PDF(Pubmed)
Abstract：
A 76-year-old woman was admitted to our department for pneumonia. Although she gradually recovered, she complained of chest and back pain and went into shock. Electrocardiogram showed ST-segment elevation in the inferior leads; thus, an acute inferior myocardial infarction (MI) was strongly suspected. Emergent coronary angiography revealed subtotal right coronary artery (RCA) occlusion, and intravascular ultrasound showed flattening of the RCA ostium. Although the coronary artery flow improved after percutaneous coronary intervention with rescue stent implantation, the patient was still in a prolonged state of shock. Contrast-enhanced computed tomography revealed a ruptured thoracic aortic aneurysm (TAA) with a massive posterior mediastinal hematoma. We presumed that the acute MI and shock were caused by compression of the RCA ostium by the mediastinal hematoma and hemorrhage with TAA rupture, respectively. The patient was urgently transferred to another hospital for surgery. To the best of our knowledge, there has been no report on acute MI due to coronary artery compression by a mediastinal hematoma associated with TAA rupture. A staged therapeutic approach, involving preoperative coronary stent implantation, could be used to save the patient. .
摘要：
一名76岁的妇女因肺炎入院。虽然她逐渐康复，她抱怨胸部和背部疼痛，休克。心电图显示下导联ST段抬高；因此，强烈怀疑急性下壁心肌梗死(MI).急诊冠状动脉造影显示右冠状动脉次全闭塞，血管内超声显示RCA口变平。虽然经皮冠状动脉介入治疗后冠状动脉血流得到改善，但患者仍处于长期休克状态。对比增强计算机断层扫描显示胸主动脉瘤（TAA）破裂，并伴有巨大的后纵隔血肿。我们推测急性MI和休克是由纵隔血肿压迫RCA口和TAA破裂出血引起的。分别。该患者被紧急转移到另一家医院进行手术。据我们所知,尚无关于与TAA破裂相关的纵隔血肿压迫冠状动脉导致急性MI的报道.分阶段的治疗方法，涉及术前冠状动脉支架植入术，可以用来拯救病人.学习目标：一例因纵隔血肿合并胸主动脉瘤（TAA）破裂而压迫冠状动脉引起的急性心肌梗死（MI）极为罕见。尽管尚未建立由冠状动脉压迫引起的急性MI并发TAA破裂的标准治疗策略，术前冠状动脉支架植入术可以挽救患者。>.
