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病例报告:一例罕见的急性前壁心肌梗死同时合并原发性血小板增多症所致主动脉壁血栓形成的病例

Case Report: A Rare Case of Acute Anterior Myocardial Infarction Simultaneously Associated With Aortic Mural Thrombosis Due to Essential Thrombocytosis.

作者信息

Ye Sheng, Xia Wu-Jie, Chen Peng

机构信息

Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.

出版信息

Front Cardiovasc Med. 2022 Feb 23;9:840906. doi: 10.3389/fcvm.2022.840906. eCollection 2022.

Abstract

BACKGROUND

Essential thrombocytosis (ET) simultaneously complicated with acute myocardial infarction and aortic thrombosis is extremely rare and associated with poor outcomes.

CASE

A 54-year-old female was admitted to our emergency department with abdominal pain for 3 h. ST-segment elevation in leads V1-V3 on electrocardiography led to the diagnosis of acute anterior myocardial infarction. Coronary angiography demonstrated total occlusion of the proximal left anterior descending artery, and the patient was treated with angioplasty and placement of a drug-eluting stent. CT angiography revealed a massive mural thrombus located in the descending aorta. Bone marrow biopsy confirmed the diagnosis of ET. The patient was successfully treated with antithrombotic therapy and hydroxyurea.

CONCLUSION

At present, the clinical diagnosis and treatment of ET complicated with acute myocardial infarction and aortic thrombosis are mostly based on literature reports. Early target vessel revascularization, antiplatelet and anticoagulant combined with cytoreductive therapy may improve the prognosis. Clinicians should consider the risk of bleeding and thrombosis and create individualized treatment strategies for these patients.

摘要

背景

原发性血小板增多症(ET)同时并发急性心肌梗死和主动脉血栓形成极为罕见,且预后不良。

病例

一名54岁女性因腹痛3小时入院。心电图显示V1-V3导联ST段抬高,诊断为急性前壁心肌梗死。冠状动脉造影显示左前降支近端完全闭塞,患者接受了血管成形术并植入药物洗脱支架。CT血管造影显示降主动脉有巨大壁内血栓。骨髓活检确诊为ET。患者接受抗栓治疗和羟基脲治疗后成功康复。

结论

目前,ET并发急性心肌梗死和主动脉血栓形成的临床诊断和治疗大多基于文献报道。早期靶血管血运重建、抗血小板和抗凝联合减细胞治疗可能改善预后。临床医生应考虑出血和血栓形成风险,为这些患者制定个体化治疗策略。

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