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一名年轻男性的心脏骤停：斑块内出血和冠状动脉痉挛的作用

Sudden Cardiac Arrest in a Young Male: The Role of Intraplaque Hemorrhage and Coronary Spasm.

作者信息

Nishi Takeshi, Kobayashi Yuhei, Kitahara Hideki, Parikh Manish, Kobayashi Yoshio

机构信息

Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Internal Medicine, Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Weill Cornell Medical College, Brooklyn, New York, USA.

Department of Internal Medicine, Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Weill Cornell Medical College, Brooklyn, New York, USA.

出版信息

JACC Case Rep. 2025 May 7;30(9):103292. doi: 10.1016/j.jaccas.2025.103292. Epub 2025 Feb 26.

DOI:10.1016/j.jaccas.2025.103292
PMID:40345735
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12245425/
Abstract

BACKGROUND

Sudden cardiac death (SCD) is commonly linked to coronary artery disease (CAD), often involving plaque rupture or erosion. Intraplaque hemorrhage (IPH) has emerged as a significant factor in SCD.

CASE SUMMARY

A 39-year-old man experienced intermittent chest pain before collapsing with ventricular fibrillation cardiac arrest. Coronary angiography revealed significant stenosis in the left anterior descending artery. Optical coherence tomography identified IPH. Coronary spasm was confirmed by acetylcholine testing. The patient was treated with percutaneous coronary intervention and long-term medical therapy including antiplatelet therapy and calcium channel blocker, with no adverse events over 3 years.

DISCUSSION

This case underscores the importance of recognizing IPH and coronary spasm as contributors to SCD. Recent pathologic findings suggest a notable association between IPH and coronary spasm.

摘要

背景

心源性猝死（SCD）通常与冠状动脉疾病（CAD）相关，常涉及斑块破裂或糜烂。斑块内出血（IPH）已成为SCD的一个重要因素。

病例摘要

一名39岁男性在因心室颤动心脏骤停而晕倒前曾经历间歇性胸痛。冠状动脉造影显示左前降支有明显狭窄。光学相干断层扫描发现了IPH。乙酰胆碱试验证实存在冠状动脉痉挛。该患者接受了经皮冠状动脉介入治疗以及包括抗血小板治疗和钙通道阻滞剂在内的长期药物治疗，3年内无不良事件发生。

讨论

本病例强调了认识到IPH和冠状动脉痉挛是SCD的促成因素的重要性。最近的病理学发现表明IPH与冠状动脉痉挛之间存在显著关联。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/b76cad416b86/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/4443e14c1ff0/ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/51299eaeec60/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/b558808c68d7/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/1d7a69a4abde/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/1c85c607a13d/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/67c24c7b16b4/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/b76cad416b86/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/4443e14c1ff0/ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/51299eaeec60/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/b558808c68d7/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/1d7a69a4abde/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/1c85c607a13d/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/67c24c7b16b4/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4ec/12245425/b76cad416b86/gr6.jpg

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