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一例罕见的产后妇女自发性冠状动脉夹层导致急性冠状动脉综合征的病例报告

A Rarer Case of Spontaneous Coronary Artery Dissection causing Acute Coronary Syndrome in a Puerperal Woman: Case Report.

作者信息

Asfar Milad

机构信息

McLaren Macomb, PGY2, Emergency Medicine.

出版信息

Spartan Med Res J. 2017 Dec 19;2(2):6435. doi: 10.51894/001c.6435.

Abstract

Chest pain is one of the most common complaints of patients presenting to the emergency room department. There are many causes of chest pain and providers must always consider acute coronary syndrome (ACS). Spontaneous coronary artery dissection is a very rare cause of ACS but providers must consider this possibility in younger patients without risk factors or a history of coronary artery disease. This rare phenomenon is commonly associated with pregnant women or those in the postpartum period. This is a case report study describing a classic scenario of a postpartum female in her early 30s who presented with spontaneous coronary artery dissection. Providers obtained the usual tests of an electrocardiogram (EKG) and blood work. She then had a heart catheterization performed. The patient was conservatively managed through use of medications without any use of invasive measures. The patient also had other images of the chest taken to rule out other causes of chest pain such as pneumothorax and pulmonary embolism. There were EKG changes noted, as well elevated troponin levels suggestive of heart damage. The heart catheterization results showed coronary artery dissection involving the artery that correlated with the EKG changes. Spontaneous coronary artery dissection is a rare phenomenon that can present as ACS. Pregnant and postpartum women are at higher risk to develop this condition. It is essential to consider this condition along with other causes of chest pain.

摘要

胸痛是前往急诊科就诊的患者最常见的主诉之一。胸痛的病因众多,医护人员必须始终考虑急性冠状动脉综合征(ACS)。自发性冠状动脉夹层是ACS的一种非常罕见的病因,但医护人员必须在无危险因素或无冠状动脉疾病史的年轻患者中考虑这种可能性。这种罕见现象通常与孕妇或产后女性有关。这是一篇病例报告研究,描述了一名30岁出头的产后女性出现自发性冠状动脉夹层的典型病例。医护人员进行了常规的心电图(EKG)检查和血液检查。然后她接受了心脏导管插入术。患者通过药物进行保守治疗,未采取任何侵入性措施。患者还进行了胸部的其他影像学检查,以排除气胸和肺栓塞等其他胸痛原因。记录到了EKG变化,肌钙蛋白水平也升高,提示心脏损伤。心脏导管插入术结果显示冠状动脉夹层累及与EKG变化相关的动脉。自发性冠状动脉夹层是一种可表现为ACS的罕见现象。孕妇和产后女性发生这种情况的风险更高。必须将这种情况与其他胸痛原因一并考虑。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8201/7746080/53f419d78991/smrj_2018_2_2_6435_16760.jpg

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