Kassab Kameel, Matar Ralph, Alyousef Tareq, Malhotra Saurabh
Cardiology, John H Stroger, Jr. Hospital of Cook County, Chicago, USA.
Cureus. 2020 Apr 3;12(4):e7526. doi: 10.7759/cureus.7526.
Evaluation of acute coronary syndromes (ACS) in young women presents a clinical challenge. An unremarkable coronary angiogram may not exclude ACS, as spontaneous lesion revascularization, resolved coronary spams, or spontaneous coronary dissection (SCAD) can often be missed. Cardiac magnetic resonance imaging (CMR) can provide useful information in acute myocardial infarction (MI) by confirming and sizing acute infarction and delineating the etiology when angiography is inconclusive. Here, we report a case of a 39-year-old postpartum woman with a history of hyperlipidemia who presented with a one-day history of atypical angina. On presentation, she was found to have transient ST-segment elevation in high lateral leads and elevated troponin. Coronary angiography revealed a nonobstructive lesion in the first obtuse marginal branch (OM1) distribution. The patient subsequently underwent cardiac magnetic resonance imaging (MRI) for further delineation of etiology, which confirmed acute infarction in the OM1 distribution. Diagnosis of myocardial infarction with no obstructive coronary artery disease (MINOCA) secondary to acute coronary artery dissection type 2 (SCAD-2) was made. The patient was managed conservatively with medical therapy. CMR has emerged as a front-line diagnostic imaging modality in acute MI and can provide invaluable information in the confirmation and sizing of infarction, delineating tissue characteristics, establishing the etiology of infarction, and prognostication.
评估年轻女性的急性冠状动脉综合征（ACS）是一项临床挑战。冠状动脉造影结果正常可能无法排除ACS，因为自发病变血管再通、已缓解的冠状动脉痉挛或自发冠状动脉夹层（SCAD）常常会被漏诊。心脏磁共振成像（CMR）在急性心肌梗死（MI）中可通过确认急性梗死并测量其大小，以及在血管造影结果不明确时明确病因，从而提供有用信息。在此，我们报告一例39岁的产后女性病例，她有高脂血症病史，出现非典型心绞痛1天。就诊时，发现她高侧壁导联有短暂ST段抬高，肌钙蛋白升高。冠状动脉造影显示第一钝缘支（OM1）分布区有非阻塞性病变。该患者随后接受了心脏磁共振成像（MRI）检查以进一步明确病因，结果证实OM1分布区存在急性梗死。诊断为继发于2型急性冠状动脉夹层（SCAD-2）的无阻塞性冠状动脉疾病心肌梗死（MINOCA）。该患者接受了药物保守治疗。CMR已成为急性心肌梗死一线诊断成像方式，在确认梗死及测量其大小、明确组织特征、确定梗死病因和预测预后方面可提供宝贵信息。
