Sia Sung-Kien, Huang Chien-Ning, Ueng Kwo-Chang, Wu Yi-Liang, Chan Kuei-Chuan
Division of Cardiology, Department of Internal Medicine, Institute of Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan.
Circ J. 2008 Jun;72(6):1034-6. doi: 10.1253/circj.72.1034.
Simultaneous double vessel acute myocardial infarction (AMI) is extremely rare and usually has poor clinical outcomes. Management of this complicated condition is challenging and time-limited. The case of a 46-year-old Taiwanese man with simultaneous anterior and inferior wall AMI is reported. Rapid deterioration of clinical condition with ventricular fibrillations (VF), cardiogenic shock and asystole developed before catheterization. Coronary angiogram revealed simultaneous total occlusion of left anterior descending (LAD) and right coronary arteries (RCA). Frequent VF attack was still noted after diagnostic catheterization. After cardiopulmonary resuscitation, immediate percutaneous coronary intervention of the LAD and RCA, and intra-aortic balloon counterpulsation was inserted. Due to intractable heart failure and cardiogenic shock, extracorporeal membrane oxygenation was performed. Rabdomyolysis with acute renal failure was also noted with hemodialysis treatment. Thirty-one days after hospitalization, he was discharged with a New York Heart Association functional class III heart failure, without hemodialysis.
同时发生的双支血管急性心肌梗死（AMI）极为罕见，临床预后通常较差。处理这种复杂情况具有挑战性且时间紧迫。本文报告了一例46岁台湾男性同时发生前壁和下壁AMI的病例。该患者在导管插入术前临床状况迅速恶化，出现室颤（VF）、心源性休克和心搏停止。冠状动脉造影显示左前降支（LAD）和右冠状动脉（RCA）同时完全闭塞。诊断性导管插入术后仍频繁出现VF发作。心肺复苏后，立即对LAD和RCA进行经皮冠状动脉介入治疗，并插入主动脉内球囊反搏。由于难治性心力衰竭和心源性休克，进行了体外膜肺氧合治疗。还注意到横纹肌溶解伴急性肾衰竭，并进行了血液透析治疗。住院31天后，患者出院时纽约心脏协会心功能分级为III级心力衰竭，但无需血液透析。
