Herzog C A, Henry T D, Zimmer S D
Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota 55415.
Am J Med. 1991 Mar;90(3):392-7.
Coronary embolism is a known complication of bacterial endocarditis that sometimes causes acute myocardial infarction. The necessity for rapidly restoring coronary artery perfusion and the time constraints governing clinical decisions may prevent endocarditis from being diagnosed before pharmacologic or mechanical thrombolysis. This report describes the first documented cases of coronary angioplasty in two patients with acute myocardial infarction caused by bacterial endocarditis, and reviews the literature on coronary artery complications of bacterial endocarditis. The first patient developed a coronary artery mycotic aneurysm at the dilatation site; the second experienced a small intracerebral hemorrhage following reperfusion. It is, of course, unwise to generalize from two cases, but we believe that in patients who are most likely to have endocarditis as the cause of acute myocardial infarction, the impulse to follow conventional strategies for coronary reperfusion should be tempered by thoughts of possible consequences.
冠状动脉栓塞是细菌性心内膜炎的一种已知并发症，有时会导致急性心肌梗死。迅速恢复冠状动脉灌注的必要性以及临床决策的时间限制，可能会导致在进行药物或机械溶栓之前无法诊断出心内膜炎。本报告描述了两例由细菌性心内膜炎引起急性心肌梗死患者首次进行冠状动脉血管成形术的记录病例，并回顾了关于细菌性心内膜炎冠状动脉并发症的文献。第一例患者在扩张部位出现冠状动脉霉菌性动脉瘤；第二例患者在再灌注后发生少量脑出血。当然，从两例病例进行归纳是不明智的，但我们认为，对于最有可能因心内膜炎导致急性心肌梗死的患者，在考虑冠状动脉再灌注的传统策略时，应权衡可能的后果。
