Baroldi G, Marzilli M, L'Abbate A, Arbustini E
Institute of Clinical Physiology, CNR, Milan, Italy.
Clin Cardiol. 1990 Jan;13(1):49-54. doi: 10.1002/clc.4960130109.
A 45-year-old man with unstable angina developed persistent ECG changes of myocardial ischemia during coronary angiography. Occlusion of the left anterior descending branch (LAD) was documented 20 minutes after these changes. Intracoronary nitrate, Ca antagonist, urokinase, removal by percutaneous transluminal coronary angioplasty (PTCA) of atherosclerotic obstructions, and emergency bypass surgery failed to restore myocardial perfusion. Only short periods of reflow were obtained by urokinase and PTCA. The repeated coronary injections demonstrated a progressive disappearance of the left anterior descending artery (LAD) starting from the distal portion and progressing retrogradely up to the origin of the vessel. The patient developed a transmural anterolateral myocardial infarction and 12 months later underwent cardiac transplantation for untractable failure. His heart was examined and the infarct confirmed. Analysis of this case suggests that coronary occlusion in acute myocardial infarction can be an event secondary to increased intramyocardial resistance rather than the cause of reduced coronary blood flow in subepicardial coronary arteries.
一名45岁不稳定型心绞痛男性患者在冠状动脉造影期间出现心肌缺血的持续性心电图改变。这些改变出现20分钟后记录到左前降支（LAD）闭塞。冠状动脉内硝酸酯、钙拮抗剂、尿激酶、经皮腔内冠状动脉成形术（PTCA）清除动脉粥样硬化阻塞以及急诊搭桥手术均未能恢复心肌灌注。尿激酶和PTCA仅获得了短时间的再灌注。重复冠状动脉注射显示左前降支（LAD）从远端开始逐渐消失，并逆行发展至血管起源处。患者发生透壁前外侧心肌梗死，12个月后因难治性心力衰竭接受心脏移植。对其心脏进行检查并证实了梗死。该病例分析表明，急性心肌梗死中的冠状动脉闭塞可能是心肌内阻力增加继发的事件，而非心外膜下冠状动脉血流减少的原因。
