Abuosa Ahmed, AlRahimi Jamilah, Mansour Nasir, Bilal Ashar, AlQabbani Atif, Neyaz Akram
King Faisal Cardiac Center, King Saud Bin Abdulaziz University for Health Science, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi ArabiaaSaudi Arabia.
J Saudi Heart Assoc. 2018 Oct;30(4):331-335. doi: 10.1016/j.jsha.2018.06.005. Epub 2018 Jul 26.
A case of a young Saudi patient with a previous diagnosis of bronchial asthma, nasal polyps, and chronic smoker, presented with atypical chest pain, elevated serum troponin and borderline ischemic electrocardiogram (ECG) changes, with no significant regional wall motion abnormalities at bedside echocardiography is reported. The patient was admitted to the coronary care unit for continuous monitoring as possible acute coronary syndrome, non-ST elevation myocardial infarction (STEMI). One hour after admission, the patient had ventricular fibrillation (VF) cardiac arrest that required three DC shocks and amiodarone bolus before returning of spontaneous circulation, which followed the fourth shock. The resuscitation took 15 minutes of cardiopulmonary resuscitation (CPR). An immediate 12-leads ECG showed significant ST elevation in precordial leads that mandate an urgent coronary angiogram that revealed patent coronary arteries, therefore spasm of normal coronary arteries was postulated as the operative factor. The cardiac magnetic resonance image (MRI) showed a picture of transmural anterior myocardial infarction, which correlates with the follow up echocardiogram reporting hypokinetic anterior wall. A complete history was taken and no use of illicit drugs or alcohol was found. The unusual presentation in such a patient with evidence of extensive anterior STEMI and normal coronary arteries raise the thought of considering uncommon causes. In view of previous medical history and laboratory evidence of eosinophilia, Kounis syndrome was considered dominant in the differential diagnosis.
报告了一例年轻的沙特患者，既往诊断为支气管哮喘、鼻息肉，且长期吸烟，出现非典型胸痛、血清肌钙蛋白升高及临界性缺血性心电图（ECG）改变，床旁超声心动图检查未发现明显的节段性室壁运动异常。该患者因可能的急性冠状动脉综合征、非ST段抬高型心肌梗死（STEMI）入住冠心病监护病房进行持续监测。入院一小时后，患者发生心室颤动（VF）心脏骤停，在恢复自主循环前需要三次直流电除颤及静脉推注胺碘酮，第四次除颤后恢复自主循环。复苏进行了15分钟的心肺复苏（CPR）。即刻12导联ECG显示胸前导联ST段显著抬高，这需要紧急冠状动脉造影，结果显示冠状动脉通畅，因此推测正常冠状动脉痉挛是致病因素。心脏磁共振成像（MRI）显示透壁性前壁心肌梗死图像，这与后续超声心动图报告的前壁运动减弱相符。采集了完整病史，未发现使用非法药物或酒精的情况。该患者出现广泛前壁STEMI且冠状动脉正常的不寻常表现，引发了考虑罕见病因的想法。鉴于既往病史和嗜酸性粒细胞增多的实验室证据，鉴别诊断中考虑以库尼斯综合征为主。
