双重冠状动脉封闭呈现为下层ST段升高心肌梗塞和A型威伦斯综合征:一个病例报告
Enrico Marchi1, Iacopo Muraca1, Daniel Cesarini1
1Interventional Cardiology Unit, Careggi University Hospital, Largo G.A. Brambilla 3, 50141 Florence, Italy.
European heart journal. Case reports
|August 23, 2024
概括
带有多个动脉阻塞的ST升高心肌梗塞 (STEMI) 是罕见的,但危险的,可能会引起休克. 这种病例突出显示了一名患者同时出现右冠状动脉和左前下垂动脉堵塞,通过皮肤冠状动脉干预成功治疗.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 急性冠状动脉综合征是什么
背景情况:
- ST升高心肌梗塞 (STEMI) 通常涉及单一的罪祸首病变.
- 多重冠状动脉封闭发生在2.5%的STEMI病例中,具有显著的风险.
- 同时的冠状动脉封闭会导致危及生命的并发症,如心脏性休克和心室节律失常.
研究的目的:
- 为了呈现一种罕见的ST升高心肌梗塞 (STEMI) 病例,同时出现两个主要冠状动脉的封闭.
- 为了说明在STEMI中与多血管冠状动脉疾病相关的诊断和治疗挑战.
- 讨论STEMI多个罪祸首病变的潜在机制和临床影响.
主要方法:
- 一个74岁的男性的病例报告,胸部疼痛和ST段升高.
- 电心电图 (ECG) 发现表明威伦斯综合征A型.
- 紧急冠状动脉扫描 (CA) 揭示了靠近右冠状动脉 (RCA) 的血栓性阻塞和左前下垂动脉 (LAD) 的中侧阻塞.
- 在RCA和LAD病变的初级皮肤穿冠状动脉干预 (PCI).
主要成果:
- 患者在心电图上呈现下部STEMI和交替前部STE.
- 冠状动脉扫描证实了RCA的同时封闭和LAD的次封闭.
- 患者在CA期间经历了血液动力学不稳定性,需要内和血管压缩剂的支持.
- 对两种罪祸首病变进行了成功的初级PCI.
- 患者没有任何事件恢复,在手术后5天就出院了.
结论:
- 多个罪祸首冠状动脉的STEMI并不常见,但与高血动力学损害风险有关.
- 潜在的原因包括冠状动脉栓塞,脱血,斑块破裂,血管,高凝血和药物滥用.
- 这种情况可能涉及血栓性细胞因子释放和肌肉心脏功能障碍导致的流动受损的组合.
- 及时诊断和多血管PCI对于管理这些高风险的STEMI病例至关重要.
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