PDF(Pubmed)
Abstract：
A 67-year-old woman with pulmonary hypertension (PH) presented with a 1-day history of worsening shortness of breath and pleuritic chest pain and was found to have a troponin T level of 3755 ng/L (ref. range 0-19 ng/L). An initial diagnostic workup in the emergency department (ED) led to an urgent left heart catheterization which revealed a 90% occlusive right coronary artery blood clot, even though a recent heart catheterization less than a month prior was completely unremarkable. Further workup led to the discovery of a patent foramen ovale (PFO) and an aneurysmal interatrial septum, suggesting the presence of a paradoxical embolism. While typically asymptomatic, a PFO is an important clinical entity that can lead to irreversible cardiac damage. Suspicion should be high for this finding in the case of an acute myocardial infarction (MI) with no clear cause, especially in a patient with elevated right heart pressures.
摘要：
一名67岁的肺动脉高压（PH）女性，有1天的呼吸急促和胸膜炎性胸痛恶化的病史，被发现肌钙蛋白T水平为3755ng/L（参考范围0-19纳克/升)。急诊科（ED）的初步诊断检查导致紧急左心导管检查，发现90％闭塞性右冠状动脉血凝块，尽管最近不到一个月前的心脏导管检查完全没有什么异常。进一步的研究发现了卵圆孔未闭（PFO）和动脉瘤性房间隔，提示存在矛盾的栓塞.虽然通常无症状，PFO是一种重要的临床实体，可导致不可逆的心脏损伤。在没有明确原因的急性心肌梗死（MI）的情况下，对这一发现的怀疑应该很高。尤其是右心压升高的病人.
