A case of neurofibromatosis associated with a coronary artery aneurysm and myocardial infarction

A case of myocardial infarction secondary to thrombosis of a coronary artery aneurysm in a patient with neurofibromatosis is presented. The vascular manifestations of neurofibromatosis, and the associated clinical sequelae, are reviewed.     

急性心肌梗死直接冠状动脉介入治疗

 目的探讨急性心肌梗死急诊介入治疗在临床应用的策略.方法76例ST段抬高和(或)新发生左束支传导阻滞的急性心肌梗死患者,男52例,女24例;年龄43～82(61.5±13.6)岁.采用经股动脉或经桡动脉途径常规方法,行急诊冠脉造影和急诊PCI.结果76例患者PCI术后梗死相关血管血流达TIMI3级73例(96.1%),TIMI血流2级1例,失败2例.74支IRA共植入支架97枚,胸痛发作至IRA再通时间≤12 h和＞12h两组在年龄和性别方面有显著差异,胸痛发作至IRA再通时间＞12 h组的冠脉多支病变和心功能不全发生率高.结论急诊PCI不仅及时开通梗死相关血管,而且能消除狭窄,减低心脏事件发生率.故有条件的医院应首选PCI为急性心梗患者的治疗措施,尤其对高龄患者、有溶栓禁忌征者及有心原性休克的患者.     

法舒地尔治疗有机磷农药中毒的临床观察

目的探讨法舒地尔(Fasudil,Rho激酶抑制剂)对有机磷农药中毒迟发性神经病发病率的影响,以及对其治疗作用。方法对80例重度有机磷农药中毒患者,随机分为对照组和治疗组,两组均给予阿托品、盐酸戊乙奎醚及氯解磷定等综合治疗,治疗组在此基础上给予应用Fasudil静脉滴注,对两组患者的临床表现、发病率进行分析,观察两组患者临床表现、神经电生理变化,判断临床疗效。结果 Fasudil治疗组患者迟发性神经病发生率低于对照组(P<0.05);Fasudil能改善患者的神经功能。结论临床应用法舒地尔治疗有机磷农药中毒能降低迟发性神经病的发生率,并能有效治疗该病。     

急性心肌梗死心肌血流再灌注评价技术

TIMIFlow作为评价再灌注的方法自20世纪80年代起就一直应用于临床。TIMIFrameCount是较TIMI血流分级更为客观、更具可重复性的联系性变量指标。TMBG和TMP从心肌微血管水平对再灌注进行评价。冠脉内多普勒血流频谱变化常作为造影过程中的附加检查指标评价血管再通及心肌再灌注。同时心肌声学造影、连续心电图ST段监测、核素心肌灌注显像和心肌增强磁共振成像作为无创性的评价方法也显示出其应用价值。     

犬心肌梗死模型的制备及评价

 目的 建立犬心肌梗死动物模型并加以评价.方法 选取杂种犬14只,建立模型前进行心电图、超声及SPECT 检查;常规麻醉实验犬,开胸结扎左冠状动脉前降支,同时作心电监护;11 d后行超声心动图及SPECT检查.结果 犬冠状动脉前降支结扎后,心电监护示心率加快和室性早搏,ST段压低;11 d后超声心动图显示有室壁活动减弱,心梗区心肌变薄,射血分数(EF)、每搏量(SV)、左室短轴缩短率(FS)下降,较结扎前差异有统计学意义(P＜0.05) ;99rnTc-MIBI示:心尖部、左室前壁、室间隔明显充盈缺损.结论 该方法效果确实可靠、手术方便安全,是构建心肌梗死模型的理想方法.     

Usefulness of different myocardial sampling zones for the postmortem diagnosis of myocardial infarction

Summary The diagnosis of myocardial infarction requires the use of a group of tests that are very efficient, quick and inexpensive. Another important consideration is the choice of myocardial sampling zones, especially in cases of differential diagnosis between a cardiac injury secondary to a trauma or violent asphyxia and others, secondary to myocardial infarction. The aim of this work was to choose, through discriminant analysis, the most useful zones of cardiac tissue for the quantification of free fatty acids and free carnitine and for the performance of the K/Na quotient, as biochemical parameters for the postmortem diagnosis of myocardial infarction. According to the discriminant analysis performed, seven zones of cardiac tissue are necessary to achieve a differential diagnosis among myocardial infarction, other natural deaths, and violent deaths with a 71.9% efficacy. Greater diagnostic efficacy was found (78.1%) for differentiating between natural deaths and violent deaths. Offprint requests to: E. Lachica     

A case of fatal benzalkonium chloride poisoning

Five elderly persons with senile dementia accidentally ingested Hoesmin, a 10% aqueous solution of benzalkonium chloride (BAC). The condition of one patient, an 84-year-old woman whose lips and oral cavity became erythematous, gradually deteriorated. Although gastric lavage was performed, the patient died 3 h after ingestion of Hoesmin. Autopsy revealed corrosive changes of the mucosal surfaces of the tongue, pharynx, larynx, esophagus and stomach which may have come in contact with BAC. In addition, BAC was detected in the serum. We conclude that the patient died of BAC poisoning. Fatal BAC poisoning is rare and autopsy findings in only a few cases of BAC poisoning have been reported. Our findings emphasize the risk of oral ingestion of BAC. Received: 11 August 1997 / Received in revised form: 10 December 1997     

磁共振心肌灌注成像及心肌活力分析诊断急性心肌梗死的价值

目的:研究磁共振心肌灌注成像及心肌活力分析在诊断急性心肌梗死中的价值。方法:选择37例急性心肌梗死患者作为观察组,同时选出37例无心血管疾病的正常志愿者作为对照组,均行灌注成像和心肌活力分析,观察2组相应心肌信号强度平均值、首过最大上升斜率及首过时间。结果:磁共振心肌灌注成像延迟期观察组梗死心肌的信号强度平均值为73.23±35.24,对照组正常心肌(对应观察组梗死区)为17.99±8.15,2组对比差异具有统计学意义(P<0.01);观察组梗死心肌的首过最大上升斜率平均值为32.85±20.69,对照组正常心肌(对应观察组梗死区)为44.68±23.60,2组对比差异具有统计学意义(P<0.01)。观察组患者心肌梗死区首过时间平均为(5.04±1.74)s,对照组正常心肌(对应观察组梗死区)为(2.82±1.82)s,2组对比差异具有统计学意义(P<0.01)。结论:磁共振心肌灌注成像及心肌活力分析可用于诊断急性心肌梗死。     

Acute myocardial infarction demonstrated by multidetector CT scanning

A 55-year-old man was brought to the emergency room complaining of left-sided chest pain. His electrocardiogram was indeterminate, and a multidetector computed tomogram (MDCT) was performed to exclude aortic dissection. The patients aorta was normal, but an area of hypoperfusion was evident in the lateral ventricular myocardial wall. The ability to diagnose myocardial ischemia and infarcts on nongated MDCT is of particular clinical interest. As more imaging technology is devoted to imaging the heart, the greater expectations of radiologists ability to diagnose cardiac disease in the emergency room will become.     

急性心肌梗死合并肾梗死1例

临床资料 患者男,45岁.因“持续性胸闷,胸痛2d”于2015年5月17日入院,否认高血压、糖尿病、心脏病病史,有吸烟史30年,约20支/d,少量饮酒,曾有吸毒史.患者于3d前晚19时许无明显诱因突发胸骨下段压榨性疼痛,无放射痛,伴大汗淋漓、恶心、呕吐胃内容物、咳嗽咯痰,持续无缓解,遂来娄底市中心医院心血管内科就诊.     

Reduced myocardial flow reserve in anatomically normal coronary arteries due to elevated baseline myocardial blood flow in men with old myocardial infarction

BACKGROUND: Decreased myocardial flow reserve (MFR) in angiographically normal coronary arteries in patients with old myocardial infarction (OMI) has been reported. METHODS AND RESULTS: To clarify factors for the reduced MFR in OMI and to compare them with those in angina pectoris (AP), baseline myocardial blood flow (MBF) and MBF during dipyridamole administration were measured with nitrogen 13 ammonia positron emission tomography, after which MFR was calculated for 13 men with AP, 18 men with OMI, and 15 age-matched male control subjects. MFR was compared among the 3 groups in segments perfused by nonstenotic arteries. Baseline MBF in patients with OMI was significantly higher than that in patients with AP and control subjects. MBF during dipyridamole administration in patients with OMI was significantly lower than that in control subjects. MFR in patients with AP was 2.50 +/- 0.91 (P <.05 vs control subjects [3.47 +/- 1.25]), and that in patients with OMI was 1.83 +/- 0.61 (P <.01 vs control and AP groups). Ejection fraction (EF) in patients with OMI was significantly decreased compared with that in patients with AP. However, there was no significant difference in the mean score of the individual risk factors between patients with AP and those with OMI. In the pooled data with AP and OMI, baseline MBF and EF were significant for the reduced MFR. CONCLUSIONS: MFR and EF in patients with OMI were significantly decreased compared with those in patients with AP. Increased baseline MBF and decreased EF were significant factors for the reduced MFR in patients with AP and OMI.     

Cardiac adrenergic denervation in patients with non-Q-wave versus Q-wave myocardial infarction

In spite of smaller infarct size and better preserved left ventricular function the long-term prognosis after a non-Q-wave infarction is not better than after a Q-wave infarction. In fact, the risk of sudden cardiac death is higher in patients with a non-Q-wave infarction than in patients with a Q-wave infarction. One possible reason for postinfarction arrhythmias is cardiac adrenergic denervation resulting from myocardial infarction. In this study we compared cardiac adrenergic innervation after non-Q-wave and Q-wave infarctions. Single-photon emission tomography using iodine-123 metaiodobentzylguanidine (MIBG) and technetium-99m sestamibi (MIBI) tracers were conducted in order to compare cardiac adrenergic denervation and myocardial perfusion in 12 patients with a non-Q-wave infarction and 15 patients with a Q-wave infarction. MIBG and MIBI defects were determined as regional uptake ≤30% of maximal myocardial activity. The size of MIBI defects calculated as a percentage of left ventricular mass was significantly smaller in patients with a non-Q-wave infarction than in patients with a Q-wave infarction (4%±3% vs 9%±7%, P<0.05, respectively). According to the maximal serum creatine kinase activity, less myocardium was damaged in patients with a non-Q-wave infarction than in patients with a Q-wave infarction (502±436 IU/l vs 1878± 1265 IU/l, P<0.001). In spite of this, the extent of MIBG defects was similar in patients with a non-Q-wave and patients with a Q-wave infarction (21%±18% vs 23%± 12%, respectively). In addition, the size of MIBG defect correlated with the infarct size (maximal creatine kinase activity) (r=0.52, P<0.05) after a Q-wave infarction but not after a non-Q-wave infarction. In conclusion, despite a smaller infarct size in non-Q-wave infarct patients, the extent of cardiac adrenergic denervation was similar in patients with a non-Q-wave and patients with a Q-wave infarction. In addition, the extent of cardiac adrenergic denervation was related to the infarct size in patients with a Q-wave infarction but not in patients with a non-Q-wave infarction. Received 19 January 2000 and in revised form 24 March 2000     

小鼠心肌梗死模型的快速制作方法研究

目的探讨小鼠心肌梗死模型的快速建立方法及成功率。方法小鼠诱导麻醉后,经呼吸面罩持续麻醉,于胸骨左缘第3~4肋间分离胸大肌。通过挤压法将心脏挤出胸腔,结扎前降支,将心脏放回胸腔,胸大肌覆盖复位。观察制作小鼠心肌梗死模型时间,心肌梗死成功率、死亡率,术后检查心电图,超声检查左室射血分数（left ventricular ejection fraction,LVEF）、左室收缩末内径（left ventricular end-systolic diameter,LVESD）、左室舒张末内径（left ventricular end-diastolic diameter,LVEDD）、左室短轴缩短率（left ventricular fractional shortening,LVFS）及左室前壁（left ventricular anterior wall,LVAW）厚度较术前变化情况,术后2周处死小鼠,观察心肌梗死情况及HE染色心肌组织变化。结果制作小鼠心肌梗死模型时间是(40±10)s,心肌梗死模型成功率94%,小鼠存活率96%,心电图显示小鼠术后心电图ST段显著抬高;模型制作后超声检查可见术后左室舒缩功能明显减弱,LVEF较术前降低[（27.5±3.9）%,P<0.01],LVESD较术前增加[（1.07±0.23）mm,P<0.01],LVEDD较术前增加[（1.41±0.29）mm,P<0.01],LVFS较术前降低[（8.1±3.1）%,P<0.05],LVAW较术前降低[（0.44±0.06）mm,P<0.01];术后取小鼠心脏LVAW冠状面切开可见厚度明显低于正常心肌,病理检查HE染色可见大量疤痕组织形成。结论本研究探讨了新的制作小鼠心肌梗死模型方法,通过优化操作流程,熟练掌握操作技巧,克服了现有技术的弊端,本方法在无气管插管支持呼吸的情况下可快速制作心肌梗死模型,成功率高,死亡率低,在涉及小鼠心肌梗死模型的研究中可以极大提高实验效率。     

Multiple myocardial bridging in the elderly: A rare case

Myocardial bridging occurs when a segment of major epicardial coronary artery courses intramurally through myocardium, commonly involving the left anterior descending. However, myocardial bridging involving coronary arteries other than left anterior descending is less-common and rarely reported, especially in the elderly population. We report a rare case of multiple myocardial bridging involving the left anterior descending, first obtuse marginal, and ramus intermedius in a 68-year-old Asian female. We also briefly discuss the imaging evaluation and pathophysiology of myocardial ischemia in myocardial bridging. This is the second reported case of myocardial bridging involving such combination, and to our knowledge, the first for elderly patient.     

硝酸甘油介入核素心室显像对心肌梗塞患者存活心肌的估测

为评价硝酸甘油（ＮＧ）介入核素心室显像（ＲＮＶ）对检测心肌梗塞患者存活心肌的临床价值，３０例心肌梗塞患者均于静息核素心室显像结束后，即刻舌下含服ＮＧ０５～１０ｍｇ，行平衡法核素心室显像。将左室分为６个节段，采用定性（目测打分）及定量方法（局部射血分数）分析室壁运动。结果：采用定性方法，静态共检出９８个室壁运动异常节段，平均得分为５９±２８；ＮＧ介入后，３６个心肌节段室壁运动得到改善，平均得分为４４±３１，与介入前比较差异有显著性（ｔ＝５９，Ｐ＜０００１）。采用定量分析方法，静息ＲＮＶ显示室壁运动异常节段数１０１个，ＮＧ介入后有５２个节段得到改善。表明：ＮＧ介入核素心室显像可观察局部室壁运动，室壁运动改善与否可用于检测存活心肌。     

Q-wave regression after acute myocardial infarction assessed by Tl-201 myocardial perfusion SPECT

BACKGROUND: The actual relationship between the interval change of myocardial thallium 201 (Tl-201) radioactivity in the infarct area and the pattern of Q-wave regression is still unknown. This study was conducted to evaluate their relationship after acute myocardial infarction (AMI). METHODS AND RESULTS: A total of 30 patients who had a first Q-wave AMI (11 without Q-wave regression and 19 with Q-wave regression) were retrospectively included. Two sets of 12-lead surface electrocardiograms and Tl-201 myocardial perfusion images were obtained 0 to 2 months and 14 to 84 months after the AMI event, respectively. The acute/subacute redistribution Tl-201 radioactivity was similar between the patients with and those without Q-wave regression. However, the patients with Q-wave regression had higher chronic redistribution Tl-201 radioactivity than those without Q-wave regression. Moreover, the patients with Q-wave regression presented a higher gradient in the redistribution Tl-201 radioactivity between the chronic and acute/subacute images than those without Q-wave regression. CONCLUSIONS: This study supports the role of functional recovery of stunning and/or hibernating myocardium in the disappearance of Q waves after AMI.     

Practical tips and tricks in cardiovascular computed tomography: Diagnosis of myocardial infarction

In addition to accurately diagnosing coronary artery disease, cardiac CT (CCT) has the potential to provide information on myocardial function, perfusion, and viability. As ongoing research continues to support the utility of such noncoronary uses of CCT, this information is increasingly being integrated into clinical practice. An emerging important use of CCT is the ability to accurately identify areas of infarcted myocardium. From a clinical perspective, detecting and quantifying infarct size has important prognostic and therapeutic implications. This article provides a brief overview on the use of CT to diagnose myocardial infarction (MI) and provide practical “tips and tricks” that can aid in the CT-based detection of MI.     

门控SPECT心肌灌注显像评估急性心肌梗死患者心肌挽救量的研究进展

急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）的目的在于尽可能地挽救濒死心肌。心肌挽救量（MS）与患者能否获益密切相关,在PCI的疗效评估及预后判断中具有重要价值。评价MS需明确初始心肌危险区面积（AAR）和心肌最终梗死面积（FIS）,二者之差即为MS。通过急诊时和PCI后2次99Tcm-甲氧基异丁基异腈门控SPECT心肌灌注显像（GSMPI）可分别定量AAR和FIS,从而获得MS,结果客观、准确,其临床价值在早期的大样本研究中已得到肯定。但在急诊时行GSMPI受到很多限制,致使AAR较难获得。近年来有学者提出的新显像方案,仅通过PCI后早期行1次GSMPI即可测定AAR,替代了2次显像法计算得到MS,其可行性及在临床中的实用价值显著提高。同时,新显像方案也扩展了核素GSMPI在AMI诊疗中的应用范围,为AMI患者的危险度分层提供了补充信息。笔者拟对GSMPI评估AMI患者MS的新显像方案的机制、应用价值、优势及发展前景作一综述。     

低剂量增强多层螺旋CT对陈旧性心肌梗死心肌活性的评价

目的 前瞻性评价低剂量增强多层螺旋CT(MSCT)显示陈旧性心肌梗死心肌活性的可行性和可靠性,并与MR心肌灌注和心肌活性成像进行对照研究.方法 对32例临床明确诊断为陈旧性心肌梗死的患者行前瞻性首过和延迟增强64层MSCT及MR心肌灌注成像,在短轴面上将左心室分为16个心肌段进行分析,所有患者的MSCT和MR影像资料被双盲分析,确定早期心肌灌注缺损区和晚期延迟增强区的大小及范围.采用一致性检验的Kappa检验,评价两种方法对显示心肌活性的一致性.结果 32例患者,首过灌注期MSCT提示灌注缺损为41个节段,无灌注缺损为471个节段;首过灌沣期MRI提示灌注缺损为47个节段,无灌注缺损为465个节段,两种方法一致性Kappa值为0.650,符合率为94.5%(484/512).延迟期MSCT显示延迟增强为135个节段,其中非透壁性梗死为50个节段,透壁性梗死为85个节段,未出现延迟增强为377个节段;延迟期MRI显示延迟增强为120个节段,其中非透壁性梗死为56个节段,透壁性梗死为64个节段,未出现延迟增强为392个节段,两种方法一致性Kappa值为0.609,符合率为80.7%(413/512).结论 低剂量增强螺旋MSCT与MRI对心肌活性的评价有较好的相关性,MSCT对陈旧性心肌梗死的存活心肌和非存活心肌的检测是呵行和可靠的,减少不必要的X线辐射剂量是该研究的重要方面.