冠状动脉痉挛致心肌梗死的诊断及治疗1例

Diagnosis and Treatment of Myocardial Infarction Caused by Coronary Artery Spasm: One Case Report

摘要: 目的：通过1例患者的临床实践并复习文献，阐述冠状动痉挛导致心肌梗死的诊断要点、治疗手段及可能机制。方法：回顾性分析1例5个月前有胸闷、胸痛症状，造影提示冠脉心肌桥且有冠状动脉痉挛的患者，突发持续性胸骨后胸痛2天，于2021-08-11急诊收治，发生心肌梗死患者的临床资料。结果：经给予抗血小板聚集，稳定斑块，强化改善血管痉挛等药物治疗，急诊冠状动脉造影(CAG)、冠状动脉内推注抗痉挛药物等措施，成功抢救，1周后病情稳定。既往冠状动脉造影及本次冠状动脉造影、心肌酶谱及动态心电图对比提示，患者左前降支痉挛，引发ST段抬高型心肌梗死。结论：冠状动脉痉挛是ST段抬高型心肌梗死的原因之一，规范的药物治疗是预防急性心血管事件发作最根本的手段。

Abstract: Aim: Through the clinical practice of 1 patient and the literature review, to explain the main points of diagnosis, treatment and possible mechanism of myocardial infarction caused by coronary spasm. Methods: A retrospective analysis of a patient with chest tightness and chest pain symptoms 5 months ago, coronary myocardial bridge and coronary artery spasm revealed by angiography, sudden and persistent retrosternal chest pain for 2 days, was admitted to the emergency department on August 11, 2021. Clinical data of patients with myocardial infarction were analyzed. Results: After treatment with anti-platelet aggregation, stabilization of plaques, intensified treatment of vasospasm, emergency coronary angiography (CAG), intracoronary bolus injection of antispasmodic drugs and other measures, the rescue was successful and the condition was stable after 1 week. The comparison of previous coronary angiography and this coronary angiography, myocardial enzyme spectrum and dynamic electrocardiogram indicated that the patient’s left anterior descending artery spasm caused ST-segment elevation myocardial infarction. Conclusion: Coronary artery spasm is a cause of ST-segment elevation myocardial infarction. The appropriate medication plays a crucial role in prevention of acute cardiovascular events related to coronary artery spasm.