Honda Tsuyoshi, Fujimoto Kazuteru, Miyao Yuji, Koga Hidenobu, Ishii Masanobu
Department of Cardiology, Cardiovascular Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
J Cardiol Cases. 2013 Dec 12;9(2):67-70. doi: 10.1016/j.jccase.2013.10.003. eCollection 2014 Feb.
We report a case of acute myocardial infarction caused by left anterior descending artery occlusion presenting as ST elevation in the inferior leads and ST depression in the precordial leads, suggesting an involvement of the right coronary artery (RCA). However, coronary angiography (CAG) showed a complete occlusion of the proximal left anterior descending (LAD) coronary artery and collaterals from the left circumflex coronary artery and the RCA. Although he underwent primary percutaneous coronary intervention (PCI), he had chest pain at four days after primary PCI. His electrocardiogram (ECG) showed precordial ST elevation, suggesting an involvement of the LAD. Emergent CAG showed a complete occlusion of the proximal LAD without collaterals, but his ECG showed precordial ST elevation that was different from ST changes seen on admission. These unusual ST-segment changes might be associated with a weaker anterior ischemia due to collaterals and a strong inferior ischemia due to wrapped LAD artery. < Inferior ST elevation and anterior ST depression generally indicate inferior myocardial infarction. However, the unusual ST-segment changes seen in this patient with anterior myocardial infarction might be associated with a weaker anterior ischemia due to collaterals and a strong inferior ischemia due to wrapped left anterior descending artery.>.
我们报告一例由左前降支动脉闭塞引起的急性心肌梗死病例，其表现为下壁导联ST段抬高及胸前导联ST段压低，提示右冠状动脉（RCA）受累。然而，冠状动脉造影（CAG）显示左前降支（LAD）冠状动脉近端完全闭塞，并有来自左旋支冠状动脉和RCA的侧支循环。尽管他接受了直接经皮冠状动脉介入治疗（PCI），但在直接PCI术后四天仍有胸痛。他的心电图（ECG）显示胸前导联ST段抬高，提示LAD受累。急诊CAG显示LAD近端完全闭塞且无侧支循环，但他的ECG显示胸前导联ST段抬高，这与入院时所见的ST段变化不同。这些不寻常的ST段变化可能与侧支循环导致的前壁缺血较轻以及LAD动脉包绕导致的下壁缺血较重有关。<下壁ST段抬高和前壁ST段压低通常提示下壁心肌梗死。然而，该前壁心肌梗死患者所见的不寻常ST段变化可能与侧支循环导致的前壁缺血较轻以及左前降支动脉包绕导致的下壁缺血较重有关。>
