Isaza Nicolas, Posada Adriana Maria, Diaz Mauricio Eduard, Isaza-Restrepo Daniel
Faculty of Medicine, Pontificia Universidad Javeriana, Carrera 7 No. 40 - 62, Bogotá, Colombia.
Faculty of Medicine, Universidad del Bosque, Carrera 9 No. 131A - 02, Bogotá, Colombia.
Eur Heart J Case Rep. 2018 Aug 3;2(3):yty091. doi: 10.1093/ehjcr/yty091. eCollection 2018 Sep.
Cardiogenic shock secondary to coronary involvement in large vessel vasculitis (LVV) is an unsuspected finding, even more, when no other vascular territories are compromised and when it constitutes the initial clinical manifestation. This case report illustrates a case in which a complete diagnostic study uncovered this aetiology.
A 33-year-old woman with cough and chest pain who was diagnosed with acute bronchitis returned with worsening dyspnoea, chest pain, and developed cardiogenic shock. The initial differential diagnoses included myocarditis and takotsubo cardiomyopathy (TCM) owing to a positive troponin I, and echocardiogram with left ventricular dilation, dyskinesia in mid-ventricular and apical segments, systolic dysfunction, and functional mitral regurgitation. A cardiac magnetic resonance showed contractility abnormalities resembling the pattern of TCM but lacked the characteristic myocardial oedema. Subsequently, a coronary angiography expected to result without obstructions showed a critical narrowing of the left main coronary artery. Surgical management consisted of a pericardium patch grafted in the stenotic ostium to restore adequate perfusion. The surgical specimens were sent to the pathology laboratory that reported findings compatible with LVV. Four days after the surgical intervention the patient was discharged alive with a complete recovery of left ventricular systolic function.
Chest pain symptoms in a young woman, could be caused by multiple entities, and an ischaemic aetiology from a non-atherosclerotic origin should be kept in mind. A complete study with coronary angiography is crucial to rule out an ischaemic cause even in low-risk groups for atherosclerotic coronary heart disease.
继发于大血管血管炎（LVV）累及冠状动脉的心源性休克是一个意想不到的发现，尤其是在没有其他血管区域受累且它构成初始临床表现时。本病例报告阐述了一例通过全面诊断研究揭示病因的病例。
一名33岁咳嗽、胸痛的女性最初被诊断为急性支气管炎，之后出现呼吸困难、胸痛加重，并发展为心源性休克。最初的鉴别诊断包括心肌炎和应激性心肌病（TCM），因为肌钙蛋白I呈阳性，且超声心动图显示左心室扩张、心室中部和心尖段运动障碍、收缩功能障碍以及功能性二尖瓣反流。心脏磁共振成像显示收缩异常类似于应激性心肌病的模式，但缺乏特征性的心肌水肿。随后，预计无阻塞的冠状动脉造影显示左主干冠状动脉严重狭窄。手术治疗包括在狭窄开口处植入心包补片以恢复充足灌注。手术标本被送往病理实验室，报告结果与大血管血管炎相符。手术干预四天后，患者出院，左心室收缩功能完全恢复。
年轻女性的胸痛症状可能由多种病因引起，应考虑非动脉粥样硬化性起源的缺血性病因。即使在动脉粥样硬化性冠心病低风险人群中，进行冠状动脉造影的全面检查对于排除缺血性病因也至关重要。
