Ye Changqing, Zhang Qiang, Chao Yongsheng, Yin Chun
Department of Cardiovascular Medicine, The 902nd Hospital of PLA Joint Service Support Force, Bengbu, China.
Department of Physiology and Pathophysiology, Fourth Military Medical University, Xi'an, China.
Front Cardiovasc Med. 2021 Apr 30;8:623708. doi: 10.3389/fcvm.2021.623708. eCollection 2021.
Acute myocardial infarction (AMI) is a rare complication of acute organophosphorus pesticide poisoning. Although chlorpyrifos has been widely used as an organophosphate insecticide, a few cases of AMI complicated by chlorpyrifos poisoning have been reported thus far. Hence, a suitable treatment strategy remains to be explored. Based on the clinical manifestations, medical history, results of an auxiliary examination, and serum biomarkers, a 65-year-old male farmer with complaints of nausea, vomiting, chest tightness, and pain was clearly diagnosed as having a severe chlorpyrifos self-poisoning with acute non-ST-segment elevation MI. Because the patient and his family confirmedly refused a coronary intervention, conservative treatment was used instead. It should be noted that there were some conflicts of the management for chlorpyrifos poisoning and AMI. Although rapid atropinization would contribute to the relief of muscarinic symptoms, it would also lead to an increased heart rate and myocardial oxygen consumption in AMI. Furthermore, the reduction of platelet aggregation, which is necessary for coronary recanalization of an AMI patient, is known to aggravate the gastrointestinal injury caused by poisoning. In this case, these conflicts were properly addressed, which led to an excellent effect and prognosis of the patient. To our knowledge, this is the first case report of acute chlorpyrifos poisoning with AMI. It is emphasized that patients with chest pain or coronary heart disease should be treated with atropine more cautiously because of the possible AMI. Moreover, proper resolution of conflicts in the management for chlorpyrifos poisoning and AMI played contributing roles in patient improvement.
急性心肌梗死（AMI）是急性有机磷农药中毒的一种罕见并发症。尽管毒死蜱已被广泛用作有机磷杀虫剂，但迄今为止，仅有少数几例毒死蜱中毒并发AMI的病例报道。因此，仍有待探索合适的治疗策略。根据临床表现、病史、辅助检查结果及血清生物标志物，一名65岁男性农民，因恶心、呕吐、胸闷及胸痛就诊，被明确诊断为重度毒死蜱自服中毒伴急性非ST段抬高型心肌梗死。由于患者及其家属坚决拒绝冠状动脉介入治疗，故采用保守治疗。需要注意的是，在毒死蜱中毒和AMI的治疗管理上存在一些冲突。虽然快速阿托品化有助于缓解毒蕈碱样症状，但也会导致心率加快及AMI患者心肌耗氧量增加。此外，降低血小板聚集虽对AMI患者冠状动脉再通是必要之举，但已知会加重中毒所致的胃肠道损伤。在本病例中，这些冲突得到了妥善处理，从而使患者获得了良好的疗效及预后。据我们所知，这是首例关于急性毒死蜱中毒并发AMI的病例报告。强调对于有胸痛或冠心病的患者，由于可能并发AMI，使用阿托品时应更加谨慎。此外，妥善解决毒死蜱中毒和AMI治疗管理中的冲突对患者病情改善起到了促进作用。
