Okai Iwao, Inoue Kenji, Yamaguchi Naotaka, Makinae Haruka, Maruyama Sonomi, Komatsu Kaoru, Kawano Yasunobu, Okazaki Shinya, Fujiwara Yasumasa, Sumiyoshi Masataka, Amano Atsushi, Daida Hiroyuki
Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan.
Department of Emergency and Intensive Care, Juntendo University Nerima Hospital, Tokyo, Japan.
J Cardiol Cases. 2009 Nov 8;1(1):e28-e32. doi: 10.1016/j.jccase.2009.06.003. eCollection 2010 Feb.
A 53-year-old Japanese man presented with severe chest pain. He had suffered from persistent fever, muscle pain, arthralgia, and dyspnea on exertion (New York Heart Association class I) for two and half months prior to admission. He had been treated with several antibiotics for two months and prednisolone for almost one month prior to admission. On the day of admission, he had suffered from chest pain at rest, and had come to our hospital. Electrocardiography showed a normal sinus rhythm with significant ST segment elevation in leads V3-6 and abnormal Q waves in leads V4-6. Transthoracic echocardiography demonstrated left ventricular ejection fraction of 52% with severe mitral regurgitation and an 18-mm vegetation on the anterior mitral valve leaflet. Multiple blood cultures identified . The diagnosis was acute myocardial infarction and mitral regurgitation associated with infective endocarditis (IE). The incidence of acute coronary syndrome caused by IE is quite low in patients with native valves. After a 6-week course of antibiotics, mitral valve replacement and partial cardiomyotomy were performed. Two years after the surgery, follow-up echocardiography showed almost normal left ventricle function and no mitral regurgitation, and the patient has been living an active life without any complications.
一名53岁的日本男性因严重胸痛前来就诊。入院前两个半月，他一直持续发热、肌肉疼痛、关节痛以及劳力性呼吸困难（纽约心脏协会心功能I级）。入院前两个月，他接受了多种抗生素治疗，近一个月来一直在服用泼尼松龙。入院当天，他出现静息性胸痛，遂前来我院。心电图显示窦性心律正常，V3 - 6导联ST段显著抬高，V4 - 6导联出现异常Q波。经胸超声心动图显示左心室射血分数为52%，伴有严重二尖瓣反流，二尖瓣前叶有一个18毫米的赘生物。多次血培养确诊。诊断为急性心肌梗死和二尖瓣反流合并感染性心内膜炎（IE）。在天然瓣膜患者中，由IE引起的急性冠状动脉综合征的发生率相当低。经过6周的抗生素治疗后，进行了二尖瓣置换术和部分心肌切开术。术后两年，随访超声心动图显示左心室功能几乎正常，无二尖瓣反流，患者一直过着积极的生活，没有任何并发症。
