Kujime Shingo, Hara Hidehiko, Enomoto Yoshinari, Yoshikawa Hisao, Itaya Hideki, Noro Mahito, Suzuki Makoto, Nakamura Masato, Sugi Kaoru
Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Japan.
Intern Med. 2012;51(14):1851-5. doi: 10.2169/internalmedicine.51.7069. Epub 2012 Jul 15.
This report describes an obese 39-year-old man who experienced ST-segment elevation myocardial infarction with total thrombotic occlusion of the right coronary artery. Culprit vessel flow was improved by aspiration. Data suggested that myocardial infarction had resulted from paradoxical embolus via a patent foramen ovale triggered by the Mueller maneuver, which had induced negative intrathoracic pressure following an acute increase of right-heart volume in the context of obesity and sleep-disordered breathing (SDB). Obesity is increasing among younger populations and it represents a risk for SDB and thrombosis. Thus, this mechanism should be included within the differential diagnosis for myocardial infarction in young patients.
本报告描述了一名39岁的肥胖男性，他经历了ST段抬高型心肌梗死，右冠状动脉完全血栓闭塞。通过抽吸改善了罪犯血管血流。数据表明，心肌梗死是由卵圆孔未闭导致的矛盾栓塞引起的，该矛盾栓塞由米勒动作触发，在肥胖和睡眠呼吸障碍（SDB）的情况下，右心容积急性增加后导致胸腔内负压。肥胖在年轻人群中日益增多，它是SDB和血栓形成的一个危险因素。因此，这种机制应纳入年轻患者心肌梗死的鉴别诊断中。
