冠状动脉栓塞致急性心肌梗死一例

<正>1病例资料患者男,82岁,因"间断心悸、气促4年,加重1个月,突发腹痛3 h"经急诊收住入院。患者4年前起反复出现心悸、气促,每次持续数十分钟至数小时,间隔数日至数月发作,曾在某次发作后就诊于社区医院,心电图提示心房颤动,静脉予胺碘酮后成功转复。此后,患者仍间断有上述症状,发作时自服"胺碘酮",症状均可逐渐缓解。近1个月来,患者发     

心脏转移瘤致急性冠状动脉栓塞1例

1病例简介患者女性,36岁。因“腹胀、恶心4年,伴胸闷、气短1个月”于2007年1月17日入院。患者于4年前因腹胀、恶心、厌油食,在当地医院诊断为胰腺癌肝转移,先后予静脉、动脉灌注化疗,腹胀、恶心症状时轻时重。近1个月腹胀、恶心进行性加重伴胸闷、气短、活动后心慌,下肢浮肿,尿     

心房颤动引起冠状动脉栓塞导致急性心肌梗死2例

1 临床资料 例1,女,80岁.突发胸痛伴频繁呕吐2h入院.既往有高血压史3年,糖尿病史2年,慢性支气管炎史20余年.长期服用雷米普利,格列齐特缓释片,间断服用阿司匹林.查体:血压90/60mmHg(1mmHg=0.133kPa),脉搏(60±4)次/min,体温36.2℃,呼吸频率28次/min.神志清,痛苦病容,颈静脉无怒张.两肺呼吸音清,未闻及干湿啰音.房颤心律,心尖区可闻及3/6级收缩期杂音,主动脉瓣区可闻及2/6级收缩期杂音.     

风湿性心脏病冠状动脉栓塞致急性心肌梗死1例

患者,男,55岁。因突发上腹疼痛并向后背及颈部放射,伴大汗、面色苍白5h入院。既往有风湿性心脏病(风心病)、二尖瓣狭窄病史40余年,无高血压、血脂异常及心绞痛病史。入院体检:T36.0℃,P54次/min,R24次/min,BP90/60mmHg(1mmHg=0.133kPa)。神志清、精神差,自主体位,全身皮肤黏膜未见皮疹,口唇轻度发绀,双肺呼吸音清,未闻及干、湿性啰音,心音略低,律齐,心尖部可闻及舒张期隆隆样杂音及开瓣音,P2>A2,主动脉瓣第2听诊区可闻及舒张期叹气样杂音,肝脾未触及,双下肢无水肿。急诊心电图示窦性心律,Ⅱ、Ⅲ、aVF导联ST段弓背向上抬高0.05~0.10mV,…     

冠状动脉血栓栓塞致急性心肌梗死一例

患者为77岁男性,主因＂突发持续性胸痛2小时＂急诊入院。患者于入院前2 h无明显诱因突发剧烈胸痛伴大汗,并呕吐胃内容物2次。既往未曾住过院及体检,病史不详。吸烟20余年,1盒/日。入院查体：神清,精神萎靡,四肢湿冷,脉搏微弱,血压74/47 mm Hg（多巴胺2000μg/min维持下）,     

心脏瓣膜置换术后抗凝不当导致冠状动脉栓塞一例

患者女性,24岁,因"突发剑突下烧灼样疼痛2小时"于2010年12月16日入院。患者入院前2小时工作中突发剑突下烧灼样疼痛,并放射至后背部,伴恶心、出虚汗,疼痛持续不缓解,急来诊。患者2008年4月因风湿性心脏瓣膜病而行二尖瓣、主动脉瓣置换术,术后服用华法林1.5mg/d,2     

冠状动脉弥漫性扩张致急性心肌梗死一例

1 临床资料 患者,男性,69岁,因发作性心前区疼痛3个月,加重1周入院。3个月前患者因突发胸骨后剧烈疼痛、心慌、大汗30rain,并伴晕厥一次就诊于外院。当时血压90／60mmHg（1mmHg=0．133kPa）（既往无高血压病史）,心电图示：窦性心律100次／min,I、AVL导联ST段下斜型压低0．05～0．10mV,Ⅱ、Ⅲ、AVF导联ST段压低0．1-0．2mV,     

反复冠状动脉痉挛发作致心肌梗死一例

变异性心绞痛，由Prinzmetal等于1959年首先报道，是与活动或情绪应激无关、多在休息时发作的一种心绞痛，发作时伴有心电图ST段抬高。现报告一例2年多来反复发作同时伴有2次心肌酶谱明显升高，经两次冠状动脉(冠脉)造影证实并结合献复习报告如下：     

冠状动脉痉挛致急性心肌梗死病例1例

<正>随着冠状动脉造影技术的普及,冠心病患者得到了及时诊治,但是仍有部分冠心病患者,行冠状动脉造影显示冠状动脉血管无明显狭窄,目前认为冠状动脉痉挛参与到非阻塞型冠心病的发生发展中~([1])。本文报道了1例典型冠状动脉痉挛致急性心肌梗死病例,并结合相关文献讨论冠状动脉痉挛所致急性心肌梗死的临床特点、诊断及治疗。     

自发性左右冠状动脉夹层致急性心肌梗死1例

1病例资料患者,女,49岁,绝经3年,因发作性心慌、胸闷、胸痛10年余,加重1个月入院。患者10余年前开始出现心慌、胸闷及胸痛,多于劳累和受凉感冒后出现,每次持续时间不定,口服"速效救心丸"可以缓解。     

急性心肌梗死合并肺栓塞一例

<正>1病例资料患者男,28岁。因"外伤后突发胸闷、胸痛"于2008年8月28日入院。患者1月余前左脚踝扭伤后局部肿胀伴淤血,仍能行走,行针灸治疗,过程中出现恶心,休息后好转,半小时后于家中进餐时发作胸闷,有哽噎感,呈持续性,未在意。次日活动时突发心前区剧烈胸痛,呈烧灼感,伴大汗、面色苍白,胸痛无放射,无黑曚、晕厥,疼痛持续约20 min后缓解,就诊当地,心肌损伤标志物示肌酸激酶同工酶(CK-MB)     

冠状动脉前降支心肌桥致急性心肌梗死一例

<正>1病例资料患者男性,47岁。主因"间断胸痛12 d"入院。患者入院前12 d,于夜间睡眠中突发胸痛,位于心前区,手掌大小范围,无放射痛,持续不缓解。5 h后于当地医院就诊,诊断"急性前壁心肌梗死",负荷剂量阿司匹林及氯吡格雷口服,并予"尿激酶150万U"溶栓。此后,患者于日常体力活动时仍间断出现胸痛,位于心前区,手掌大小范围,无放射痛,每     

Percutaneous transluminal coronary angioplasty of coronary artery embolism

A 35-yr-old woman with known valvular heart disease presented with acute myocardial infarction. Angiography demonstrated a totally occluded distal left anterior descending coronary artery. Though initially successful, angioplasty ultimately failed to maintain arterial patency, leaving a more distal total occlusion after several balloon inflations. In spite of this, PTCA possibly provided a more localized infarction via a peripheral mobilization of the embolus.     

Contained rupture of left ventricular false aneurysm after acute myocardial infarction secondary to left anterior descending artery embolism

Left ventricular free wall rupture is a rare complication of acute myocardial infarction and accounts for a significant number of fatalities. Pseudoaneurysm is a variety of left ventricular rupture whereby the pericardium seals the defect, forming the wall of the pseudoaneurysm. The diagnosis is usually confirmed with echocardiography, and emergent surgical repair is required in suspected impending rupture. The present report describes the case of a 58-year-old woman who presented with a myocardial infarction due to distal left anterior descending artery occlusion, complicated by ventricular pseudoaneurysm with impending rupture. The patient had an otherwise normal coronary tree.     

Perioperative myocardial infarction in a patient with metabolic syndrome

We report on the case of a 19-year-old Hispanic male with metabolic syndrome who developed a myocardial infarction after an uneventful appendectomy. To our knowledge, this is the first published report of a young adult with metabolic syndrome suffering a major cardiac event after a simple abdominal surgical procedure. It raises the question as to how to prevent such complications in the future.     

冠状动脉搭桥围术期急性心肌梗死紧急再搭桥

目的：回顾性分析冠状动脉搭桥围术期急性心肌梗死急诊再搭桥的临床经验。方法：在510例冠状动脉搭桥患中，5例患在术后4h内因急性心肌梗死需急诊再搭桥，发生率0．98％。5例患中，男女比例为4：1，年龄56－77岁（平均63．6岁），均为冠状动脉三支血管病变（3例伴左主干病变），手术中搭桥3－5支（人均搭桥3．6支），左乳内动脉桥5根，其余为大隐静脉桥。2例在关胸后20min，3例在回重症监护病房后2－4h出现急性心肌缺血表现（明显心电图ST－T变化），伴室颤2例，5例血液动力学均不稳定，药物处理难以稳定血液动力学。全部患均立即送手术室（2例仍在手术室），急诊再次开胸。探查发现，2例患静脉桥（分别搭桥到回旋支第二钝缘支和右冠状动脉后降支）内急性血栓形成；另3例所有静脉桥良好，但左室前壁收缩运动明显减弱，结合心电图变化，诊断为左乳内动脉灌注不良。重新建立体外循环，清除桥内血栓重新搭桥2例（1例在非体外循环心脏跳动下进行）；另取一段静脉搭桥到左乳内动脉－左前降支吻合口远端的左前降支3例。结果：5例患顺利度过手术，均置入主动脉内球囊反搏，支持22－25h（平均42h）。手术后呼吸机支持4h－18d（平均7．3d）合并消化道出血4例，肾功能不全2例，肺部感染2例，切口感染1例。手术后住院时间12－35d，平均21d。全组均痊愈出院。结论：冠状动脉搭桥围术期急性心肌梗死应重在预防。如怀疑桥有问题，急诊再搭桥是良好选择，但手术后并发症发生率明显增加。     

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。     

Relationship between symptom-onset-to-balloon time and long-term mortality in patients with acute myocardial infarction treated with drug-eluting stents

Background

Time from hospital arrival to reperfusion in ST-segment elevation myocardial infarction (STEMI) has been predictive of in-hospital mortality. The purpose of this study was to evaluate the relationship between symptom-onset-to-balloon time and long-term mortality in patients with STEMI in the drug-eluting stent (DES) era.

Methods

A series of 393 patients with STEMI treated with DES from 2005 to 2007 was stratified according to risk profile and preprocedural Thrombolysis In Myocardial Infarction (TIMI) flow grade, and clinical, angiographic, and follow-up data were collected.

Results

A total of 98 (24.9%) low-risk patients and 295 (75.1%) non-low-risk patients were identified. Three-year mortality rate was 3.1% for low-risk patients and 10.2% for non-low-risk patients (p = 0.034), respectively; however it did not differ according to symptom-onset-to-balloon time in either low-risk (p = 0.333) or non-low-risk patients (p = 0.881). Similarly, symptom-onset-to-balloon time and mortality were not related to preprocedural TIMI flow (p = 0.474 for TIMI 0–1; p = 0.428 for TIMI 2–3). In multivariate analysis, final TIMI flow 0–2, systolic blood pressure <100 mmHg at admission, age ≥70 years, anterior infarction, C-reactive protein level, and peak creatine kinase myocardial band isoenzyme level were identified as independent predictors of 3-year mortality while symptom-onset-to-balloon time and preprocedural TIMI flow were not.

Conclusions

In STEMI patients treated with DES, symptom-onset-to-balloon time does not affect long-term outcomes even in individuals at non-low risk and with poor preprocedural TIMI flow grade.     

Acute inferior ST-segment elevation myocardial infarction and previous cryptogenic stroke caused by a paradoxical embolism with a concomitant pulmonary embolism

A 61-year-old patient suffered sudden acute ST-segment elevation myocardial infarction (STEMI) after stool, who only took thrombus aspiration by percutaneous coronary intervention (PCI) and got reperfusion totally, without balloon dilatation or stenting. While bilateral pulmonary embolism and deep venous thrombosis (DVT) was found on this patient, warfarin and inferior vena cava filter were used to antithrombotism. From the results of echocardiography, we noticed right ventricular enlargement and pulmonary hypertension, and the retrograde flow was detected at the foramen ovale, which meant patent foramen ovale (PFO), so it was considered that the thrombus caused acute myocardial infarction (AMI) was origianted from DVT through the foramen ovale. This rare case showed the importantce to define the source of the thrombus to find appropriate treatments and effective preventive measures.     

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