Internal Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA
Internal Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA.
BMJ Case Rep. 2020 Sep 17;13(9):e236379. doi: 10.1136/bcr-2020-236379.
A 36-year-old woman presented with a 3-month history of recurrent substernal chest pain, which acutely worsened 2 days prior to presentation. Her initial troponin I was mildly elevated and ECG showed subtle changes initially concerning for ischaemia; however, these were present on her prior ECG and were not considered an acute change. Because of her age and lack of significant risk factors, she was considered low risk for cardiac disease and initially treated conservatively for a non-ST elevation myocardial infarction. Due to persistent symptoms and dynamic changes on ECG concerning for ischaemia, she was immediately taken for a cardiac catheterisation and was found to have critical left main coronary artery dissection with a focal stenotic lesion. She had an extensive workup to identify the underlying cause of her coronary artery dissection which was unrevealing. She underwent an uncomplicated coronary artery bypass graft surgery and was discharged home in stable condition.
一位 36 岁女性因反复发作胸骨后胸痛就诊，胸痛病史 3 个月，于就诊前 2 天急性加重。她的肌钙蛋白 I 最初轻度升高，心电图最初显示细微变化，提示存在缺血；然而，这些变化在她之前的心电图上已经存在，不被认为是急性改变。由于她的年龄和缺乏明显的危险因素，她被认为患心脏病的风险较低，最初接受非 ST 段抬高型心肌梗死的保守治疗。由于持续存在症状和心电图上的缺血动态变化，她立即接受了心脏导管检查，发现存在严重的左主干冠状动脉夹层伴局灶性狭窄病变。她进行了广泛的检查以确定导致她的冠状动脉夹层的潜在原因，但结果未显示任何异常。她接受了顺利的冠状动脉旁路移植手术，出院时情况稳定。
