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病例报告:以急性冠状动脉综合征为表现的自发性冠状动脉破裂:一种对常见疾病的罕见诊断。

Case report: Spontaneous coronary artery rupture presenting with acute coronary syndrome: A rare diagnosis of common disease.

作者信息

Sayed Ahmed Ibrahim

机构信息

Faculty of Medicine, Jazan University, Jizan, Saudi Arabia.

出版信息

Front Cardiovasc Med. 2022 Aug 11;9:922180. doi: 10.3389/fcvm.2022.922180. eCollection 2022.

Abstract

Acute coronary syndrome (ACS), myocardial infarction, and sudden death have all been linked to spontaneous coronary artery rapture (SCAR). Patients primarily afflicted by SCAR are those with or without cardiovascular risk factors, notably men, implying a mechanism distinct from the more prevalent atherosclerosis. Both medical and interventional treatment should consider the diverse causes of ACS as well as the patient's clinical stability. I herein report an unusual case of a 33 years old male who presented with acute chest pain to the emergency department. His physical exam was normal. The electrocardiogram showed non-specific ST segment changes in anterior leads, and the echocardiogram revealed mild anterior wall hypokinesia with no evidence of pericardial effusion. He underwent coronary angiography which revealed a contained rupture in the anterior descending coronary artery. The patient underwent uneventful lifesaving coronary artery perforation repair. It concluded that, though rare, SCAR should be considered as a differential diagnosis in patients with ACS, even in the absence of pericardial effusion in adult patients of all ages.

摘要

急性冠状动脉综合征(ACS)、心肌梗死和猝死都与自发性冠状动脉破裂(SCAR)有关。主要受SCAR影响的患者是那些有或没有心血管危险因素的人,尤其是男性,这意味着其机制不同于更常见的动脉粥样硬化。药物治疗和介入治疗都应考虑ACS的多种病因以及患者的临床稳定性。我在此报告一例不寻常的病例,一名33岁男性因急性胸痛到急诊科就诊。他的体格检查正常。心电图显示前壁导联有非特异性ST段改变,超声心动图显示前壁轻度运动减弱,无心包积液迹象。他接受了冠状动脉造影,结果显示前降支冠状动脉有一处局限性破裂。患者接受了成功的挽救生命的冠状动脉穿孔修复术。得出的结论是,尽管SCAR罕见,但在ACS患者中应将其视为鉴别诊断,即使在各年龄段的成年患者中没有心包积液时也应如此。

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