Dhungana Reechashree, Pokharel Prajjwal, Poudel Chandra Mani, Khanal Raja Ram, Shakya Smriti, Gajurel Ratna Mani
Department of Cardiology Manmohan Cardiothoracic Vascular and Transplant Center Institute of Medicine Maharajgunj Medical Campus Kathmandu Nepal.
Department of Cardiology Manmohan Cardiothoracic Vascular and Transplant Center Kathmandu Nepal.
Clin Case Rep. 2024 Feb 20;12(2):e8532. doi: 10.1002/ccr3.8532. eCollection 2024 Feb.
This case underscores the importance of considering myocardial infarction with nonobstructive coronary arteries (MINOCA) in patients experiencing acute chest pain following rabies vaccination, emphasizing the need for heightened awareness and further research into the association between MINOCA and Rabies vaccination.
Rabies is a vaccine-preventable deadly viral disease prevalent in Asia and Africa that causes thousands of deaths annually. Rabies pre (PrEP) and postexposure prophylaxis (PEP) is highly effective in annulling rabies-associated deaths. The adverse reactions following rabies vaccination are typically mild. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare condition, and its association with rabies vaccination is unprecedented. We present a case of a 43-year-old male with MINOCA following Rabies PEP. A 43-year-old male, nonsmoker and nonalcoholic, presented to the ER with complaints of acute onset left sided chest pain following the completion of the third dose of intradermal rabies vaccine, whose clinical features, ECG changes and lab reports were suggestive of acute presentation of inferior wall MI. Coronary angiography was performed, which however revealed normal coronaries with only slow flow being noted in the left anterior descending (LAD) artery. Echocardiography later showed a normal study with no other relevant diagnosis unveiled on further investigations. Hence a diagnosis of vaccine-induced MINOCA was made. Treatment included antiplatelet therapy, statins, and beta-blockers. MINOCA following rabies vaccination is an unprecedented finding. The clear etiology behind this couldn't be ascertained. The patient's treatment was conventional, emphasizing the need for further research and clinical trials in MINOCA diagnosis and management. This case highlights the need for clinicians to consider MINOCA in patients with acute chest pain post-rabies vaccination. Further research is essential to unravel the association between MINOCA and rabies vaccination, paving the way for optimal management strategies.
该病例强调了在狂犬病疫苗接种后出现急性胸痛的患者中考虑非阻塞性冠状动脉心肌梗死（MINOCA）的重要性，突出了提高对MINOCA与狂犬病疫苗接种之间关联的认识以及进一步研究的必要性。
狂犬病是一种可通过疫苗预防的致命病毒性疾病，在亚洲和非洲流行，每年导致数千人死亡。狂犬病暴露前预防（PrEP）和暴露后预防（PEP）在消除狂犬病相关死亡方面非常有效。狂犬病疫苗接种后的不良反应通常较轻。非阻塞性冠状动脉心肌梗死（MINOCA）是一种罕见病症，其与狂犬病疫苗接种的关联尚无先例。我们报告一例在狂犬病PEP后发生MINOCA的43岁男性病例。一名43岁男性，不吸烟、不饮酒，在完成第三剂皮内狂犬病疫苗接种后因急性左侧胸痛就诊于急诊室，其临床特征、心电图变化及实验室检查结果提示下壁心肌梗死急性发作。进行了冠状动脉造影，结果显示冠状动脉正常，仅左前降支（LAD）动脉血流缓慢。随后的超声心动图检查显示正常，进一步检查未发现其他相关诊断。因此诊断为疫苗诱导的MINOCA。治疗包括抗血小板治疗、他汀类药物和β受体阻滞剂。狂犬病疫苗接种后发生MINOCA是一个前所未有的发现。无法确定其确切病因。该患者接受了常规治疗，强调了对MINOCA诊断和管理进行进一步研究和临床试验的必要性。该病例突出了临床医生在狂犬病疫苗接种后急性胸痛患者中考虑MINOCA的必要性。进一步研究对于阐明MINOCA与狂犬病疫苗接种之间的关联至关重要，为优化管理策略铺平道路。
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