左冠状动脉异常起源于肺动脉致急性心肌梗死合并室性心动过速1例  

A case of acute myocardial infarction caused by anomalous origin of left coronary artery from the pulmonary artery complicated with ventricular tachycardia

作　　者：黄超群 舒尚志 周苗苗 孙振铭 李树岩[1] HUANG Chao-qun;SHU Shang-zhi;ZHOU Miao-miao;SUN Zhen-ming;LI Shu-yan(Department of Cardiology,the First Hospital of Jilin University,Changchun 130061,China)

机构地区：[1]吉林大学第一医院心血管内科,吉林长春130061

出　　处：《中国介入心脏病学杂志》2023年第1期69-73,共5页Chinese Journal of Interventional Cardiology

摘　　要：左冠状动脉异常起源于肺动脉是一种死亡率极高的疾病,大约90%的患者在出生后的第1年死于心肌梗死和心力衰竭,很少有患者在不做手术的情况下活到成年。而超过50岁的成人左冠状动脉异常起源于肺动脉就更为少见,可能表现为无症状、心绞痛、劳力性呼吸困难、心肌梗死和心原性猝死。而以室性心动过速为首发表现的病例报道更罕见。本文报道1例独特的病例,患者为58岁女性,既往体健,因胸闷、心悸症状持续不缓解于当地医院行心电图检查发现室性心动过速,心肌损伤标志物阴性。5 h后于本院急诊行心电图检查发现胸前导联Q波,ST-T改变,肌钙蛋白I明显升高,后行冠状动脉造影及冠状动脉CT血管造影检查发现左冠状动脉异常起源于肺动脉。Anomalous origin of the left coronary artery from the pulmonary artery is a disease with an extremely high mortality and approximately 90% of patients die f rom myocardial infarction and heart failure in the first year of life, with few patients surviving to adulthood without surgery. Moreover, patients over 50 years old with it are much less. These patients may present with asymptomatic, angina pectoris, exertional dyspnea, myocardial infarction and sudden cardiac death.Cases with ventricular tachycardia as the initial presentation have been reported more rarely. We report a unique case. A 58-year-old previously healthy woman with persistent chest tightness and palpitations underwent ECG at a local hospital and f ound ventricular tachycardia with negative markers of myocardial injury. Five hours later, troponin was significantly increased and ECG showed Q-wave, ST-T changes in the chest lead. Later, coronary angiography and computed tomographic angiography of coronary artery found anomalous origin of the left coronary artery from the pulmonary artery.

关 键 词：室性心动过速 急性心肌梗死 左冠状动脉异常起源于肺动脉 布兰德-怀特-加兰德综合征 

分 类 号：R541.1[医药卫生—心血管疾病]