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前间隔支痉挛所致可逆性右束支传导阻滞：病例报告

Reversible right bundle branch block caused by spasm of the anterior septal branch: case report.

作者信息

Bao Yue, Yi Hongwei, Ma Jun

机构信息

Departmentof Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.

出版信息

BMC Cardiovasc Disord. 2024 Dec 27;24(1):745. doi: 10.1186/s12872-024-04403-y.

DOI:10.1186/s12872-024-04403-y
PMID:39730998
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11673359/
Abstract

BACKGROUND

Coronary Artery Spasm (CAS) often presents in the epicardial coronary arteries. The anterior septal branch is distributed within the myocardium, and occurrences of spasms are rare. Currently, there is no available literature on this topic, and the onset of symptoms remains elusive, potentially leading to misdiagnosis.

CASE PRESENTATION

We present a case of acute myocardial infarction (AMI) caused by spasm in the anterior septal branch, accompanied by transient right bundle branch block (RBBB). The administration of nitroglycerin via intracoronary injection resulted in the alleviation of spasm in the anterior septal branch and the disappearance of RBBB. After the administration of anti-coronary spasm medications, the patient exhibited favorable recovery outcomes. No episodes of myocardial ischemia were observed during the six-month follow-up.

CONCLUSIONS

The presence of new RBBB in patients may warrant consideration of anterior septal coronary artery spasm, which necessitates urgent coronary angiography to clarify the underlying cause and facilitate the prompt initiation of anti-spasm treatment.

摘要

背景

冠状动脉痉挛（CAS）常发生于冠状动脉的 epicardial 段。前间隔支分布于心肌内，痉挛发生率较低。目前关于该主题尚无可用文献，症状发作难以捉摸，可能导致误诊。

病例报告

我们报告 1 例由前间隔支痉挛引起的急性心肌梗死（AMI），伴有短暂性右束支传导阻滞（RBBB）。经冠状动脉内注射硝酸甘油后，前间隔支痉挛缓解，RBBB 消失。给予抗冠状动脉痉挛药物后，患者恢复良好。随访 6 个月期间未观察到心肌缺血发作。

结论

患者出现新发 RBBB 可能提示前间隔冠状动脉痉挛，这需要紧急冠状动脉造影以明确病因并及时启动抗痉挛治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/7ef279686ed9/12872_2024_4403_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/8cb6dc27e25f/12872_2024_4403_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/64b4e77c28b4/12872_2024_4403_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/e6805c603069/12872_2024_4403_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/b0d5388d36c0/12872_2024_4403_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/a16a1baa2048/12872_2024_4403_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/7ef279686ed9/12872_2024_4403_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/8cb6dc27e25f/12872_2024_4403_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/64b4e77c28b4/12872_2024_4403_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/e6805c603069/12872_2024_4403_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/b0d5388d36c0/12872_2024_4403_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/a16a1baa2048/12872_2024_4403_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/019f/11673359/7ef279686ed9/12872_2024_4403_Fig6_HTML.jpg

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本文引用的文献

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2023 ESC Guidelines for the management of acute coronary syndromes.2023年欧洲心脏病学会急性冠状动脉综合征管理指南
Eur Heart J Acute Cardiovasc Care. 2024 Feb 9;13(1):55-161. doi: 10.1093/ehjacc/zuad107.
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Some observations on and controversies about coronary arterial spasm.关于冠状动脉痉挛的一些观察与争议
Int J Cardiol. 2015 Feb 15;181:389-98. doi: 10.1016/j.ijcard.2014.12.047. Epub 2014 Dec 23.
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Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina) (JCS 2013).变异性心绞痛（冠状动脉痉挛性心绞痛）患者的诊断和治疗指南（日本循环学会2013年版）
Circ J. 2014;78(11):2779-801. doi: 10.1253/circj.cj-66-0098. Epub 2014 Sep 30.
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Right bundle-branch block in anterior acute myocardial infarction in the coronary intervention era: acute angiographic findings and prognosis.冠状动脉介入治疗时代前壁急性心肌梗死合并右束支传导阻滞：急性血管造影结果及预后
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