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冠状动脉痉挛所致反复经期心肌梗死：一例报告

Repetitive catamenial myocardial infarction due to coronary artery spasm: a case report.

作者信息

Talmor Nina, Gurin Michael, Smilowitz Nathaniel, Gossett Dana, Eisner Bruria, Pleasure Mitchell, Reynolds Harmony R

机构信息

Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine 530 First Avenue New York, NY 10016, USA.

Stanley H. Kaplan Professor and Chairman of Obstetrics and Gynaecology, Department of Obstetrics and Gynecology at NYU Grossman School of Medicine - Joan H. Tisch Center for Women's Health159 East 53rd Street, 5th Floor, New York, NY 10022, USA.

出版信息

Eur Heart J Case Rep. 2023 Jan 11;7(2):ytad019. doi: 10.1093/ehjcr/ytad019. eCollection 2023 Feb.

DOI:10.1093/ehjcr/ytad019
PMID:36793935
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9924495/
Abstract

BACKGROUND

Coronary artery spasm is an established mechanism of myocardial infarction with non-obstructive coronary arteries (MINOCA). Various mechanisms have been proposed, ranging from vascular smooth muscle hyperreactivity to endothelial dysfunction, to autonomic nervous system dysregulation.

CASE SUMMARY

We report a case of a 37-year-old woman who presented with recurrent non-ST elevation myocardial infarction (NSTEMI), coinciding with her menstrual periods. Intracoronary acetylcholine provocation testing resulted in coronary spasm in the left anterior descending artery (LAD) that was relieved with nitroglycerine. Initiating calcium channel blockade and suppressing cyclical variation in sex hormones resulted in improvement of her symptoms and cessation of monthly NSTEMI events due to coronary spasm.

DISCUSSION

Initiating calcium channel blockade and suppressing cyclical variation in sex hormones resulted in improvement of her symptoms and cessation of monthly NSTEMI events due to coronary spasm. Catamenial coronary artery spasm is a rare, but clinically important, presentation of myocardial infarction with non-obstructive coronary arteries (MINOCA).

摘要

背景

冠状动脉痉挛是无阻塞性冠状动脉心肌梗死（MINOCA）的一种既定机制。已经提出了各种机制，从血管平滑肌高反应性到内皮功能障碍，再到自主神经系统失调。

病例摘要

我们报告了一例37岁女性，她反复出现非ST段抬高型心肌梗死（NSTEMI），且与月经期同时发生。冠状动脉内乙酰胆碱激发试验导致左前降支（LAD）冠状动脉痉挛，使用硝酸甘油后缓解。开始使用钙通道阻滞剂并抑制性激素的周期性变化，使她的症状得到改善，因冠状动脉痉挛导致的每月NSTEMI事件停止。

讨论

开始使用钙通道阻滞剂并抑制性激素的周期性变化，使她的症状得到改善，因冠状动脉痉挛导致的每月NSTEMI事件停止。月经性冠状动脉痉挛是无阻塞性冠状动脉心肌梗死（MINOCA）的一种罕见但临床上重要的表现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5039/9924495/e4edab71ee1b/ytad019f5.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5039/9924495/fcdfb2ad866a/ytad019f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5039/9924495/0f2d50de2b2a/ytad019f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5039/9924495/e4edab71ee1b/ytad019f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5039/9924495/f6bdbf89ee90/ytad019_ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5039/9924495/59084ea41efc/ytad019f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5039/9924495/dceebb808c34/ytad019f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5039/9924495/fcdfb2ad866a/ytad019f3.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5039/9924495/e4edab71ee1b/ytad019f5.jpg

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本文引用的文献

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Syndrome of Nonobstructive Coronary Artery Diseases: A Comprehensive Overview of Open Artery Ischemia.非阻塞性冠状动脉疾病综合征：开放动脉缺血的综合概述。
Am J Med. 2021 Nov;134(11):1321-1329. doi: 10.1016/j.amjmed.2021.06.038. Epub 2021 Jul 31.
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Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease.乙酰胆碱痉挛激发试验在非阻塞性冠状动脉疾病中的病理生理学评估作用。
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