Balachandran K P, Oldroyd K G
Department of Cardiology, Hairmyres Hospital, East Kilbride, Glasgow G75 8RG.
Scott Med J. 2001 Jun;46(3):87-8. doi: 10.1177/003693300104600308.
Early thrombolytic therapy reduces the risk of cardiac rupture but delayed thrombolysis may increase this risk, despite improving overall survival. The mechanism appears to be related to both unsuccessful early reperfusion and haemorrhagic transformation following delayed reperfusion. The effect of antiplatelet therapy with glycoprotein IIb-IIIa receptor blockers (abciximab) on cardiac rupture is unknown. It is possible that they may contribute to cardiac rupture by promoting haemorrhagic transformation of the infarcted area. In this report we describe a 57 year old man who underwent emergency coronary angioplasty and stenting following failed thrombolytic therapy for an acute anterior myocardial infarction. A suboptimal result was obtained which necessitated an intravenous bolus of abciximab followed by an infusion. He abruptly developed electromechanical dissociation. Echocardiogram confirmed pericardial tamponade and a pericardial drain was inserted but the patient could not be resuscitated. Postmortem examination confirmed a large transmural rupture of the infarcted anterior wall which had undergone haemorrhagic transformation.
早期溶栓治疗可降低心脏破裂风险，但延迟溶栓尽管能提高总体生存率，却可能增加此风险。其机制似乎既与早期再灌注未成功有关，也与延迟再灌注后的出血性转化有关。糖蛋白IIb-IIIa受体阻滞剂（阿昔单抗）抗血小板治疗对心脏破裂的影响尚不清楚。它们有可能通过促进梗死区域的出血性转化而导致心脏破裂。在本报告中，我们描述了一名57岁男性，他在急性前壁心肌梗死溶栓治疗失败后接受了急诊冠状动脉血管成形术和支架置入术。结果不理想，需要静脉推注阿昔单抗，随后进行输注。他突然发生电机械分离。超声心动图证实有心包填塞，插入了心包引流管，但患者未能复苏。尸检证实梗死的前壁有大面积透壁破裂，并已发生出血性转化。
