Bin Jawaid Zaib, Du Jin Ling, Iqbal Sohail, Zhang Lei
The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No.107, Wen Hua Xi Road, Jinan, Shandong 250012, China.
Division of Cardiology, Department of Cardiac Imaging, Wythenshawe Hospital, Manchester University (NHS Foundation) Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.
Eur Heart J Case Rep. 2020 Oct 18;5(2):ytaa263. doi: 10.1093/ehjcr/ytaa263. eCollection 2021 Feb.
Management of cardiovascular sequelae to Kawasaki disease (KD) is challenging to adult cardiologists. Vasculitis of medium-sized arteries especially coronary arteries often leads to focal intimal thickening and aneurysmal dilatation of one or more coronary arteries. It needs special attention to recognize coronary artery involvement because of potential long-term morbidity and mortality. We present a case of diagnostic dilemma in young adult Chinese male with KD.
This asymptomatic patient was found to have deep Q waves in anterior leads on screening electrocardiography and was thought to have myocarditis after depiction of wall motion abnormality on echocardiography, later to be confirmed to have left anterior descending artery (LAD) territory infarct on cardiac magnetic resonance imaging. Coronary computed tomography angiogram depicted proximal LAD aneurysm with calcified plaque/thrombus. Additionally, there was an 18 mm giant right coronary artery (RCA) aneurysm with braid-like appearance and soft plaque (mural thrombus). His previous medical history included fever and cervical lymphadenopathy. Because of the high risk he was commenced on long-term low-dose aspirin and β-adrenergic-blocking agent to reduce myocardial oxygen consumption; however, 3 years later, he presented to the emergency department with acute inferior myocardial infarction. He was noted to have total occlusion of the proximal RCA and was treated aggressively with thrombectomy and percutaneous balloon angioplasty followed by medical management with β-blockers, sacubitril/valsartan, clopidogrel, and rivaroxaban without subsequent adverse cardiovascular events.
Kawasaki disease is one of the main causes of coronary artery disease in young adults and can be easily overlooked.
川崎病（KD）心血管后遗症的管理对成年心脏病专家来说具有挑战性。中等大小动脉的血管炎，尤其是冠状动脉血管炎，常导致一根或多根冠状动脉的局灶性内膜增厚和动脉瘤样扩张。由于潜在的长期发病率和死亡率，识别冠状动脉受累需要特别关注。我们报告一例年轻中国男性KD患者的诊断困境。
这位无症状患者在筛查心电图时发现前壁导联有深Q波，在超声心动图显示室壁运动异常后被认为患有心肌炎，后来心脏磁共振成像证实为左前降支（LAD）区域梗死。冠状动脉计算机断层血管造影显示LAD近端动脉瘤伴有钙化斑块/血栓。此外，还有一个18毫米的巨大右冠状动脉（RCA）动脉瘤，呈辫状外观且有软斑块（壁内血栓）。他既往病史包括发热和颈部淋巴结病。由于风险高，他开始长期服用低剂量阿司匹林和β肾上腺素能阻滞剂以减少心肌耗氧量；然而，3年后，他因急性下壁心肌梗死就诊于急诊科。发现他的RCA近端完全闭塞，积极接受了血栓切除术和经皮球囊血管成形术治疗，随后用β受体阻滞剂、沙库巴曲缬沙坦、氯吡格雷和利伐沙班进行药物治疗，此后未发生不良心血管事件。
川崎病是年轻成年人冠状动脉疾病的主要原因之一，容易被忽视。
