Whyte Gregory, Godfrey Richard, O'Hanlon Rory, Wilson Mathew, Buckley John, Sharma Sanjay
Liverpool John Moores University, Research Institute for Sport and Exercise Science, Henry Cotton Campus, Truman Street, Liverpool, L3 2ET, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.07.2008.0384. Epub 2009 May 25.
Around 6% of patients suffering an acute myocardial infarction (AMI) have normal coronary arteries. The mechanisms responsible are not fully known, but include hypercoagulable state, coronary endothelial dysfunction, aortic dissection, inflammation, coronary thrombosis, aortic wall stiffening, cocaine abuse, carbon monoxide poisoning and paradoxical embolism. Here, the case of a lifelong regular exerciser without risk factors for cardiovascular disease who suffered an AMI with normal coronaries is reported. Despite normal cardiac function on left ventriculography and echocardiography, late gadolinium enhancement by cardiac magnetic resonance (CMR) revealed significant cardiac necrosis. The long-term prognosis is favourable with low rates of coronary morbidity and mortality. Acute chest pain should not be considered as benign and warrants medical investigation.
约6%的急性心肌梗死（AMI）患者冠状动脉正常。其发病机制尚不完全清楚，但包括高凝状态、冠状动脉内皮功能障碍、主动脉夹层、炎症、冠状动脉血栓形成、主动脉壁硬化、可卡因滥用、一氧化碳中毒和反常栓塞。本文报告了一例无心血管疾病危险因素的终身规律运动者发生冠状动脉正常的AMI病例。尽管左心室造影和超声心动图显示心脏功能正常，但心脏磁共振成像（CMR）延迟钆增强显示存在明显的心肌坏死。长期预后良好，冠状动脉发病率和死亡率较低。急性胸痛不应被视为良性，需要进行医学检查。
