Kanjanarutjawiwat Wiwat, Pibalyart Sarunpong, Makarasen Paruepong
Cardiology Unit, Department of Internal Medicine, Phrapokklao Hospital Chanthaburi, 38 Leabnean Road, Chanthaburi, Thailand 22000.
J Invasive Cardiol. 2022 Oct;34(10):E750-E752. doi: 10.25270/jic/22.00061.
A 55-year-old man with history of alcoholism presented to our hospital complaining of severe substernal chest pain. After a series of tests and procedures, a large mobile thrombus occupying the left coronary cusp with extension into the ascending aorta was discovered. The patient's hemodynamics remained unstable. After 6 hours of resuscitation, his hemodynamics could not be maintained and eventually, he expired. The autopsy result revealed an ascending aortic aneurysm with atheromatous plaques and focal ulceration without thrombus in the aneurysm. The pathological report showed evidence of acute anterior myocardial infarction, aneurysm with endarteritis and plasma cell infiltration, as well as atherosclerosis with ulcerative plaque. These findings were compatible with syphilitic aortitis. Tertiary syphilis is rarely encountered in current medical practice. Thrombus in the ascending aorta occluding the left coronary artery ostia and resulting in coronary embolus into the left anterior descending is a rare cause of acute anterior ST-segment-elevation myocardial infarction. The combination of these rare causes raises special attention to early recognition of thrombus forming from the syphilitic aortic aneurysm in the ascending aorta propagating to the coronary artery as a cause of myocardial infarction.
一名有酗酒史的55岁男性因严重的胸骨后胸痛前来我院就诊。经过一系列检查和操作，发现一个巨大的活动血栓占据左冠状动脉瓣叶并延伸至升主动脉。患者的血流动力学仍不稳定。经过6小时的复苏，其血流动力学仍无法维持，最终死亡。尸检结果显示升主动脉瘤伴动脉粥样硬化斑块和局灶性溃疡，动脉瘤内无血栓。病理报告显示有急性前壁心肌梗死、伴有动脉内膜炎和浆细胞浸润的动脉瘤以及伴有溃疡性斑块的动脉粥样硬化的证据。这些发现符合梅毒性主动脉炎。三期梅毒在当前医疗实践中很少见。升主动脉血栓阻塞左冠状动脉开口并导致冠状动脉栓子进入左前降支是急性前壁ST段抬高型心肌梗死的罕见原因。这些罕见病因的组合引起了特别关注，即早期识别升主动脉梅毒瘤形成的血栓蔓延至冠状动脉导致心肌梗死。
