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一名年轻成年男性自发性冠状动脉夹层伴急性前壁心肌梗死病例——一种日益被认识到的罕见疾病。

A case of spontaneous coronary artery dissection presenting with acute anterior wall myocardial infarction in a young adult male - an increasingly recognized rare disease.

作者信息

Taha Mohamed, Latt Htun, Al-Khafaji Jaafar, Ali Mohamed, Seher Richard

机构信息

Department of Internal Medicine, University of Nevada - Reno, School of Medicine, Reno, NV, USA.

Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, NV, USA.

出版信息

J Community Hosp Intern Med Perspect. 2018 Apr 17;8(2):60-63. doi: 10.1080/20009666.2018.1440855. eCollection 2018.

DOI:10.1080/20009666.2018.1440855
PMID:29686789
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5906760/
Abstract

: Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction and sudden death. Although some correlations have been noted in relation to aetiology, no direct causes have been identified in a large number of patients. Most of the patients are women in peripartum period or of childbearing age, with few if any risk factors for coronary heart disease. In men, however, risk factors for atherosclerosis are more prevalent in cases of SCAD : We report a case of a 43-years-old healthy male, with no known risk factors, who presented with ischemic chest pain and elevated troponin levels. He underwent an emergent percutaneous transluminal coronary angiography which revealed a total occlusion of the left anterior descending artery at its origin with an evidence of spontaneous dissection as the cause of the occlusion, which was subsequently treated with placement of a drug-eluting stent and thrombectomy from the distal occluded portion. This case highlights the importance of including spontaneous coronary artery dissection as a cause of ischemic cardiac insults and illustrates the approach to treatment. : Internists should have a low threshold of clinical suspicion for SCAD especially in a young patient with no known risk factors and should know the importance of emergency in management.

摘要

自发性冠状动脉夹层(SCAD)日益被认为是心肌梗死和猝死的重要原因。尽管在病因方面已发现一些相关性,但大量患者中尚未确定直接病因。大多数患者为围产期或育龄期女性,几乎没有冠心病危险因素。然而,在男性SCAD病例中,动脉粥样硬化危险因素更为普遍。我们报告一例43岁健康男性病例,无已知危险因素,出现缺血性胸痛且肌钙蛋白水平升高。他接受了急诊经皮冠状动脉腔内血管造影,结果显示左前降支起始部完全闭塞,有证据表明自发性夹层是闭塞原因,随后通过植入药物洗脱支架和对远端闭塞部分进行血栓切除术进行治疗。该病例突出了将自发性冠状动脉夹层作为缺血性心脏损伤原因的重要性,并说明了治疗方法。内科医生对SCAD应保持较低的临床怀疑阈值,尤其是在无已知危险因素的年轻患者中,并且应了解紧急处理的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8846/5906760/358106de5192/ZJCH_A_1440855_F0004_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8846/5906760/373a7603fdca/ZJCH_A_1440855_F0001_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8846/5906760/28afe17b6619/ZJCH_A_1440855_F0002_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8846/5906760/9a374b458656/ZJCH_A_1440855_F0003_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8846/5906760/358106de5192/ZJCH_A_1440855_F0004_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8846/5906760/373a7603fdca/ZJCH_A_1440855_F0001_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8846/5906760/28afe17b6619/ZJCH_A_1440855_F0002_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8846/5906760/9a374b458656/ZJCH_A_1440855_F0003_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8846/5906760/358106de5192/ZJCH_A_1440855_F0004_B.jpg

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Int J Cardiol. 2016 Jan 1;202:336-8. doi: 10.1016/j.ijcard.2015.09.072. Epub 2015 Sep 25.
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Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection.自发性冠状动脉夹层的管理与长期预后
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Circ Cardiovasc Interv. 2014 Oct;7(5):645-55. doi: 10.1161/CIRCINTERVENTIONS.114.001760. Epub 2014 Oct 7.
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