来自右冠状动脉的异常左环动脉作为ST升高心肌梗塞 (STEMI) 的罪祸首
Abhishek Vadher1, Nikhale Malik1, Kurian Pannikottu2
1Internal Medicine, Garden City Hospital, Garden City, USA.
Cureus
|September 6, 2024
概括
异常的左环动脉 (ALCx) 即使是动脉样硬化,也可能导致心肌梗塞. 这一案例凸显了在临床实践中识别ALCx变异的重要性.
科学领域:
- 心脏病学 心脏病学
- 解剖学的变化 解剖学的变化
- 干预心脏病学 干预心脏病学
背景情况:
- 先天性冠状动脉异常很少见,异常左环动脉 (ALCx) 是最常见的.
- ALCx通常起源于Valsalva的右鼻腔或作为右冠状动脉 (RCA) 的分支.
- 临床表现范围从无症状到严重的事件,如ST段升高心肌梗塞 (STEMI).
研究的目的:
- 报告一个由动脉硬性狭窄引起的STEMI病例,该病例发生在异常的左环动脉 (ALCx) 中.
- 强调ALCx变异的临床意义,特别是在动脉样硬化疾病和心脏手术的背景下.
- 要强调临床医生对这些解剖学异常的警的需要.
主要方法:
- 一名45岁的女性患者患有多种心血管风险因素,出现胸痛.
- 电心电图显示劣质的STEMI,导致心脏导管.
- 冠状动脉扫描显示,90%的静脉异常LCx起源于右冠状动脉尖端,并在其他冠状动脉中扩散动脉样性疾病.
主要成果:
- 在异常的LCx中成功部署了释放药物的支架,将狭窄症降低到0%.
- 患者在稳定状态下出院,但后来失去了随访.
- 患者的STEMI归因于异常LCx内的动脉样硬化狭窄,而不仅仅是异常解剖本身.
结论:
- 虽然来自RCA的异常LCx通常是良性的,但它可以导致心肌梗塞或心脏突然死亡.
- 心脏手术期间ALCx的压缩是已知的并发症.
- 临床医生必须保持 ALCx 变异的意识,因为它们的潜在临床影响,特别是当与动脉样硬化疾病结合时.
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