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     

弥漫性巨大冠状动脉瘤样扩张并发心肌梗死的临床分析

目的研究弥漫性巨大冠状动脉瘤样扩张并发心肌梗死的临床特征,以及治疗效果。方法选取2011年1月~2014年6月我院收治的患者15例作为研究对象,行冠脉造影检查,并积极进行抗凝治疗。观察患者的诊断和治疗结果,比较生活质量状况。结果 15例患者经冠脉造影检查后确诊,治疗后均好转,随访显示未心肌梗死复发,心功能未见明显变化。患者治疗后的心率、左室射血分数指标均优于治疗前,差异有统计学意义(P0.05)。结论弥漫性巨大冠状动脉瘤样扩张并发心肌梗死病情严重,冠脉造影检查对于临床诊断具有重要作用。积极治疗能够降低病死率,改善心功能,提高患者的生活质量。     

弥漫性巨大冠状动脉瘤样扩张1例

正1病例简介患者男性,66岁,因"胸痛2个月"入院。既往有高血压病史30余年,血压最高达140/120 mm Hg。13年前患者无明显诱因下于夜间发作胸痛,位于心前区,呈闷痛,无放射痛,休息约30 min后好转。当地医院给予对症处理(具体不详),后未进一步诊治。近2个月来患者胸痛加重。入院查体:血压130/100 mm Hg,神情,双肺呼吸音清,未闻及干湿性     

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…     

冠状动脉瘤样扩张并发反复心肌梗死1例

正1病例资料患者,男,61岁,既往高血压病病史30年,血压最高达180/100mmHg(1mmHg=0.133kPa),现规律应用替米沙坦80mg、琥珀酸美托洛尔23.75mg,1次/d,血压可控制在130/80 mmHg;吸烟史40余年,20支/d,已戒3个月;血脂异常病史10余年,现血脂水平正常。患者3个月前无明显诱因突发心前区剧烈闷痛,伴后背部及左臂放散痛,伴大汗,持续10h不缓解就诊于我院。心肌酶26.9     

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,     

肺动脉巨大瘤样扩张一例

肺动脉巨大瘤样扩张一例包头医学院第二附属医院内科陈玉林，秦正义，刘志敏包头医学院第一附属医院超声科刘民杰１临床资料患者男性，５３岁。因反复咯血３０年，１９９２年１０月２１日来诊。３０年前无诱因出现咳痰带血，诊断＂肺结核＂，服异烟肼１０余天后血痰消失。...     

冠状动脉瘤样扩张并急性心肌梗死1例报告

<正>冠状动脉瘤样扩张临床上少见,是一种经冠脉造影明确诊断的冠状动脉病变,患者临床表现各异,常表现为心绞痛,严重时可致心肌梗死,现将我院收治的1例冠状动脉瘤样扩张伴急性心肌梗死患者的诊治情况报告如下。1病例资料患者男,47岁,因胸痛7 d于2015年3月30日由当地医院转入我科,患者2015年3月23日在家饮茶吸烟后突发胸痛,心前区疼痛,向颈部、左手臂放射,程度剧     

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。     

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…     

A case of acute coronary thrombosis in diffuse coronary artery ectasia

A 75-year-old Afro-Caribbean male presented with a non-ST-elevation myocardial infarction. Coronary angiography showed generally grossly dilated coronary arteries with a large lobular thrombus in the distal right coronary artery. We briefly review this case and discuss the definition, pathophysiology and treatment for coronary artery ectasia.     

Three novel ATG16L1 mutations in a patient with acute myocardial infarction and coronary artery ectasia: A case report

Introduction:Acute myocardial infarction (AMI) is a specific type of coronary artery disease (CAD) caused by the rupture of coronary atherosclerotic plaques. Coronary artery ectasia (CAE) is a rare phenotype of cardiovascular disease that may promote thrombosis and inflammatory responses leading to myocardial infarction due to abnormal dilatation of blood vessels and coronary blood flow disorders. It is a complicated disease and shows interaction between genetic and environmental factors.Patient concerns:A 34-year-old male patient was admitted to our hospital on May 12, 2016, with complaints of chest pain for 1 hour duration.Diagnosis:Coronary angiography through the emergency medical service (EMS) system showed 100% occlusion at the first turning point of the right coronary artery (RCA), along with tumor-like expansion of the proximal segment of the RCA and the end of the left main (LM) artery. The patient was diagnosed with AMI and CAE. Three-point mutations in the ATG16L1 gene were identified by direct sequencing.Interventions:After admission, the patient underwent emergency green channel coronary angiography and percutaneous coronary intervention (PCI) to assess and unblock the stenosis and occlusion of the RCA lumen, but no stenting was performed because the catheter could not pass the second inflection point of the RCA. Aspirin enteric-coated tablets, clopidogrel sulfate tablets, tirofiban hydrochloride, and low molecular weight heparin calcium were given as anticoagulant and antiplatelet therapy. Atorvastatin calcium tablets were used to regulate blood lipid levels. Perindopril and spironolactone were used to inhibit the renin-angiotensin-aldosterone system (RAAS) to reverse myocardial remodeling. Acetylcholinesterase inhibitors (ACEI) and beta blockers were administered to resist ventricular remodeling and improve cardiac function and prognosis after the patient''s blood pressure and heart rhythm were stabilized.Outcomes:After active rescue treatment, the patient recovered and was discharged. A coronary angiogram performed 2 years later showed that the RCA blood flow was restored, and the patient had recovered well.Conclusion:Three-point mutations in the ATG16L1 gene were identified in a patient with AMI and CAE, which extended the mutation spectrum of the ATG16L1 gene. Hence, the etiology of coronary artery aneurysmal dilatation is worthy of further investigation.     

Altered coronary flow properties in diffuse coronary artery ectasia

Objectives The purpose of this study was to investigate coronary blood flow properties in patients with diffuse coronary artery ectasia (CAE) associated with exercise-induced myocardial ischemia.Methods Seventeen patients with diffuse CAE and without coexisting coronary artery stenosis were enrolled in the study (CAE group). CAE was defined as luminal dilatation 1.5 to 2 times that of the adjacent normal coronary artery segment or the diameter of the corresponding coronary artery of the control group when there was no normal segment. The age- and sex-matched control group (n = 20) comprised patients with normal epicardial coronary arteries. Coronary blood flow velocities were obtained invasively by use of Doppler scanning flow wire. Coronary flow reserve (CFR) was measured by administration of intracoronary papaverine as the hyperemic stimulus. Volumetric coronary blood flow was estimated by multiplying the velocity time integral of coronary blood flow with the cross-sectional area of the coronary artery and the heart rate.Results Fifteen patients with CAE, but none of the patients in the control group, had electrocardiographic signs of myocardial ischemia at peak exercise on ergometry. Baseline average peak velocities (APVs) of coronary blood flow were similar in the 2 groups. Peak hyperemic APVs of coronary blood flow were lower in the CAE group than in the control group (17.5 ± 7.4 cm/s vs 41.5 ± 12.6 cm/s, respectively, P < .001). Volumetric coronary blood flow was significantly higher in the CAE group than in the control group, both at rest and at hyperemia (146.3 ± 71.2 cm³/min vs 45.1 ± 16.1 cm³/min, respectively, P < .001, and 202 ± 87.3 cm³/min vs 104.1 ± 37.6 cm³/min, respectively, P < .003). The mean CFR of the CAE group was significantly reduced compared with that of the control group (1.51 ± 0.31 vs 2.67 ± 0.52, respectively, P < .001).Conclusions The CFR is significantly reduced in patients with diffuse CAE compared to a matched control group. Although volumetric coronary blood flow is significantly higher in CAE, microcirculatory dysfunction that is reflected as depressed CFR may be the underlying cause of exercise-induced myocardial ischemia. (Am Heart J 2003;145:66-72.)     

Giant coronary artery aneurysm in association with systemic arterial ectasia. A case report

Since the advent of coronary angiography, coronary artery aneurysm has been diagnosed with increased frequency. The etiology of coronary artery aneurysm is atherosclerosis in 50%, followed by other causes. In a 71-year-old man with previously documented abdominal aortic aneurysm of 6 cm diameter and ectasia of both left and right middle cerebral arteries, thoracic magnetic resonance imaging (MRI) demonstrated a large hollow para-cardiac mass (maximum diameter of 7 cm) lying in the anterior-lateral part of the atrio-ventricular sulcus. Coronary arteriography confirmed the aneurysmatic nature of the proximal tract of left anterior descending (LAD) artery lesion. Screening for laboratory signs of vasculitis was negative and other vascular and systemic diseases were excluded, suggesting an atherosclerotic aetiology of the aneurysm. In the absence of current cardiac symptoms, conservative management has been chosen and the patient is still well 2 years after presentation.     

Coronary artery ectasia in a patient with myocardial infarction

We report on a case of triple-vessel coronary artery ectasia (CAE) in a young patient. This patient presented with anterior wall myocardial infarction (MI) with post-infarct angina. His coronary angiogram revealed coronary artery ectasia involving the left anterior descending, circumflex and right coronary arteries.     

Exercise-induced myocardial ischemia in patients with coronary artery ectasia without obstructive coronary artery disease

BACKGROUND: Aetiology, clinical significance and treatment options for coronary artery ectasia/aneurysm is not clear. OBJECTIVE: We sought to determine whether exercise can induce coronary ischemia in patients with coronary artery ectasia/aneurysm without significant coronary stenosis. METHODS: Coronary artery ectasia was defined as 1.5-2-fold, aneurysm as >2-fold luminal dilatation of the adjacent normal segment. The study patients could have irregularities with ectatic coronaries but they did not have stenotic lesions >50% with visual assessment of two blinded observers. Patients having coronary artery ectasia or aneurysm with prior myocardial infarction, dilated cardiomyopathy, valvular heart disease, bundle branch block, significant ST-T changes were excluded. The control group was formed from a well matched population of 32 patients with normal coronary arteries who have not performed a treadmill test before coronary angiography. The study group underwent a symptom limited treadmill test if they did not have one before coronary angiogram, all control patients underwent treadmill test. RESULTS: Thirty-three patients with coronary artery ectasia/aneurysm (ranging from one to three vessels) but without significant stenosis were derived from 4470 cardiac catheterization procedures between January 1998 and July 2000. In the study group, 17 of the patients had positive treadmill tests with respect to five patients in the control group (P = 0.004). In subgroup analysis, diffuse ectasia/aneurysm (involving 2-3 vessels) was found to be strongly related with ischemia (P = 0.005) with respect to local disease. CONCLUSION: Coronary artery ectasia/aneurysm may lead to exercise induced ischemia, especially in the diffuse form.     

Single coronary artery in a patient with acute myocardial infarction and supraventricular tachycardia--a case report

A case of a 66-year-old patient with a history of paroxysmal supraventricular tachycardia, hypertension and chronic obturatory pulmonary disease is presented. The patient was admitted to the hospital due to acute myocardial infarction. Coronary angiography revealed a single coronary artery originating from the right sinus of Valsalva without any significant lesions. Literature concerning this rare coronary anomaly is discussed.     

Resistance to activated protein C in a patient with multiple myocardial infarctions and stroke--a case report

A case of a 49-year-old female with a history of two myocardial infarctions (MI) and ischaemic stroke is presented. The patient was admitted to the hospital due to a third acute MI. Laboratory investigations revealed resistance to activated protein C due to factor V Leiden mutation. Diagnosis and treatment of patients with this condition are discussed.     

A case report of a patient with a large aneurysmatic coronary artery fistula

A coronary artery fistula is a rare congenital malformation, which can become symptomatic in adulthood. This report describes a 65-year-old patient with a large aneurysmatic fistula who presented with signs of heart failure. Angiographically a large aneurysmatic fistula was found running from the left coronary artery to the junction of the superior vena cava and the right atrium.