Wiernek Szymon L, Dai Xuming
Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
BMJ Case Rep. 2017 Oct 15;2017:bcr-2017-222437. doi: 10.1136/bcr-2017-222437.
Thrombotic thrombocytopenic purpura (TTP) affects essentially all organ systems. Myocardial injury in TTP is often attributed to microthrombi formation. We present the first case report in the literature of an acute TTP patient with concomitant obstructive coronary artery disease (CAD) and acute myocardial infarction who underwent successful percutaneous coronary intervention (PCI). A 70-year-old female patient who was diagnosed with acute TTP required plasma exchange. The patient also experienced episodes of angina pectoris, elevated cardiac enzymes and global ST segment depressions on ECG. A subsequent non-invasive ischaemia workup revealed significant ischaemia. Coronary angiography revealed obstructive CAD in her right coronary artery, requiring PCI with a bare metal stent placement and dual antiplatelet therapy. The patient tolerated antiplatelet therapy well. At 6 months of follow-up, she had no recurrent angina. This case highlights the potential co-existence of obstructive CAD and acute TTP requiring careful differential diagnosis and treatment.
血栓性血小板减少性紫癜（TTP）几乎会影响所有器官系统。TTP中的心肌损伤通常归因于微血栓形成。我们报告了文献中首例伴有阻塞性冠状动脉疾病（CAD）和急性心肌梗死的急性TTP患者成功接受经皮冠状动脉介入治疗（PCI）的病例。一名70岁女性患者被诊断为急性TTP，需要进行血浆置换。该患者还出现心绞痛发作、心肌酶升高以及心电图上广泛的ST段压低。随后的无创缺血检查显示存在明显缺血。冠状动脉造影显示其右冠状动脉存在阻塞性CAD，需要置入裸金属支架并进行双重抗血小板治疗的PCI。患者对抗血小板治疗耐受性良好。随访6个月时，她没有复发性心绞痛。该病例突出了阻塞性CAD与急性TTP可能并存，需要仔细鉴别诊断和治疗。
