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肺癌在1个月内并发急性心肌梗死和肺栓塞。

Lung cancer presenting with acute myocardial infarction and pulmonary embolism within 1 month.

作者信息

Jin Jiacheng, Qi Xin, Zhang Hongyu, Li Min, Li Shuangbin, Shen Guangyin

机构信息

The First Affiliated Hospital of Dalian Medical University, Dalian, China.

Department of Cardiology, Affiliated Hospital of Jilin Medical College, Jilin, China.

出版信息

SAGE Open Med Case Rep. 2023 Jul 6;11:2050313X231181979. doi: 10.1177/2050313X231181979. eCollection 2023.

Abstract

Acute myocardial infarction and pulmonary embolism can have life-threatening consequences such as congestive heart and respiratory failure, respectively. Cancer patients are at great risk of both acute myocardial infarction and pulmonary embolism complications because the malignancy sparks the patient's blood hypercoagulable state. Nevertheless, the literature currently offers only a few reports on acute myocardial infarction associated with pulmonary embolism, and two of them occurred in the same cancer patient. Here, we present a case of a 60-year-old woman who had been diagnosed with lung cancer. She was admitted to the emergency department twice. She was diagnosed with acute myocardial infarction at her first admission, when she experienced sudden-onset chest pain. Electrocardiography showed ST-segment elevation in leads V1-V3 with inverted T wave and pathological Q wave, suggesting an acute myocardial infarction. Coronary angiography revealed a thrombus in the left anterior descending coronary artery, and thrombus aspiration was performed. After 1 month, she had an attack of pulmonary embolism with syncope upon the second admission. A computed tomographic pulmonary angiography showed branches of right and left pulmonary embolism. Anticoagulation and antiplatelet measures were taken. In this article, we discuss the relationship between cancer and thrombosis with a special focus on the conservative management strategy regarding anticoagulant and antiplatelet therapy in our case.

摘要

急性心肌梗死和肺栓塞可能分别导致充血性心力衰竭和呼吸衰竭等危及生命的后果。癌症患者发生急性心肌梗死和肺栓塞并发症的风险很高,因为恶性肿瘤会引发患者血液高凝状态。然而,目前文献中关于急性心肌梗死合并肺栓塞的报道较少,其中两例发生在同一癌症患者身上。在此,我们报告一例60岁女性肺癌患者。她两次入住急诊科。首次入院时因突发胸痛被诊断为急性心肌梗死。心电图显示V1-V3导联ST段抬高,T波倒置及病理性Q波,提示急性心肌梗死。冠状动脉造影显示左前降支冠状动脉内有血栓形成,并进行了血栓抽吸术。1个月后,她第二次入院时因肺栓塞发作伴晕厥。计算机断层扫描肺动脉造影显示左右肺动脉分支栓塞。采取了抗凝和抗血小板措施。在本文中,我们讨论癌症与血栓形成的关系,并特别关注我们病例中关于抗凝和抗血小板治疗的保守管理策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e11d/10331209/4cc69a420120/10.1177_2050313X231181979-fig1.jpg

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