UNASSIGNED:左心室血栓(LVT)是糖尿病患者心肌梗死(MI)的公认并发症。由LVT引起的栓塞并发症是关键的临床问题,并且与长期生存率恶化有关。
UNASSIGNED:一名45岁的男子因持续左腹痛1周且左腿疲劳而被送往急诊科。腹痛的原因是肾动脉栓塞,脾动脉,和心源性血栓形成引起的肠系膜上动脉,进一步导致脾梗死和肾梗死。尚不清楚何时发生MI,因为患者没有典型的严重胸痛,这可能与糖尿病并发症有关,如糖尿病周围神经病变。糖尿病在MI和LVT形成中起关键作用。因为冠状动脉造影提示三血管疾病,进行经皮冠状动脉腔内成形术(PTCA),在左冠状动脉前降支(LAD)内置入两个药物洗脱支架。由于缺乏随机对照临床试验,LVT和相关栓塞的治疗一直存在争议。根据目前的指导方针,该患者接受低分子肝素和华法林(口服抗凝药)治疗3个月,同时接受阿司匹林(100mg/日)和氯吡格雷(75mg/日)治疗1年.无严重出血并发症,随访检查显示左心室无血栓或进一步的外周血栓事件.
UNASSIGNED:由MI引起的LVT周围栓塞导致多器官栓塞仍然很少发生。糖尿病在MI和LVT形成中起关键作用。成功的梗死相关冠状动脉血运重建和抗凝治疗对于最大程度地减少心肌损伤和预防LVT很重要。本病例将帮助临床医生识别和管理糖尿病患者的LVT和相关的外周动脉血栓事件与抗凝治疗。
UNASSIGNED: Left ventricular thrombus (LVT) is a well-recognized complication of myocardial infarction (MI) in patients with diabetes. An embolic complication caused by LVT is a key clinical problem and is associated with worsened long-term survival.
UNASSIGNED: A 45-year-old man with persistent left abdominal pain for 1 week and left leg fatigue was admitted to the emergency department. The cause of abdominal pain was embolism of the renal artery, the splenic artery, and the superior mesenteric artery caused by cardiogenic thrombosis, which further led to splenic infarction and renal infarction. It was unclear when MI occurred because the patient had no typical critical chest pain, which may have been related to diabetic complications, such as diabetic peripheral neuropathy. Diabetes plays a pivotal role in MI and LVT formation. Because coronary angiography suggested triple vessel disease, percutaneous transluminal coronary angioplasty (PTCA) was conducted, and two drug-eluting stents were placed in the left anterior descending coronary artery (LAD). Due to a lack of randomized clinical control trials, the therapy of LVT and associated embolization has been actively debated. According to the present guidelines, this patient was treated with low-molecular-weight heparin and warfarin (oral anticoagulants) for 3 months in addition to aspirin (100 mg/day) and clopidogrel (75 mg/day) for 1 year. No serious bleeding complications were noted, and a follow-up examination showed no thrombus in the left ventricle or further peripheral thrombotic events.
UNASSIGNED: Peripheral embolization of LVT caused by MI leading to multiple organ embolization remains a rare occurrence. Diabetes plays a pivotal role in MI and LVT formation. Successful revascularization of the infarct-related coronary artery and anticoagulation therapy is important to minimize myocardial damage and prevent LVT. The present
case will help clinicians recognize and manage LVT in patients with diabetes and related peripheral arterial thrombotic events with anticoagulation.