Faraj Raid, Djibril Ahmed, Benmessaoud Fatima-Azzahra, Benasser Mohamed, Zarzur Jamila, Oukerraj Latifa, Amri Rachida, Cherti Mohamed
Mohammed V University, Rabat, Morocco.
Ann Med Surg (Lond). 2022 Mar 3;75:103465. doi: 10.1016/j.amsu.2022.103465. eCollection 2022 Mar.
Chronic rheumatic heart disease is the most common cause of mitral stenosis. It remains a major public health problem. In almost half of the cases, paroxysmal or chronic atrial fibrillation occurs during the evolution of mitral stenosis, thereby exposing to an increased risk of thrombo-embolic events.Whereas the most frequent site for embolism is the cerebral circulation, any organ may be involved, especially the coronary circulation, resulting in a myocardial infarction (MI).
Here, we report a rare case of a 50-year-old patient, with no risk factors for cardiovascular disease, presenting an acute ST-elevation myocardial infarction (STEMI) as initial presentation of unknown mitral stenosis with atrial fibrillation and strongly suggesting an embolic origin. The diagnosis was made based on the national cerebral and cardiovascular center (NCVC) criteria for the clinical diagnosis of coronary artery embolism (CE). Coronary angiography showed a distal thrombus in the right coronary artery that has been medically treated. The outcome was favorable and the patient was referred after that for mitral valve replacement.
慢性风湿性心脏病是二尖瓣狭窄最常见的病因。它仍然是一个重大的公共卫生问题。在几乎一半的病例中，阵发性或慢性房颤在二尖瓣狭窄的病程中出现，从而增加了血栓栓塞事件的风险。虽然栓塞最常见的部位是脑循环，但任何器官都可能受累，尤其是冠状动脉循环，可导致心肌梗死（MI）。
在此，我们报告一例罕见病例，一名50岁患者，无心血管疾病危险因素，以急性ST段抬高型心肌梗死（STEMI）为首发表现，病因是不明的二尖瓣狭窄合并房颤，强烈提示为栓塞起源。诊断依据国家脑心血管中心（NCVC）冠状动脉栓塞（CE）临床诊断标准做出。冠状动脉造影显示右冠状动脉远端有血栓，已接受药物治疗。结果良好，患者随后被转诊进行二尖瓣置换术。
