冠状动脉造影正常的心肌梗死患者的病因分析

目的　探讨冠状动脉造影正常患者心肌梗死病因。方法　对我院近 10年因心肌梗死而行冠状动脉造影检查的 12 0 0例患者中有 4 0例 (3 3% )造影正常并行血管内超声检查 ,回顾分析其可能的病因 ,并进行定期 (门诊和电话询问 )随诊观察临床预后。结果　 4 0例心肌梗死患者中 2 9例患者由于冠状动脉痉挛所致 ,4例患者为结缔组织病 ,1例冠状动脉畸形 ,6例冠状动脉肌桥。所有患者随诊 (2 5± 17)个月 ,无主要心脏事件发生。结论　心肌梗死的病因中部分患者为冠状动脉痉挛、血管炎 ,冠状动脉畸形或肌桥等其他病因所致 ,这些患者预后良好。     

Acute myocardial infarction caused by multivessel coronary spasm due to calcium channel blocker withdrawal

Calcium channel blockers are a commonly used class of medications for the management of hypertension, angina, and superventricular tachyarrhythmias. Abrupt withdrawal of these agents can precipitate coronary vasospasm, which may result in myocardial infarction. We present the case of a 47‐year‐old woman who sustained an acute myocardial infarction mediated by multivessel coronary vasospasm secondary to verapamil withdrawal and the associated interventional management. © 2011 Wiley‐Liss, Inc.     

Angiographically documented coronary vasospasm as a cause of myocardial infarction during the acute phase of aortic dissection

Summary We angiographically documented coronary vasospasm which resulted in myocardial infarction during the acute phase of aortic dissection (Stanford A). Coronary and aortic angiography performed at admission of the patient revealed complete occlusion of the right coronary artery and dissection of the aorta. Intracoronary injection of isosorbide dinitrate and intravenous administration of verapamil opened the occluded right coronary artery and blood flow was fully restored. We conclude that, in this case of aortic dissection, the severe stimulation by the aortic dissection brought about vasospasm of the right coronary artery which was the major cause of myocardial infarction. This is the first case report showing clear evidence that myocardial infarction is brought about by vasospasm associated with aortic dissection.     

A case of acute myocardial infarction due to indirect lightning strike

Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the leading causes of cardiac arrest and death from environmental phenomena. Almost every organ system may be impaired as lightning passes through the human body prefering the pathways that the lowest resistance betweem the contact points. Lightning can also have widespread effects on the cardiovascular system, producing extensive catecholamine release or autonomic stimulation. The victim may develop hypertension, tachycardia, nonspecific electrocardiographic changes (including prolongation of the QT interval and transient T-wave inversion), and myocardial necrosis with release of creatine phosphokinase-MB fraction. We present the case of a 13-year-old boy with acute myocardial infarction secondary to an indirect lightning strike.     

A cold shock response triggering acute myocardial infarction

Acute risk factors are activities and events that suddenly and transiently increase the risk of acute cardiac events, as reported recently in International Journal of Cardiology. It has already been reported that sudden submersion in cold water may provoke myocardial infarction in both subjects with atherosclerotic coronary disease and young people with angiographically normal coronary arteries.We report a case of an acute myocardial infarction triggered by sudden exposure to cold air temperature extreme in a young person with acutely occluded proximal part of the left anterior descending coronary artery and normal other coronary arteries who had extreme obesity and cigarette smoking as cardiovascular risk factors.Our report indicates that the sudden cold exposure and the resulting cold shock response may provoke acute myocardial infarction in young susceptible patients.     

Coronary spasm and acute myocardial infarction due to a mutation (V734I) in the nucleotide binding domain 1 of ABCC9

Background

Alterations in coronary vasomotor tone may participate in the pathogenesis of acute myocardial infarction (AMI). Vascular ATP-sensitive K⁺ (K_ATP) channels, formed by Kir6.x/SUR2B, are key regulators of coronary tone and mutations in cardiac (Kir6.2/SUR2A) K_ATP channels result in heart disease. Here we explore the pathophysiological mechanism of a rare mutation (V734I) found in exon 17 of the ABCC9 gene, estimated to cause a 6.4-fold higher risk of AMI before the age of 60.

Methods and results

Eleven patients carrying the mutation were identified; they presented AMI of vasospastic origin associated with increased plasma levels of endothelin-1 and increased leukocyte ROCK activity. The effects of the mutation on the functional properties of the two splice variants of ABCC9 (SUR2A and SUR2B) were studied using patch-clamp electrophysiology. The mutation reduced the sensitivity to MgATP inhibition of Kir6.2/SUR2B channels but not of Kir6.2/SUR2A and Kir6.1/SUR2B channels. Furthermore, the stimulatory effects of MgNDP (MgADP, MgGDP and MgUDP) were unaltered in mutant Kir6.2/SUR2A and Kir6.1/SUR2B channels. In contrast, mutant channels composed of Kir6.2 and SUR2B were less sensitive to MgNDP activation, assessed in the presence of MgATP. The antianginal drug nicorandil activated Kir6.2/SUR2B–V734I channels, thus substituting for the loss of MgNDP stimulation, suggesting that this drug could be of therapeutic use in the treatment of AMI associated with V734I.

Conclusions

The 734I allele in ABCC9 may influence susceptibility to AMI by impairing the response of vascular, but not cardiac, K_ATP channels to intracellular nucleotides. This is the first human mutation in an ion channel gene to be implicated in AMI.     

嗜铬细胞瘤致急性心肌梗死一例报道

1 病例资料 患者,72 岁,男性,因"突发胸痛8 小时余,晕厥1 次"入院.患者于晨4 时睡眠中突发胸骨中下段后压迫样疼痛,伴后颈部胀痛,持续不缓解.伴大汗、头晕、黑蒙,伴一过性晕厥.既往史:有"高血压"史8 年,最高血压达200/100 mm Hg(1 mm Hg=0.133 kPa),服药不详,未监测血压.     

前列腺素E1脂微球载体制剂治疗非ST段抬高心肌梗死的疗效分析

目的 探讨前列腺索E1脂微球载体制剂(凯时)治疗非ST抬高心肌梗死(NSTEMI)的有效性与安全性.方法 入选86例NSTEMI患者随机分为治疗组(43例)和对照组(43例),对照组给予低分子肝素、氯吡格雷、阿司匹林和其他基础治疗,治疗组在此基础上给予凯时,比较两组基础临床情况和疗效,30 d内主要心脏不良事件(MACEs)发生率(包括死亡、新近发生急性心肌梗死,靶血管血运重建),出血并发症及其他不良反应.结果 两组基础临床情况相同;治疗组心绞痛缓解和缺血性心电图改善(95.3%和93.0%)均优于对照组(81.4%和74.4%)(x2=4.070、4.440,P＜0.05).治疗组左心衰竭发生率和30 d内MACEs发生率(2.3%和4.7%)均低于对照组(14.0%和18.6%)(x2=4.962、4.077,P＜0.05);两组均无肝肾功能损害等其他不良反应.结论 前列腺素E1能改善NSTEMI患者的临床症状、心肌灌注、心功能,减少30 d内主要心脏不良事件发生,疗效确切,安全性好.     

急性高侧壁心肌梗死的梗死相关血管分析

目的　分析急性高侧壁心肌梗死的梗死相关血管特点 ,为临床判断冠状动脉病变部位提供线索。方法　 96例初次发病的急性高侧壁心肌梗死患者 ,男性 77例 ,女性 19例 ,年龄 (35～ 77)岁 ,平均 (5 7 3± 10 7)岁 ,均经冠状动脉造影证实为单支血管病变。根据发病时心电图表现的梗死范围分为 3组 :(1)单纯高侧壁组 2 3例 ,(2 )高侧壁加前壁组 5 8例 (其中前间壁 2 7例、广泛前壁 31例 ) ,(3)高侧壁加侧壁组 15例。比较各组之间梗死相关血管的病变特点。结果　高侧壁合并前壁心肌梗死的罪犯病变主要在前降支 (5 6 5 8) ,高侧壁合并侧壁心肌梗死主要由回旋支病变引起 (13 15 ) ,而单纯高侧壁心肌梗死的罪犯病变则可能在对角支 (12 2 3)或回旋支 (11 2 3) ,各组之间梗死相关血管部位的分布差异有统计学意义 (P <0 0 0 1)。合并前壁心肌梗死者闭塞性病变的比例较高 (39 5 8)。合并前间壁心肌梗死者与合并广泛前壁心肌梗死者相比 ,病变部位和闭塞病变比例均相似 ,而前者侧支循环建立情况明显好于后者 (14 2 7比 7 31,P <0 0 5 )。结论　根据心肌梗死时心电图异常的分布特点可以推测高侧壁心肌梗死相关病变的部位 ,良好的侧支循环可以限制梗死面积。     

Hypovolemia-induced severe coronary spasm leading to acute myocardial infarction

Acute ST-elevation myocardial infarction (STEMI) is a well recognized manifestation of severe coronary artery spasm. Although there are many recognized triggers, hypovolemia has not been previously described. The present report describes a case of acute STEMI that occurred four days following major colonic surgery in a severely dehydrated patient. Coronary angiography revealed underfilled coronary arteries with severe multifocal spasm, which largely resolved with aggressive fluid repletion and intracoronary nitrate.     

血栓抽吸装置在经皮冠状动脉介入治疗中对心肌再灌注的影响

目的:评估血栓抽吸装置在急性心肌梗塞(AMI)急诊冠状动脉介入治疗(PCI)患者治疗中的临床应用。方法:86例行急诊PCI治疗的AMI患者被随机分为血栓抽吸组(41例,应用抽吸导管后再行PCI),直接PCI组(45例,直接行PCI),观察无复流发生率、术后ST段下降率及左心室射血分数等。结果:PCI后血栓抽吸组患者的无复流发生率明显低于直接PCI组(4.9%∶11.1%,P0.05),ST段回落率(66.67%、75.61%)、LVEF[(54.02±8.93)%∶(49.23±9.12)%]均优于直接PCI组(P均0.05)。结论:急诊冠脉介入治疗急性心肌梗塞患者时,应用血栓抽吸导管可以降低无复流发生率,改善心功能,且安全有效。     

ST deviation pattern in acute myocardial infarction is not related to lesion location

Background In ST-elevation MI (STEMI) the culprit artery is usually occluded, whereas non-STEMI (NSTEMI) it is usually patent. The location of the ruptured plaque may influence MI type. We examine whether the distance from the coronary ostium to the culprit lesion is different in STEMI as compared to NSTEMI. Methods We selected patients who presented with an acute MI and underwent coronary angiography during hospitalization. The analysis included 754 patients of whom 514 had STEMI and 240 had NSTEMI. The distance from the coronary ostium to the site of thrombosis was measured. Results For both STEMI and NSTEMI patients the first 60 mm of the coronary artery contained 75% of the culprit lesions. There were no significant differences in median distances from the vessel ostium to the site of thrombosis as well. Conclusions The distance from coronary ostium to culprit lesion is similar in STEMI and NSTEMI. Culprit lesion location does not appear to influence the development of STEMI as opposed to NSTEMI.     

Acute myocardial infarction associated with acute gouty arthritis

The association of hyperuricemia with increased risk of atherosclerosis has been reported in previous studies but the link of acute gouty arthritis, hyperuricemia and acute myocardial infarction (MI) is not seen frequently. Here we report a 33 year old male who presented with hyperuricemia, acute gouty arthritis and acute myocardial infarction. Hyperuricemia contributed not only to accelerated atherosclerosis but might be blamed for promoting environment for acute myocardial infarction.     

冠状动脉造影影像正常的急性心肌梗死病例分析

目的　探讨冠状动脉造影影像正常的急性心肌梗死病例的临床特点。方法　在 34 9例诊断急性心肌梗死患者行选择性冠状动脉造影检查 ,其中有 17例冠状动脉影像正常 ,分析这 17例患者的性别、年龄、临床症状及预后。结果　冠状动脉影像正常的急性心肌梗死占 17/34 9(4 87% ) ,平均年龄 (4 3 6± 6 32 )岁 ,45岁以下者 15例 ,全部为男性 ,临床无心衰、休克及严重心律失常等并发症 ,预后好。结论　急性心肌梗死可以发生在正常的冠状动脉基础上 ,此种情况多发生在 45岁以下的男性患者 ,病前多健康 ,临床无严重并发症 ,预后好 ,预防冠状动脉痉挛是该病的主要策略     

冠状动脉造影正常的急性心肌梗死患者临床预后的研究

目的　通过对冠状动脉 (冠脉 )造影正常的急性心肌梗死 (MINC)患者的随访 ,探讨其临床预后 ,并分析发病危险因素。方法　 1987至 2 0 0 1年北京大学第一医院 4 0例 (A组 )首次急性心肌梗死后冠脉造影正常 (冠脉造影狭窄程度小于 2 0 % )患者。同时随访了 12 9例 (B组 )年龄、性别、梗死部位与A组相匹配的冠脉造影严重狭窄 (梗死相关血管狭窄程度 >5 0 % )的急性心肌梗死患者 ,比较分析两组患者急性期、远期预后及发病危险因素。结果　高血压史、危险因素个数、梗死后心绞痛发生率A组明显低于B组。住院期间LVEFA组明显高于B组。两组患者平均随访时间相似 (6 7± 4 0比 6 8± 34月 )。复合心血管事件发生率A组明显少于B组。结论　MINC患者急性期、远期预后明显好于MICS患者 ,冠心病危险因素明显少于后者     

血栓经导管吸引后直接支架术在急性心肌梗死并发冠状动脉内血栓急诊介入治疗中的应用

目的 :介绍血栓经导管吸引后直接置入支架处理急性心肌梗死 (AMI)并发冠状动脉 (冠脉 )内血栓的急诊介入治疗方法 ,并观察其近期临床疗效。方法 :选择急诊冠脉造影显示梗死相关血管完全闭塞伴冠脉内血栓的AMI患者 ,常规经皮腔内冠脉成形术 (PTCA) ,选用 0 .35 6mm普通冠脉导丝通过病变后 ,经导丝直接送入PercuSurge导管系统中的吸引导管至病变部位 ,持续负压吸引 ,至血栓影消失 ,前向血流恢复后采取直接冠脉内支架置入术 ,观察术前和术后梗死相关血管血流和心肌灌注情况 ,并随访术后近期心功能和主要心血管事件的发生率。结果 :17例患者中经导管吸引后即刻血栓影减少或消失 ,梗死血管直接开通者 15例 (88.3% ) ,其中前向血流恢复达TIMI 3级者 11例 (6 4 .7% ) ,TIMI 2级者 4例 (2 3.5 % ) ;另 2例前向血流未恢复 ,吸引导管不能通过。血栓吸引后再置入支架 ,术后即刻前向血流恢复达TIMI 3级者 14例 (82 .4 % ) ,TIMI 2级者 3例 (17.6 % )。TIMI心肌灌注分级达TMP 3级者 13例 (76 .5 % ) ,TMP 2级者 4例 (2 3.5 % )。未发生与手术相关的并发症。随访住院期间无心绞痛、再梗死及死亡等事件发生。出院前测定左室射血分数为 33%～ 76 % [(6 1.1± 11.3) % ]。结论 :血栓经导管吸引后直接支架术是处理AMI并发     

Thoracic spinal cord ischemia following acute myocardial infarction and cardiac arrest in a young male

In an era of percutaneous stenting for acute myocardial infarction (AMI), a case of thoracic spinal cord ischemia following AMI and cardiac arrest is presented, to highlight and discuss this rare but debilitating condition, well-documented within the neurological literature, but rarely encountered in cardiovascular practice.     

Myocardial infarction in diabetic and non-diabetic persons with and without prior myocardial infarction: the FINAMI Study

Aims/hypothesis We compared the risk of acute coronary events in diabetic and non-diabetic persons with and without prior myocardial infarction (MI), stratified by age and sex. Methods A Finnish MI-register study known as FINAMI recorded incident MIs and coronary deaths (n=6988) among people aged 45 to 74 years in four areas of Finland between 1993 and 2002. The population-based FINRISK surveys were used to estimate the numbers of persons with prior diabetes and prior MI in the population. Results Persons with diabetes but no prior MI and persons with prior MI but no diabetes had a markedly greater risk of a coronary event than persons without diabetes and without prior MI. The rate of recurrent MI among non-diabetic men with prior MI was higher than the incidence of first MI among diabetic men aged 45 to 54 years. The rate ratio was 2.14 (95% CI 1.40–3.27) among men aged 50. Among elderly men, diabetes conferred a higher risk than prior MI. Diabetic women had a similar risk of suffering a first MI as non-diabetic women with a prior MI had for suffering a recurrent MI. Conclusions/interpretation Both persons with diabetes but no prior MI, and persons with a prior MI but no diabetes are high-risk individuals. Among men, a prior MI conferred a higher risk of a coronary event than diabetes in the 45–54 year age group, but the situation was reversed in the elderly. Among diabetic women, the risk of suffering a first MI was similar to the risk that non-diabetic women with prior MI had of suffering a recurrent MI.     

无明显冠状动脉狭窄的急性心肌梗死的临床特征

目的研究无明显冠状动脉狭窄的急性心肌梗死(AMI)患者的冠心病危险因素、心功能特点,并进一步探讨其发生机制。方法将399例AMI患者根据冠状动脉造影(CAG)结果分为冠状动脉狭窄组(直径狭窄程度≥50%)和冠状动脉无明显狭窄组(直径狭窄程度<50%),比较分析二组的冠心病相关危险因素及心功能情况。结果399例AMI患者中冠状动脉造影无明显狭窄23例,占心肌梗死患者的5.76%(23399);冠状动脉狭窄376例,占94.24%(376399)。与冠状动脉狭窄组比较,冠状动脉无明显狭窄组的AMI患者平均年龄较小,其中小于40岁的患者占26.08%(623),女性多见。二组在糖尿病、高脂血症、高血压和冠心病危险因素数目方面差异无统计学意义。冠状动脉无明显狭窄组的AMI患者左心室舒张末压(LVEDP)显著低于冠状动脉狭窄组;左心室射血分数(LVEF)稍高,但差异无统计学意义。结论冠状动脉造影无明显狭窄的AMI患者在临床上并非罕见,应引起足够重视。其临床特点为心功能较好,与冠状动脉造影狭窄的AMI患者具有相似的冠心病危险因素数目和糖尿病、高脂血症、高血压发生率,但在年轻人、女性相对多见。