Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
JACC Cardiovasc Interv. 2018 Jan 22;11(2):172-180. doi: 10.1016/j.jcin.2017.08.057.
Coronary embolism is the underlying cause of 3% of acute coronary syndromes but is often not considered in the differential of acute coronary syndromes. It should be suspected in the case of high thrombus burden despite a relatively normal underlying vessel or recurrent coronary thrombus. Coronary embolism may be direct (from the aortic valve or left atrial appendage), paroxysmal (from the venous circulation through a patent foramen ovale), or iatrogenic (following cardiac intervention). Investigations include transesophageal echocardiography to assess the left atrial appendage and atrial septum and continuous electrocardiographic monitoring to assess for paroxysmal atrial fibrillation. The authors review the historic and contemporary published data about this important cause of acute coronary syndromes. The authors propose an investigation and management strategy for work-up and anticoagulation strategy for patients with suspected coronary embolism.
冠状动脉栓塞是急性冠状动脉综合征的 3%的潜在病因，但在急性冠状动脉综合征的鉴别诊断中往往不被考虑。如果尽管潜在血管相对正常或反复出现冠状动脉血栓，但血栓负荷较高，则应怀疑冠状动脉栓塞。冠状动脉栓塞可能是直接的（来自主动脉瓣或左心耳）、阵发性的（来自通过未闭卵圆孔的静脉循环）或医源性的（心脏介入治疗后）。检查包括经食管超声心动图以评估左心耳和房间隔，以及连续心电图监测以评估阵发性心房颤动。作者回顾了关于这种急性冠状动脉综合征重要病因的历史和当代已发表的数据。作者提出了一种针对疑似冠状动脉栓塞患者的检查和管理策略，以及抗凝策略。
