McFarland Craig, Swamy Rajiv S, Shah Atman
University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
University of Chicago Medical Center, 5841 South Maryland Avenue, MC 6080, Chicago, IL 60637, USA.
J Cardiol Cases. 2011 Sep 14;4(3):e148-e151. doi: 10.1016/j.jccase.2011.08.005. eCollection 2011 Dec.
A 21-year-old African American male presented to the emergency department after an episode of unexplained syncope. He had no significant past medical history. The initial physical examination was within normal limits, and his 12-lead electrocardiogram showed no signs of ischemia or evidence of chamber enlargement. The patient received a transthoracic echocardiogram which demonstrated mild global left ventricular dysfunction with an estimated ejection fraction of 45%. Coronary angiography was next performed and found no evidence of atherosclerotic coronary artery disease but did reveal hypoplasia of the left circumflex and right coronary arteries, with intraluminal diameters of approximately 1 mm. The left anterior descending coronary artery was small distally. Cardiac magnetic resonance imaging with gadolinium enhancement found no evidence of myocardial scar. The patient was ultimately diagnosed with aborted sudden cardiac death due to hypoplastic coronary artery disease (HCAD). The patient received an implantable cardioverter-defibrillator (ICD) prior to hospital discharge for secondary prevention of sudden cardiac death. One year after this presentation, the patient has been asymptomatic, with no ICD discharges.
一名21岁的非裔美国男性在一次不明原因的晕厥发作后被送往急诊科。他既往无重大病史。初次体格检查结果正常，其12导联心电图未显示缺血迹象或心室扩大证据。患者接受了经胸超声心动图检查，结果显示左心室整体轻度功能障碍，估计射血分数为45%。接下来进行了冠状动脉造影，未发现动脉粥样硬化性冠状动脉疾病的证据，但确实显示左旋支和右冠状动脉发育不全，管腔内直径约为1毫米。左前降支冠状动脉远端细小。钆增强心脏磁共振成像未发现心肌瘢痕证据。该患者最终被诊断为因冠状动脉发育不全（HCAD）导致的心脏性猝死未遂。患者在出院前接受了植入式心律转复除颤器（ICD），用于心脏性猝死的二级预防。此次就诊一年后，患者无症状，ICD未放电。
