Sinha Aish, Demir Ozan M, Ellis Howard, Perera Divaka
British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, Westminster Bridge Rd, London SE1 7EH, UK.
Eur Heart J Case Rep. 2021 Dec 6;5(12):ytab459. doi: 10.1093/ehjcr/ytab459. eCollection 2021 Dec.
Presyncope and syncope are common presentations with a wide range of differential diagnoses; when it occurs primarily on exertion, a cardiovascular cause is more likely. Structural abnormalities and primary rhythm disturbances are the usual culprits in these patients.
A 75-year-old gentleman presented with a history of progressive exertional presyncope. His investigations demonstrated normal cardiac structure, function, and rhythm. He underwent an exercise stress test, which demonstrated a significant reduction in peak blood pressure with equivocal electrocardiogram changes and absence of ischaemic symptoms. In view of his age and gender, a computerized tomography coronary angiogram (CTCA) was organized to exclude obstructive coronary artery disease (CAD). Intriguingly, the CTCA demonstrated a severe proximal left anterior descending (LAD) artery stenosis. This stenosis was confirmed to be functionally significant using invasive coronary physiology and was treated with percutaneous coronary intervention. At follow-up, there was no recurrence of exertional presyncope and the patient was continuing to return to his baseline function.
Presyncope and/or syncope as the sole manifestation of obstructive CAD, in the presence of normal ventricular function and valves, has rarely been reported. Myocardial ischaemia-mediated presyncope and/or syncope may be secondary to numerous mechanisms, which are described in this case report. Revascularization of the functionally significant proximal LAD stenosis resulted in cessation of exertional presyncope in our patient. The long-term outcome of revascularization in patients with presyncope and syncope needs to be further investigated.
先兆晕厥和晕厥是常见症状，有多种鉴别诊断；当主要在运动时发生时，更可能是心血管原因。结构异常和原发性节律紊乱是这些患者的常见病因。
一名75岁男性有进行性运动性先兆晕厥病史。他的检查显示心脏结构、功能和节律正常。他接受了运动负荷试验，结果显示峰值血压显著降低，心电图改变不明确且无缺血症状。鉴于他的年龄和性别，安排了计算机断层扫描冠状动脉造影（CTCA）以排除阻塞性冠状动脉疾病（CAD）。有趣的是，CTCA显示左前降支（LAD）动脉近端严重狭窄。使用侵入性冠状动脉生理学方法证实该狭窄具有功能意义，并接受了经皮冠状动脉介入治疗。随访时，运动性先兆晕厥未复发，患者继续恢复到基线功能。
在心室功能和瓣膜正常的情况下，阻塞性CAD仅表现为先兆晕厥和/或晕厥的情况鲜有报道。心肌缺血介导的先兆晕厥和/或晕厥可能继发于多种机制，本病例报告对此进行了描述。对具有功能意义的LAD近端狭窄进行血运重建，使我们的患者运动性先兆晕厥停止。先兆晕厥和晕厥患者血运重建的长期结果需要进一步研究。
