左前降支冠状动脉持续痉挛引起急性广泛前壁心肌梗死1例  

Acute extensive anterior wall myocardial infarction caused by persistent spasm of left anterior descending coronary artery:a case report

作　　者：秦涛 欧阳茂[2] 彭彩霞 QIN Tao;OUYANG Mao;PENG Caixia(Department of Cardiology,The Third Xiangya Hospital of Central South University,Changsha,410013,China;Department of Geriatrics,The Third Xiangya Hospital of Central South University,Changsha,410013,China)

机构地区：[1]中南大学湘雅三医院心内科,长沙410013 [2]中南大学湘雅三医院老年病科,长沙410013

出　　处：《临床心血管病杂志》2020年第5期488-492,共5页Journal of Clinical Cardiology

摘　　要：1病例资料患者,男,72岁。因"胸痛9 h"于我院急诊科就诊。患者2019年9月7日20:00散步中出现胸痛,位于胸骨中上段,约手掌大小范围,呈持续性胀痛,伴胸闷及咽喉紧缩感,无放射痛,未出冷汗,无心悸气促,无头晕头痛,无腹痛腹泻等不适。休息及含服"速效救心丸"后疼痛无明显缓解,至次日3:00仍觉胸痛不适,遂至我院就诊。Coronary arterial spasm,a clinical syndrome,means incomplete or complete occlusion of blood vessels caused by the transient contraction of coronary arteries,which leads to myocardial ischemia,angina pectoris,arrhythmia,acute myocardial infarction(AMI)and sudden death.This article reports an older man who was diagnosed with acute extensive anterior myocardial infarction based on symptoms,electrocardiogram,and troponin.Coronary angiography suggested the complete occlusion in the middle part of the anterior descending branch.Contrasted with coronary angiography,percutaneous coronary intervention(PCI)confirmed no occlusion of this position.Combined with the results of intravascular ultrasound(IVUS)and other examinations,the final diagnosis was acute extensive anterior myocardial infarction because of the vasospasm caused by myocardial bridge.The patient was treated with blood circulation improving,anti-platelet therapy,heart rate control,lipid-lowing,plaque-stabilizing,and anti-spasm with diltiazem.The symptom of chest pain resolved after these treatments.Here,we reviewed the previous studies and elaborated on the underlying mechanism of coronary spasm,the mechanism of inducing AMI,diagnostic methods,standardized treatment,and prognostic follow-up.

关 键 词：心肌桥 冠状动脉痉挛 急性心肌梗死 冠状动脉造影 心电图 

分 类 号：R541.4[医药卫生—心血管疾病]