁;因突发胸闷痛2小时于2011年9月23日入院。入院前2小时因与人争吵后出现胸     

无症状主动脉夹层1例

病例男,61岁,于20年前体检时发现血压高达200/110 mmHg,因无症状未治疗。10年前偶有头痛开始降压治疗,症状缓解后停药,未监测血压。1月前因劳累头痛、头晕复发伴乏力,自测血压高,服用苯磺酸左旋氨氯地平和缬沙坦联合降压治疗,血压控制不佳,且波动幅度大,故来我院就     

大范围主动脉夹层并急性冠状动脉综合征诊治回顾分析

目的探讨避免大范围主动脉夹层并急性冠状动脉综合征误诊的体会。方法回顾性分析1例大范围主动脉夹层并急性冠状动脉综合征的诊治经过。结果本例因反复心前区疼痛入院,经完善心电图、心肌酶等检查诊断为冠心病、急性冠状动脉综合征、高血压病3级(极高危组)。给予止痛、抗凝、抗血小板聚集、稳定斑块、改善循环及对症支持治疗,疗效不佳。进一步行X线胸片、心脏彩超及主动脉CT血管造影检查,明确诊断为主动脉夹层(DeBakeyⅠ型)。患者病情严重,入院次日抢救无效死亡。结论对于大范围主动脉夹层并急性冠状动脉综合征者,重视四肢血压测定、积极完善相关检查、客观分析各项检查结果有助于明确诊断,减少误诊。     

主动脉夹层误诊为急性心肌梗死临床特征并文献分析

目的 探讨误诊为急性心肌梗死(AMI)的主动脉夹层(AD)的临床特点、鉴别诊断要点及误诊原因、防范措施。方法 回顾性分析误诊为AMI的AD 8例的临床资料,并结合国内外文献进行分析。结果 本组8例均为男性,有高血压病史6例,皆以胸痛为主要症状,D-二聚体明显升高,心电图有明显ST-T改变。5例误诊为急性ST段抬高型心肌梗死,3例误诊为急性非ST段抬高型心肌梗死。误诊时间平均11 h。8例经AMI相关治疗后效果均欠佳,皆经主动脉CT血管造影检查确诊为AD,给予相应治疗。经治疗后好转3例,死亡5例。结论 AD以急性胸痛为主要症状并伴心电图ST-T改变时,易误诊为AMI。临床医生应提高警惕,注意上述2种疾病的鉴别诊断要点,详细问诊及仔细查体,并尽早采取有效影像学检查,以减少或避免AD误诊误治。     

右冠状动脉缺如1例

患者女,53岁,阵发性心悸1个月,无明显加重及缓解因素,伴胸闷不适,偶感两侧肋部疼痛;既往无高血压及糖尿病等病史.查体:叩诊心界不大,节律整齐,心音正常,主动脉瓣昕诊区第二心音大于肺动脉瓣听诊区第二心音,各瓣膜听诊区未闻及病理性杂音.心电图提示窦性心动过速、电轴左偏.临床拟诊为冠状动脉粥样硬化性心脏病.行冠状动脉CT血...     

1例冠脉造影术确诊冠状动脉自发夹层病人的护理

冠状动脉自发夹层（SEND）是一种罕见的心血管疾病，是心肌缺血少见原因之一。通常认为SCAD是由于冠状动脉壁内滋养血管破裂出血所致。出血量较多时可在动脉壁中膜外三分之一或中膜与外膜间形成大的夹层压迫冠状动脉。动脉粥样硬化的血管其滋养血管密度增加，更容易破裂出血引起血管夹层。一旦SCAD形成，它可以表现为稳定型心绞痛、不稳定型心绞痛、急性心肌梗死或心脏性猝死。     

冠状动脉瘤血栓脱落致左心室下壁急性心肌梗死1例

1 病例报告 患者男,22岁.因间歇性胸痛2年,加重4 h于2008-04-02 10:15入我院急诊科.2年前患者无明显诱因出现胸骨后中、下段约手掌大小范围的间歇性闷痛,有时累及心前区,活动、静息均可出现,与体位无关,无伴出汗,无放射痛,持续约1 min可自行缓解,未予重视.     

ST-segment elevation myocardial infarction in Kawasaki disease: A case report and review of literature

BACKGROUNDKawasaki disease (KD) is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm (CAA). CAAs are associated with a high rate of adverse cardiovascular events.CASE SUMMARYA Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain. Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram. An aneurysm of the left circumflex (LCX) coronary artery was found with massive thrombi within. A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications. The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7, suggestive of a small aneurysm considering his age, sex, and body surface area. We further present a case series of 19 patients with KD, including the current patient, presenting with acute coronary syndrome (ACS). Notably, none of the cases showed Z scores; only five patients (26%) had been regularly followed up by a physician, and only one patient (5.3%) was being treated with antithrombotic therapy before ACS occurred.CONCLUSIONFor KD presenting with ACS, regular follow up and medical therapy may be crucial for improved outcomes.     

Large atherosclerotic plaque related severe right coronary artery dissection during coronary angiography

Catheter-induced coronary artery dissection and occlusion is a rare but serious complication of diagnostic cardiac angiography. A 50 year-old man presented with unstable angina. ECG, exceptional of bradycardia, was normal (57 beat/min). Selective coronary angiography demonstrated 98% narrowing in the mid-portion of the left anterior descending coronary artery (LAD). During the right coronary angiography, following catheter manipulation in the vicinity of the aortic valve, the patient complained of severe chest discomfort, and he had electrocardiographic evidence of acute inferior wall myocardial infarction. Right coronary artery (RCA) was free of the significant obstruction, and it was observed to be having a dominant artery with a spiral dissection (NHLBI Grade IV) located between ostium and the proximal portion of the posterior descending and posterolateral artery bifurcation. The patient was immediately operated with off-pump coronary artery bypass surgery. Consequently, iatrogenic right coronary dissection that is a very rare condition as a cause of myocardial infarction, is discussed in this case report.     

Successful revascularization with percutaneous coronary intervention using a combination of the subintimal transcatheter withdrawal technique and coronary artery fenestration for spontaneous coronary artery dissection

The combination of the STRAW technique and coronary artery fenestration using a cutting balloon could be effective in SCAD patients, especially with dissection to the distal end of the coronary artery.     

Congenital absence of the right coronary artery with acute myocardial infarction: report of two cases and review of the literature

Congenital absence of the right coronary artery (RCA) is a rare coronary anomaly. Few cases of this condition have been reported. Congenital absence of the RCA is considered as a benign anomaly. However, in certain cases, these patients may develop life-threatening clinical complications that include acute myocardial infarction, stroke, or sudden death. We report two patients who were diagnosed with congenital absence of the RCA and presented with acute myocardial infarction. We discuss our experience in diagnosis and treatment of this disease. Congenital absence of the RCA with acute myocardial infarction is an uncommon clinical emergency. Therefore, early detection, correct diagnosis, and appropriate treatment are important.     

Spontaneous coronary artery dissection: a review of complications and management strategies

Introduction: Spontaneous coronary artery dissection (SCAD) accounts for up to 4% of acute coronary syndromes (ACS) on coronary angiography and predominantly affects women (>90%). SCAD most often occurs in patients with few or no conventional cardiovascular risk factors. This condition remains underdiagnosed due to a lack of awareness among health-care providers and misdiagnosis on coronary angiography.

Areas covered: In this review, authors aim to summarize contemporary data on the etiology, morbidity and mortality risks, as well as management strategies in order to raise awareness.

Expert opinion: The last decade of extensive research revealed that SCAD is not as rare as previously thought and needs to be in the differential diagnosis of all MI patients, especially in young to middle-aged women. Predisposing factors, such as fibromuscular dysplasia, and potential triggers like physical or emotional stresses, are frequently linked. Coronary angiography is the first-line diagnostic tool and should be performed meticulously because of more fragile vessel architecture to avoid iatrogenic dissections. If angiographic findings are uncertain, the use of intravascular imaging may be required. Conservative therapy is favored over revascularization unless patients have high-risk features. Recurrent cardiovascular events post-SCAD are frequent, and patients should be closely monitored after a SCAD event.     

Acute coronary syndrome in a young woman with a giant coronary aneurysm and mitral valve prolapse: a case report and literature review

Acute coronary syndrome in the young population is infrequently seen and has a different etiology from that in the elderly population. Giant coronary artery aneurysms are rare and usually asymptomatic, but they can cause acute clinical symptoms such as chest pain or chest tightness. We herein describe a young woman with a history of mitral valve prolapse who developed sudden-onset chest pain. She had mild elevations of her creatine kinase and cardiac troponin levels; however, no ST segment alteration was found on an electrocardiogram, and no abnormal regional wall movement was noted on echocardiography. Cardiac magnetic resonance imaging with late gadolinium enhancement revealed a “mass” at the right coronary artery and linear subendocardial enhancement at the posterior wall. Coronary angiography later confirmed a giant coronary aneurysm with a substantial thrombus. The combined presence of the coronary artery aneurysm and mitral valve prolapse in this patient was likely a sequela of Kawasaki disease.