Li Beibei, Ming Zhixu, Wu Jing, Zhang Mingyou
First Hospital of Jilin University, Changchun.
General Hospital of Ningxia medical University, Yinchuan, China.
Medicine (Baltimore). 2019 Jan;98(2):e13995. doi: 10.1097/MD.0000000000013995.
Myocardial infarction with nonobstructive coronary artery (MINOCA) is one of the common causes of cardiac related death. While patients with MINOCA usually do not need coronary artery intervention treatments, the prognosis could be worsened if the condition is not appropriately managed. This report describes a case of MINOCA patient suffered with multiple complications.
A 63-year-old female was admitted to the emergency department with acute onset of chest pain, electrocardiogram showed ST segment elevation in precordium leads.
Emergency coronary artery angiogram no significant coronary artery stenosis being observed. The diagnosis of MINOCA was established. She subsequently developed ventricular thrombus, heart failure, and ventricular arrhythmia.
The patient's ventricular tachycardia (VT) was refractory to different treatments. Due to the presence of a ventricular thrombus, epicardial ablation was performed but the VT recurred. The patient was then successfully treated with an implantable cardioverter defibrillator and surgical removal of the ventricular aneurysm.
The patient was free of events during the 3-month follow-up period after the surgery.
MINOCA can occur with multiple complications, and surgical removal of a ventricular aneurysm can successfully recover the cardiac geometry during contraction leading to an improvement of the left ventricular bump function, as well as the removal of the potentially pathological loci of the VT.
非阻塞性冠状动脉心肌梗死（MINOCA）是心脏相关死亡的常见原因之一。虽然MINOCA患者通常不需要冠状动脉介入治疗，但如果病情管理不当，预后可能会恶化。本报告描述了一例患有多种并发症的MINOCA患者。
一名63岁女性因急性胸痛入院急诊科，心电图显示胸前导联ST段抬高。
急诊冠状动脉造影未观察到明显冠状动脉狭窄。确诊为MINOCA。随后她出现了心室血栓、心力衰竭和室性心律失常。
患者的室性心动过速（VT）对不同治疗均无效。由于存在心室血栓，进行了心外膜消融，但VT复发。然后患者通过植入式心脏复律除颤器和手术切除心室瘤成功得到治疗。
术后3个月随访期间患者无事件发生。
MINOCA可伴有多种并发症，手术切除心室瘤可在收缩期成功恢复心脏几何形态，改善左心室泵功能，同时消除VT的潜在病理位点。
