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新型冠状病毒肺炎(COVID-19)中ST段抬高型心肌梗死的罕见病因:心肌梗死伴非阻塞性冠状动脉病变(MINOCA)综合征

A Rare Cause of ST-Segment Elevation Myocardial Infarction in COVID-19: MINOCA Syndrome.

作者信息

Eroglu Serkan Emre, Ademoglu Enis, Bayram Samet, Aksel Gökhan

机构信息

Health Sciences University, Umraniye Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey.

出版信息

Medeni Med J. 2021;36(1):63-68. doi: 10.5222/MMJ.2021.25478. Epub 2021 Mar 26.

Abstract

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined as having a stenosis of less than 50% or no stenosis in coronary angiography in a patient diagnosed with myocardial infarction. Because of its thrombogenic predisposition in COVID-19, the diagnosis of MINOCA syndrome is rarely thought in the patients with ST-segment elevation myocardial Infarction on electrocardiogram. In this case report, we discuss a 47-year-old male patient diagnosed with MINOCA who was followed up with respiratory failure due to COVID-19 viral pneumonia in intensive care unit. His 12-lead electrocardiogram showed "inferior STEMI". A 30-40% stenosis was also shown in the midportion of left anterior descending artery in emergency coronary angiography. The patient had a normal computed tomographic pulmonary angiography and was discharged with a full recovery. MINOCA may be triggered by hyperinflammation or various processes due to COVID-19. To explain these processes associated with MINOCA syndrome, further clinical trials are needed.

摘要

非阻塞性冠状动脉心肌梗死(MINOCA)的定义为,在被诊断为心肌梗死的患者中,冠状动脉造影显示狭窄小于50%或无狭窄。由于COVID-19具有血栓形成倾向,对于心电图显示ST段抬高型心肌梗死的患者,很少会考虑MINOCA综合征的诊断。在本病例报告中,我们讨论了一名47岁男性患者,他被诊断为MINOCA,在重症监护病房因COVID-19病毒性肺炎并发呼吸衰竭接受治疗。他的12导联心电图显示“下壁ST段抬高型心肌梗死”。急诊冠状动脉造影显示左前降支中段有30%-40%的狭窄。患者的计算机断层扫描肺血管造影正常,出院时已完全康复。MINOCA可能由COVID-19引起的过度炎症或各种过程触发。为了解释这些与MINOCA综合征相关的过程,还需要进一步的临床试验。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd29/8020180/055591a0ecfe/MEDJ-36-063-f1.jpg

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