Hackel D B, Wagner G
Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710.
Clin Cardiol. 1992 Feb;15(2):109-13. doi: 10.1002/clc.4960150211.
A 57-year-old man developed anginalike chest pain for the first time but there was no objective evidence of an infarct (i.e., EKG and serum enzymes were normal). After 12 days the pain increased, but EKG and serum enzymes remained normal ("preinfarct," crescendo, unstable, or accelerated angina). At this time a cardiac catheterization showed 90% occlusion of the left anterior descending (LAD) coronary artery. On the 17th day after the onset of pain, severe pain recurred together with an abnormal EKG and the patient was taken immediately to the laboratory where a total occlusion of the LAD was now found and he was treated with intracoronary streptokinase. The artery remained open for only a short time, and balloon angioplasty was performed. However, the patient died 12 hours after onset of the last episode of severe pain. A very early acute myocardial infarct was diagnosed at autopsy together with severe coronary atherosclerosis especially of the LAD which had disruption of atherosclerotic plaques and microscopic evidence of embolization.
一名57岁男性首次出现类似心绞痛的胸痛，但没有梗死的客观证据（即心电图和血清酶正常）。12天后疼痛加剧，但心电图和血清酶仍正常（“梗死前”、进行性、不稳定或加速性心绞痛）。此时心脏导管检查显示左前降支（LAD）冠状动脉闭塞90%。在疼痛发作后的第17天，再次出现严重疼痛并伴有异常心电图，患者立即被送往实验室，此时发现LAD完全闭塞，并接受了冠状动脉内链激酶治疗。动脉仅开放了很短时间，随后进行了球囊血管成形术。然而，患者在最后一次严重疼痛发作12小时后死亡。尸检诊断为极早期急性心肌梗死，同时伴有严重的冠状动脉粥样硬化，尤其是LAD，其动脉粥样硬化斑块破裂并有微观栓塞证据。
