Milei J, Gugliota H O, Storino R A
Arq Bras Cardiol. 1989 Apr;52(4):213-5.
It is widely known that other causes than recent coronary thrombosis may precipitate acute myocardial infarction in the presence of coronary atherosclerosis. A 48 year old male patient was admitted due to acute coronary insufficiency. The ECG showed anterolateral necrosis and lateral ischemia. Despite medication angina persisted and he died immediately after coronary angiography. At autopsy, established coagulation necrosis was observed in the internal half and the subendocardium of the lateral and posterior walls, of the left ventricle. Early coagulation necrosis occupied the inner half of the anterior, posterior and septal walls. Severe atherosclerotic coronary lesions were found in all major coronary trunks. An extensive panarteritis, involving extra and intramyocardial branches, consisting of mononuclear cells and prominent edema, was observed. A mixed mechanism may be invoked to explain the extensive myocardial necrosis: panarteritic infiltrates and extensive edema and humoral-induced coronary spasm.
众所周知，在冠状动脉粥样硬化的情况下，除了近期冠状动脉血栓形成之外，其他原因也可能引发急性心肌梗死。一名48岁男性患者因急性冠状动脉功能不全入院。心电图显示前外侧坏死和侧壁缺血。尽管进行了药物治疗，心绞痛仍持续存在，并且他在冠状动脉造影后立即死亡。尸检时，在左心室侧壁和后壁的内半层及心内膜下观察到了已形成的凝固性坏死。早期凝固性坏死占据了前壁、后壁和间隔壁的内半层。在所有主要冠状动脉主干中均发现了严重的动脉粥样硬化性冠状动脉病变。观察到广泛的全动脉炎，累及心肌外和心肌内分支，由单核细胞和明显水肿组成。可能需要用混合机制来解释广泛的心肌坏死：全动脉炎浸润、广泛水肿和体液诱导的冠状动脉痉挛。
