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     

左前降支心肌桥患者酒后大面积心肌梗死一例

患者男性 ,42岁。大量饮酒后突发急性前壁、侧壁、正后壁、下壁心肌梗死。溶栓后无再通指征。经冠状动脉 (简称冠脉 )造影发现左前降支中段心肌桥 ,余未见异常。考虑冠脉痉挛是大面积心肌梗死的主要原因。不排除本例患者大量饮酒、心肌桥与冠脉痉挛存在着因果关系。     

前降支心肌桥致急性心肌梗死误诊1例

病历摘要:患者男性,25岁,主因“间断胸骨后不适6年,加重13d”于2009-6-19入院。患者自2003年起,每于篮球比赛等剧烈活动时出现胸骨后憋闷,伴气短出汗,休息约1min左右症状可缓解。6年间共发作3次,以后自行降低活动量,未做检查和处理。2009年6月6日,患者骑自行车且负重上山过程中,反复出现胸骨后憋闷,并逐渐加重,伴大汗,周身无力,被迫被送回家休息。下午3时,胸闷再次出现并加重,持续不缓解,有濒死感。当地医院诊断为急性广泛前壁心肌梗死,予尿激酶溶栓及抗凝、改善心肌供血等治疗10余d,患者其间未再发作胸骨后憋闷,生命体征平稳。既往史:否认高血压病史,否认糖尿病史。个人史:吸烟史4年     

心肌桥所致急性心肌梗死4例报告

<正>1922年Grainicana首先论述了心肌桥(Myo-cardialBridge,MB)的存在〔1〕,1960年Portmann及Iwig在冠状动脉(冠脉)造影中证实,发现其可在心室收缩期压迫冠脉使之狭窄〔2〕,减少冠脉血流5%～30%,不产生明显血流动力学影响,被认为是一种"良性"少见现象。     

心肌桥引起急性心肌梗死一例

1病例简介 患者，男，45岁，因“反复头晕2个月，突发晕厥一次”于2008—01—16至我院急诊，查体：神志清，较淡漠，T：36．8℃，R：18次／min，BP：87／42mmHg（1mmHg=0．133kPa），HR：60次／min，律齐，各瓣膜区未闻及明显病理性杂音，肺部呼吸音清，未闻及明显啰音，腹部无明显压痛及反跳痛，肝脾未触及肿大。ECG提示急性下壁心肌梗死，     

心肌桥引起心肌梗死3例分析

冠状动脉心肌桥（Myocardial Bridge,MB）是一种常见的先天性解剖异常,是指冠状动脉及其主要分支的某一段走行于心肌纤维中,该段冠脉血管称为壁冠状动脉,壁冠状动脉上覆盖的心肌纤维称为心肌桥。近期的研究表明,心肌桥不再是一种良性的无症状的先天性解剖异常,而是与心肌缺血、冠脉痉挛、心律失常甚或急性心肌梗死和猝死等有一定关系。     

心肌桥致急性前壁心肌梗死一例

心肌桥(myocardial bridge,MB)是冠状动脉造影中比较常见的征像,且一般认为心肌桥是一种良性经过,绝大多数情况下不会造成明显的症状.但近期我们救治1例因心肌桥导致急性前壁心肌梗死的患者,现报告如下. 患者女性,79岁,体重62 kg,退休.因"用力排便时突发胸痛1小时"转入我科.患者因化脓性阑尾炎并发阑尾脓肿入我院急诊外科行抗感染、补液等治疗;既往否认高血压病及糖尿病史,入院常规心电图见:窦性心律(图1)     

经皮冠状动脉腔内血管成形术治疗急性心肌梗死合并心肌桥一例

患者 男,72岁,主因发作性胸痛4d,再发加重4h急诊入院。患者于入院前4d无明显诱因反复出现劳力性胸痛,经休息3-5min可缓解,未引起重视。入院前4h,     

孤立性心肌桥致2例急性冠脉综合征报告

冠状动脉心肌桥曾被认为是一种良性病变,近年随着研究的深入,发现冠状动脉心肌桥可导致严重的心肌缺血及其有关临床事件。现将我院2006年5月至2008年8月急性冠脉综合征患者行冠脉造影发现2例孤立性心肌桥（指仅在造影中发现心肌桥而不合并其他心脏疾病）的临床资料报道如下,并探讨本病的临床意义。     

左前降支冠状动脉持续痉挛引起急性广泛前壁心肌梗死1例

<正>1 病例资料患者,男,72岁。因"胸痛9 h"于我院急诊科就诊。患者2019年9月7日20:00散步中出现胸痛,位于胸骨中上段,约手掌大小范围,呈持续性胀痛,伴胸闷及咽喉紧缩感,无放射痛,未出冷汗,无心悸气促,无头晕头痛,无腹痛腹泻等不适。休息及含服"速效救心丸"后疼痛无明显缓解,至次日3:00仍觉胸痛不适,遂至我院就诊。5:10急诊心电图提示V2～V6 ST段弓背向上抬高(图1a、b),5:33急诊查肌钙蛋白I 0.48 mg/L     

Acute myocardial infarction caused by simultaneous occlusion of the right coronary artery and the left anterior descending coronary artery probably due to coronary spasm: a case report

A 56-year-old man had an attack of chest pain associated with ST-segment elevation in both the inferolateral and anteroseptal leads on electrocardiography. Emergency coronary angiography showed thrombus in the mid right coronary artery and total occlusion in the distal left anterior descending coronary artery. Intravenous heparin infusion and antiplatelet therapy were given without other coronary intervention. After 1 week, repeat coronary angiography showed neither significant stenosis nor thrombus in the coronary arteries. Severe coronary artery spasm in the left coronary artery was induced by the provocation test with intracoronary injection of 50 microg acetylcholine. He had an uneventful hospital course. This unique case demonstrated intracoronary thrombus formation in the right coronary artery and left anterior descending coronary artery simultaneously due to suspected coronary spasm.     

Acute myocardial infarction associated with myocardial bridging: a case report

We describe a case of a 41-year-old woman with chest pain for 1 hour who was admitted to our emergency room with acute myocardial infarction. Coronary angiography and spiral computer tomography showed myocardial bridging and an intracoronary thrombus in the mid-segment of the left anterior descending artery. She felt better after taking aspirin, diltiazem and a beta blocker and was discharged 15 days later.     

电击伤致急性心肌梗死1例

1例电击伤患者,出现心电图以及心肌酶谱的动态变化,血肌红蛋白增高,诊断为电击伤致急性心肌梗死,报告如下.     

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.     

Transient myocardial bridging of the left anterior descending coronary artery in acute inferior myocardial infarction

We observed transient myocardial bridging of left anterior descending coronary artery (LAD) in 18.75% (12 of the total 64) of the patients during acute inferior myocardial infarction (MI). Myocardial bridging occurred only in the acute phase of inferior MI and not in the chronic phase. In the acute phase of inferior MI, compensatory hypercontraction of the anterior wall is assumed to occur in response to the decrease in the movement of the infarct-related walls. In the chronic phase, disappearance of the myocardial bridging observed due to the resolution of compensatory anterior wall hypercontraction, as a result of the reperfusion of infarct-related coronary artery. Most of the myocardial bridges seen in autopsy series are not seen angiographically. Variation at angiography may in part be attributable to small and thin bridges causing little compression. Adrenergic stimulation or afterload reduction by nitroglycerin facilitates diagnosis of myocardial bridging by increasing coronary compression. Both of these conditions are almost always present in acute MI. We concluded that transient myocardial bridging of LAD can be observed in some patients with acute inferior MI during acute stage.     

Acute myocardial infarction probably induced by the oral administration of bromocriptine: a case report

This is a report of a case of acute myocardial infarction which was probably induced by the oral administration of bromocriptine. A 55-year-old man was admitted because of suspected hypothyroidism and dwarfism. The endocrinological examination revealed primary hypothyroidism, and levothyroxine sodium replacement therapy was started. Nine days later, the bromocriptine test was performed for dwarfism. Two hours after the oral administration of 2.5 mg bromocriptine, he had severe chest pain associated with loss of consciousness and hypotension. His electrocardiogram showed marked ST depression and T wave inversion, but no abnormal Q waves. Serial myocardial enzymes and electrocardiograms confirmed acute non-transmural myocardial infarction. During coronary angiography performed about three months later, coronary arterial spasm was induced by the intravenous administration of ergonovine maleate. This experience suggests that bromocriptine, a derivative of ergot alkaloids, can cause coronary arterial spasm, and subsequent myocardial infarction. To our knowledge, bromocriptine-induced myocardial infarction has not been previously reported in Japan.     

两支主要冠脉血管同时闭塞的青年急性心肌梗死1例

正两支主要冠状动脉同时闭塞的急性ST段抬高型心肌梗死临床上少见,易并发心衰、休克,常需主动脉球囊反搏(IABP)支持,其预后通常比较差,而发生在青年患者更是少见[1~3]。笔者对1例前降支、右冠状动脉同时闭塞的急性心肌梗死(AMI)患者进行了急诊介入治疗。1临床资料患者,男性,33岁,因"突发胸闷胸痛4 h"于2014年8月26日急诊。查体:BP:138/80 mmH g(1 mmH g=0.133 kP a),体质量指数(BMI)22.0 kg/m2,神清,两肺呼吸     

Myocardial bridging of the left anterior descending coronary artery in acute inferior wall myocardial infarction

BACKGROUND: We observed marked myocardial bridging of the left anterior descending coronary artery (LAD) in the acute stages of inferior wall myocardial infarction (MI) in a group of patients who developed shock despite successful reperfusion of the infarct-related lesion (IRL). HYPOTHESIS: The purpose of this study was to elucidate the clinical significance of myocardial bridging in patients with inferior wall MI and shock. METHODS: The study group consisted of 53 patients with single-vessel disease of the right coronary artery, who underwent coronary angiography for acute inferior wall MI. Clinical characteristics, coronary angiographic findings, and left ventricular function during the chronic phase were compared between the patients who developed shock (the shock group) and those who did not (the non-shock group). In addition, a multiple logistic analysis was performed to identify independent predictors of shock in patients with acute inferior wall MI. RESULTS: Reperfusion of the IRL was obtained in all 53 patients. The incidence of myocardial bridging of the LAD, the incidence of right ventricular MI, the peak creatine phosphokinase (CPK-MB). the pulmonary capillary wedge pressure, and the prevalence of pulmonary congestion seen on chest roentgenogram were significantly higher in the shock group than in the non-shock group. Myocardial bridging (p = 0.0018), right ventricular MI (p = 0.0374), and peak CPK-MB (p = 0.0189) were identified as independent predictors of shock in acute inferior wall MI. CONCLUSION: This study suggests that myocardial bridging plays a role in left ventricular function in the acute stage of inferior wall MI.     

Acute myocardial infarction probably caused by paradoxical embolus in a pregnant woman

A 19 year old pregnant woman presented to the coronary care unit with an acute anterior myocardial infarction. She was treated with primary percutaneous transluminal coronary angioplasty of the proximal left anterior descending coronary artery. Ultrasound examination showed patent foramen ovale (PFO) and atrial septal aneurysm. The patient was a heterozygote carrier of factor V Leiden. Despite the lack of a clear clue, it was considered that the pathophysiological cause of this infarction was a paradoxical embolus in the left coronary artery. Pregnancy and factor V Leiden carriership are associated with increased risk of venous thromboembolism and the association between PFO and atrial septal aneurysm is a strong risk factor for systemic embolisation.