Wilke A, Kruse T, Maisch B
Abteilung Kardiologie, Klinikum der Philipps-Universität, Marburg.
Herz. 1998 Aug;23(5):299-302. doi: 10.1007/BF03044361.
A 72-year-old patient presented himself with typical symptoms of coronary heart disease and was scheduled for invasive diagnostic procedures. Cardiac risk factors were smoking and arterial hypertension. The physical examination was inconspicious. In the laborchemistry a hemoglobin of 79 g/l with a mean corpuscular volume of 63 fl and a mean corpuscular hemoglobin of 20 pg was conspicuous. The serum iron was with 42 micrograms/dl in the lower norm. Transferrin, bili-rubin and lactate dehydrogenase were normal. Then in the gastrointestinal investigations he was diagnosed with a leiomyoma of the intestine that led to chronic anaemia and additionally to chest pain characteristic for angina pectoris. After the removal of the tumor and normalization of hemoglobin this patient was free from symptoms of the disease. The coronary angiography revealed a complex stenosis of the right coronary artery with collaterales and not significant stenosis both of the left coronary arteries. In patients with angina pectoris anaemia as the possible and only cause of angina ought to be verified. It is therefore necessary after normalization of hemoglobin and clarification of the cause for the anaemia to apply a test for coronary ischemia.
一名72岁患者因冠心病典型症状前来就诊，计划接受侵入性诊断检查。心脏危险因素为吸烟和动脉高血压。体格检查无异常。血液生化检查中，血红蛋白79g/l、平均红细胞体积63fl、平均红细胞血红蛋白20pg较为明显。血清铁42微克/分升，处于正常下限。转铁蛋白、胆红素和乳酸脱氢酶正常。随后在胃肠道检查中，他被诊断为肠道平滑肌瘤，该肌瘤导致慢性贫血，并伴有心绞痛特有的胸痛。切除肿瘤且血红蛋白恢复正常后，该患者症状消失。冠状动脉造影显示右冠状动脉有复杂狭窄并伴有侧支循环，左冠状动脉无明显狭窄。对于心绞痛患者，应证实贫血是否为心绞痛可能的唯一病因。因此，在血红蛋白恢复正常且明确贫血病因后，有必要进行冠状动脉缺血检测。
