Schwartz Matthew C, Wellen Shari, Rome Jonathan J, Ravishankar Chitra, Natarajan Shobha
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
Cardiol Young. 2013 Jun;23(3):353-60. doi: 10.1017/S1047951112001278.
We sought to describe the evaluation, treatment, and follow-up of adolescents who presented to a single institution with chest pain and an elevated troponin I value in the absence of typical symptoms of pericarditis or myocarditis. Materials and methods We performed a retrospective review of patients in the age group of 10-18 years of age with no history of significant heart disease admitted to our institution from 2000 to 2010 after presenting with chest pain and an elevated troponin I value.
A total of 16 patients were identified with a median age of 16.5 years (range 11.2-17.8 years). Of these 13 (81%) were male and 10 (63%) showed evidence of localised ST elevations on electrocardiogram. The median peak troponin I level was 17.8 nanograms per millilitre (range 0.89-227, normal less than 0.4). There were eight patients (50%) with a diagnosis of coronary vasospasm, three patients (20%) with atypical myopericarditis, one patient with coronary anomaly, one patient with hypercoagulable disorder, and one patient with prolonged supraventricular tachycardia. In two patients, no definitive diagnosis was made. There was one patient who needed catheter-based intervention, which involved stenting of a coronary artery after a procedure-related complication.
In our cohort of adolescents without history of significant cardiac disease, chest pain and elevated troponin I levels were attributed to a variety of causes. Although coronary vasospasm and atypical myopericarditis were seen most commonly, coronary anomaly was identified in one case. Magnetic resonance imaging proved a useful diagnostic tool to assess coronary artery anatomy and myocardial changes suggestive of myocarditis. On the basis of these results and a review of the literature, a general evaluation algorithm is presented.
我们试图描述那些前往单一机构就诊、胸痛且肌钙蛋白I值升高但无典型心包炎或心肌炎症状的青少年的评估、治疗及随访情况。材料与方法 我们对2000年至2010年间因胸痛和肌钙蛋白I值升高而入住我院的10至18岁无重大心脏病史的患者进行了回顾性研究。
共确定了16例患者，中位年龄为16.5岁（范围11.2 - 17.8岁）。其中13例（81%）为男性，10例（63%）心电图显示有局部ST段抬高。肌钙蛋白I峰值的中位数为每毫升17.8纳克（范围0.89 - 227，正常小于0.4）。8例（50%）诊断为冠状动脉痉挛，3例（20%）为非典型心肌心包炎，1例为冠状动脉异常，1例为高凝性疾病，1例为持续性室上性心动过速。2例患者未做出明确诊断。有1例患者需要基于导管的干预，该患者在发生与手术相关的并发症后接受了冠状动脉支架置入术。
在我们这个无重大心脏病史的青少年队列中，胸痛和肌钙蛋白I水平升高归因于多种原因。虽然冠状动脉痉挛和非典型心肌心包炎最为常见，但也发现了1例冠状动脉异常。磁共振成像被证明是评估冠状动脉解剖结构和提示心肌炎的心肌变化的有用诊断工具。基于这些结果并结合文献回顾，我们提出了一个通用的评估算法。
