Jain Sumesh, Chen Bruce, Moreland Jason A
WVU Department of Medicine, Section of Cardiovascular Diseases, Morgantown, USA.
W V Med J. 2013 Sep-Oct;109(5):14-6.
We report the case of a 45-year-old postpartum female at low risk for coronary artery disease (CAD) who presented with chest pain, a normal electrocardiogram (ECG) and elevation of serial troponin-T levels. Coronary angiography revealed dissection of the first obtuse marginal branch of the left circumflex coronary artery. The patient was treated medically and discharged home safely. Spontaneous coronary artery dissection (SCAD) is a rare condition. In the absence of CAD, it is seen most frequently in young females during the peripartum period. Insult from the hemodynamic stresses during pregnancy and labor combined with the underlying pregnancy related arterial wall changes is the proposed mechanism of dissection in this setting. The normal ECG in the presence of an acute myocardial infarction (AMI) in this case also demonstrates the occasional electrically silent ECG that can occur during acute compromise of the left circumflex coronary artery.
我们报告了一例45岁的产后女性病例，该女性患冠状动脉疾病（CAD）的风险较低，她出现胸痛症状，心电图（ECG）正常，但肌钙蛋白T水平呈系列升高。冠状动脉造影显示左旋支冠状动脉第一钝缘支夹层形成。该患者接受了药物治疗并安全出院。自发性冠状动脉夹层（SCAD）是一种罕见病症。在无CAD的情况下，它最常见于围产期的年轻女性。孕期和分娩期间血流动力学压力造成的损伤，再加上与妊娠相关的潜在动脉壁变化，被认为是这种情况下夹层形成的机制。在该病例中，急性心肌梗死（AMI）时ECG正常，这也表明在左旋支冠状动脉急性受损期间偶尔会出现电活动静默的ECG。
