Ahmed Talha, Shkullaku Melsjan
Internal Medicine, University of Maryland Medical Center, Baltimore, USA.
Internal Medicine: Cardiology, University of Maryland Medical Center, Baltimore, USA.
Cureus. 2020 Apr 7;12(4):e7569. doi: 10.7759/cureus.7569.
The etiology of ST-elevation myocardial infarction (STEMI) is either rupture or erosion of unstable plaque with subsequent thrombosis. With the widespread use of plaque-stabilizing lipid-lowering therapies (statins), plaque erosion, rather than rupture, now accounts for most cases of acute coronary syndromes (ACS). In the spectrum of ACS, STEMI usually results from the total occlusion of the culprit epicardial coronary artery, leading to the occlusion of blood flow to the affected myocardium. The differential diagnosis of ST-elevations on electrocardiograms are broad. However, an elevated cardiac marker, evidence of wall motion abnormality on echocardiogram or positive stress testing makes an alternate diagnosis less likely. This prompts emergent coronary angiography with an intent to fix the underlying cause. In some cases like ours, when the clinical suspicion of STEMI is high, the coronary angiography may be unrevealing of the diagnosis.
ST段抬高型心肌梗死（STEMI）的病因是不稳定斑块破裂或糜烂，随后形成血栓。随着斑块稳定降脂疗法（他汀类药物）的广泛应用，现在急性冠状动脉综合征（ACS）的大多数病例是由斑块糜烂而非破裂引起的。在ACS的范围内，STEMI通常是由罪犯心外膜冠状动脉完全闭塞导致受影响心肌血流中断引起的。心电图上ST段抬高的鉴别诊断范围很广。然而，心脏标志物升高、超声心动图显示室壁运动异常或负荷试验阳性使其他诊断的可能性降低。这促使进行紧急冠状动脉造影以确定潜在病因。在像我们这样的一些病例中，当临床高度怀疑STEMI时，冠状动脉造影可能无法明确诊断。
