Noto N, Osaka T, Yamanaka O, Kobayashi S, Ozaki H, Kanoh T
Department of Internal Medicine, Urayasu Hospital, Juntendo University.
Kokyu To Junkan. 1990 May;38(5):483-7.
A 55-year-old man, who has been on follow-up observation with chronic atrial fibrillation, came in with a sudden onset of chest pain on July 31, 1986. He was diagnosed as having acute myocardial infarction indicated by abnormal ECG, elevated serum enzyme and characteristic signs of echocardiography. Emergency coronary angiography was performed 2 hours after the onset of chest pain, and it was reported as showing total obstruction of the distal left anterior descending artery. Percutaneous transluminal coronary recanalization using 1,200,000 units of urokinase was unsuccessful. The repeated angiography performed 40 days later, showed normal coronary arteriogram, but left ventriculogram revealed akinesis of the apical segment. Furthermore, left atrium opacified in the levophase of pulmonary arteriogram indicated left atrial thrombus. The cause of the myocardial infarction was considered to be coronary embolism from the left atrial thrombus with atrial fibrillation. It must be the first report documented by coronary angiography, of coronary thrombo-embolism due to chronic atrial fibrillation without any underlying disease.
一名55岁男性，因慢性心房颤动接受随访观察，于1986年7月31日突发胸痛前来就诊。心电图异常、血清酶升高及超声心动图特征性表现提示其被诊断为急性心肌梗死。胸痛发作2小时后进行了急诊冠状动脉造影，报告显示左前降支远端完全阻塞。使用120万单位尿激酶进行经皮腔内冠状动脉再通术未成功。40天后重复进行的血管造影显示冠状动脉造影正常，但左心室造影显示心尖段运动减弱。此外，肺动脉造影左房期左房显影提示左房血栓形成。心肌梗死的病因被认为是伴有心房颤动的左房血栓导致的冠状动脉栓塞。这必定是第一份经冠状动脉造影记录的、由无任何基础疾病的慢性心房颤动导致冠状动脉血栓栓塞的报告。
