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病例报告：两名冠心病患者出现胸痛伴急性心肌炎——跳出框框思考。

Case report: acute myocarditis in two patients with coronary artery disease presenting with chest pain-thinking outside the box.

作者信息

Amelotti Nicola, Brusamolino Matteo, Mapelli Massimo, Contini Mauro, Baggiano Andrea, Fazzari Fabio, Pontone Gianluca, Agostoni Piergiuseppe

机构信息

Centro Cardiologico Monzino, IRCCS, Via Carlo Parea, 4, 20138 Milan, Italy.

Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.

出版信息

Eur Heart J Case Rep. 2024 Apr 26;8(5):ytae220. doi: 10.1093/ehjcr/ytae220. eCollection 2024 May.

DOI:10.1093/ehjcr/ytae220
PMID:38736997
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11087877/
Abstract

BACKGROUND

In a subset of patients, acute myocarditis (AM) may mimic acute myocardial infarction, with a similar clinical presentation characterized by chest pain, electrocardiogram (ECG) changes consistent with acute coronary syndromes (ACS), and serum markers increment.

CASE SUMMARY

We present two cases of infarct-like myocarditis in patients with known coronary artery disease (CAD), in which the discrepancy between transthoracic echocardiogram findings, ECG, and angiography prompted us to look beyond the simplest diagnosis. In these cases, making a prompt and correct diagnosis is pivotal to address adequate therapy and establish a correct prognosis.

DISCUSSION

The right diagnosis can avoid unnecessary coronary revascularizations and subsequent antiplatelet therapy that may be associated with an increased haemorrhagic risk. Moreover, it allows setting up guideline-directed therapy for myocarditis, proper follow-up, as well as recommending abstention from physical activity.

摘要

背景

在一部分患者中，急性心肌炎（AM）可能会模仿急性心肌梗死，具有相似的临床表现，其特征为胸痛、与急性冠状动脉综合征（ACS）一致的心电图（ECG）变化以及血清标志物升高。

病例总结

我们报告了两例已知患有冠状动脉疾病（CAD）的梗死样心肌炎患者，其中经胸超声心动图检查结果、心电图和血管造影之间的差异促使我们超越最简单的诊断去进一步探究。在这些病例中，迅速做出正确诊断对于采取适当治疗和确立正确预后至关重要。

讨论

正确的诊断可以避免不必要的冠状动脉血运重建以及后续可能增加出血风险的抗血小板治疗。此外，它还能为心肌炎制定指南导向的治疗方案、进行适当的随访，并建议避免体育活动。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/9b540baee1ef/ytae220f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/f27522a45120/ytae220f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/b375309a714f/ytae220f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/e4a4c5c8b706/ytae220f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/bd982a17cdeb/ytae220f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/9b540baee1ef/ytae220f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/f27522a45120/ytae220f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/b375309a714f/ytae220f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/e4a4c5c8b706/ytae220f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/bd982a17cdeb/ytae220f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ca3/11087877/9b540baee1ef/ytae220f4.jpg

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