青年女性自发冠状动脉夹层导致急性心肌梗死1例并文献复习

doi:10.3969/j.issn.1004-583X.2023.02.011

摘要/Abstract

摘要：

目的探讨自发性冠状动脉夹层的临床特点,以期提高对该病的诊治与认识。方法回顾性分析1例青年女性自发性冠状动脉夹层导致急性心肌梗死患者的临床资料,并以“自发性冠状动脉夹层”、“急性心肌梗死”以及“青年女性”等关键词,通过检索中国知网、PubMed及万方数据库,筛选公开发表的相关中英文文献,以分析自发性冠状动脉夹层的临床特点。结果本例为青年女性,35岁,因间断胸痛就诊,心电图检查提示I、aVL及V2-V5导联ST段抬高,肌钙蛋白T升高(>2 000 ng/L),冠状动脉造影结果示左主干(LM)自开口可见夹层,延伸至左前降支(LAD)远段及回旋支(LCX)中段,管腔全程受压,近段血管部分不能显影,经血管内超声(intravenous ultrasound,IVUS)指导下行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗,随访1个月并复查冠状动脉造影(coronary angiography, CAG)患者治疗效果良好。结论自发性冠状动脉夹层是导致急性冠脉综合征的罕见病因,其疾病特点及治疗方法与冠状动脉粥样硬化不同,诊断具有挑战性,临床易误诊误治,因此对于年轻急性冠状动脉综合征(acute coronary syndrome, ACS)患者需要考虑自发性冠状动脉夹层可能。

关键词: 动脉瘤, 夹层, 青年女性, 心肌梗死

Abstract:

Objective To explore the clinical characteristics of spontaneous coronary artery dissection, aiming to improve the diagnosis and treatment of this disease. Methods The clinical data of a young female patient with acute myocardial infarction caused by spontaneous coronary artery dissection were retrospectively analyzed. In addition, relevant Chinese and English language literatures were searched in the CNKI, PubMed and Wanfang databases using the keywords of “spontaneous coronary artery dissection”, “acute myocardial infarction” and “young female” to perform literature review. Results A 35-year-old young woman presented in our hospital with an intermittent chest pain. Electrocardiography showed ST-segment elevation in leads I, aVL and V2-V5. Troponin T was elevated (>2 000 ng/L). Coronary angiography (CAG) showed that the left main stem (LM) was dissected from the opening, which was extended to the distal segment of the left anterior descending branch (LAD) and the middle part of the left circumflex branch (LCX). The lumen was under pressure throughout the whole process, and the proximal vessels were unable to be visualized. Percutaneous coronary intervention (PCI) was performed under the guidance of intravenous ultrasound (IVUS). At the 1-month follow-up visit, CAG showed a good therapeutic effect. Conclusion Spontaneous coronary dissection is a rare cause of acute coronary syndrome, and its disease characteristics and treatment methods are different from those of coronary atherosclerosis. The diagnosis is challenging and it is easy to be misdiagnosed and mistreated clinically. Therefore, the possibility of spontaneous coronary dissection should be considered in young patients with ACS.

Key words: aneurysm, dissecting, young women, myocardial infarction

中图分类号:

R543.16

王家琦, 王文静, 刘立天, 张飞飞, 党懿, 齐晓勇. 青年女性自发冠状动脉夹层导致急性心肌梗死1例并文献复习[J]. 临床荟萃, 2023, 38(2): 162-165.

Wang Jiaqi, Wang Wenjing, Liu Litian, Zhang Feifei, Dang Yi, Qi Xiaoyong. Acute myocardial infarction caused by spontaneous coronary artery dissection in a young woman: A case report and literature review[J]. Clinical Focus, 2023, 38(2): 162-165.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.02.011

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I2/162

图/表 4

图1 患者入院心电图(可见I、aVL及V2-V5导联ST段抬高,Ⅱ、Ⅲ及aVF导联ST段压低)

Fig. 1 Admission electrocardiogram (ST segment elevation in leads I, aVL and V2-V5, ST segment depression in leads Ⅱ、Ⅲ and aVF)

图2 冠状动脉造影图像:LM自开口可见夹层,延伸至LAD远段及回旋支LCX中段

Fig. 2 Coronary angiography (LM self-opening visible dissection extending to the distal LAD segment and the middle part of the rotatory rami LCX)

图3 IVUS检查图像:可见夹层及壁内血肿,图中虚线区域

Fig. 3 IVUS examination image (dissection and intramural hematoma visible, dotted line area)

图4 1个月后复查CAG图像:LCX自开口至中段仍可见夹层,血肿较前明显吸收

Fig. 4 Re-examination coronary angiography images one month later (dissection was still visible from the opening to the middle part of LCX, and hematoma was significantly absorbed than before)

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