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COVID-19 感染继发急性心肌梗死:病例报告及文献复习。

Acute myocardial infarction secondary to COVID-19 infection: A case report and review of the literature.

机构信息

Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America.

Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America.

出版信息

Clin Imaging. 2021 Apr;72:178-182. doi: 10.1016/j.clinimag.2020.11.030. Epub 2020 Nov 14.

Abstract

BACKGROUND

Thrombotic complications of COVID-19 infection have become increasingly apparent as the disease has infected a growing number of individuals. Although less common than upper respiratory symptoms, thrombotic complications are not infrequent and may result in severe and long-term sequelae. Common thrombotic complications include pulmonary embolism, cerebral infarction, or venous thromboembolism; less commonly seen are acute myocardial injury, renal artery thrombosis, and mesenteric ischemia. Several case reports and case series have described acute myocardial injury in patients with COVID-19 characterized by elevations in serum biomarkers.

CASE REPORT

Here, we report the first case to our knowledge of a patient with acute coronary syndrome confirmed on catheter angiography and cardiac MRI. This patient was found to additionally have a left ventricular thrombus and ultimately suffered an acute cerebral infarction. Recognition of thrombotic complications in the setting of COVID-19 infection is essential for initiating appropriate therapy.

CONCLUSIONS

In acute myocardial injury, given the different treatment strategies for myocarditis versus acute myocardial infarction secondary to coronary artery thrombus, imaging can play a key role in clinical decision making for patients.

摘要

背景

随着 COVID-19 感染人数的增加,其引发的血栓并发症变得越来越明显。虽然血栓并发症不如上呼吸道症状常见,但并不罕见,并且可能导致严重和长期的后遗症。常见的血栓并发症包括肺栓塞、脑梗死或静脉血栓栓塞症;较少见的有急性心肌损伤、肾动脉血栓形成和肠系膜缺血。一些病例报告和病例系列描述了 COVID-19 患者的急性心肌损伤,其特征是血清生物标志物升高。

病例报告

在这里,我们报告了首例已知的经导管血管造影和心脏 MRI 证实的急性冠状动脉综合征患者。该患者还发现左心室血栓,最终发生急性脑梗死。在 COVID-19 感染的背景下识别血栓并发症对于启动适当的治疗至关重要。

结论

在急性心肌损伤中,鉴于心肌炎与冠状动脉血栓引起的急性心肌梗死的治疗策略不同,影像学在患者的临床决策中可以发挥关键作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d43e/7666611/bb81b123be64/gr1_lrg.jpg

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