Alfaqih Mohanad A, Michel Ortega Rosa M, Yang Eric H
Henry Ford Hospital, Department of Internal Medicine, Division of Cardiovascular Disease, Detroit, Michigan 48202, USA.
J Invasive Cardiol. 2012 Sep;24(9):E193-5.
A 68-year-old African American female with a prior medical history of hypertension and dyslipidemia presented with sudden onset pressure-like substernal chest pain. Initial ECG showed no ST or T wave abnormalities, and troponin elevation of 2.88 ng/mL. Two hours later, chest pain recurred with ECG change and increase in troponin to 11.97 ng/mL. She underwent urgent coronary angiography, which revealed left anterior descending artery dissection with thrombus. We successfully treated with balloon angioplasty followed by placement of 3 drug-eluting stents resulting in TIMI-3 flow; further testing for vasculitis was negative. Once spontaneous coronary artery dissection is diagnosed, the approach to treatment is controversial and treatment should be patient tailored.
一名68岁的非裔美国女性，既往有高血压和血脂异常病史，突发胸骨后压榨样胸痛。初始心电图显示无ST段或T波异常，肌钙蛋白升高至2.88 ng/mL。两小时后，胸痛复发，心电图改变，肌钙蛋白升至11.97 ng/mL。她接受了紧急冠状动脉造影，结果显示左前降支动脉夹层伴血栓形成。我们成功地进行了球囊血管成形术，随后置入3枚药物洗脱支架，使心肌梗死溶栓试验（TIMI）血流达3级；进一步的血管炎检查结果为阴性。一旦诊断为自发性冠状动脉夹层，治疗方法存在争议，应根据患者具体情况进行个体化治疗。
