病人,一个68岁的男人,带着胸痛被送到急诊室,由于心肌肌钙蛋白-I水平升高,提示紧急心导管检查。虽然没有发现明显的冠状动脉狭窄,左心室有心尖部膨胀壁运动的证据,导致诊断为takotsubo综合征。三个月后,他偶尔会在休息时出现胸痛,促使我们再进行一次心导管检查.左心室造影显示正常收缩。突然,他经历了胸痛并伴有ST段抬高,这是自发发生的。随后,在左前降支(LAD)的中间部分观察到缓慢流动现象。我们及时服用硝酸甘油以缓解症状。在诊断冠状动脉微血管功能障碍(CMD)后,患者开始钙通道阻滞剂治疗,但仍无症状.一年后,我们重新进行了心导管检查,以进一步了解他的病情.进行乙酰胆碱激发试验,没有显示心外膜冠状动脉痉挛.然而,在冠状窦血样本中观察到乳酸升高。此外,LAD的冠状动脉生理测量显示,微循环阻力指数高,冠状动脉血流储备低。基于这一系列的临床事件,我们推断CMD对患者病情有显著影响。
■冠状动脉微血管功能障碍(CMD)越来越被认为是一种重要的心血管疾病,导致心肌缺血,偶尔与Takotsubo综合征(TTS)有关。在这份报告中,我们介绍了一例与TTS相关的自发性CMD。这个案例强调了准确诊断和适当治疗的意义,强调在TTS患者中识别CMD的重要性。
The patient, a 68-year-old man, presented to our emergency room with chest pain, prompting an emergency cardiac catheterization due to elevated cardiac troponin-I levels. While no obvious coronary artery stenosis was found, there was evidence of apical ballooning wall motion in the left ventricle, leading to a diagnosis of takotsubo syndrome. Three months later, he occasionally experienced chest pain at rest, prompting us to conduct another cardiac catheterization. Left ventriculography showed normal contraction. Suddenly, he experienced chest pain accompanied by ST elevation, which occurred spontaneously. Subsequently, slow-flow phenomenon was observed in the intermediate part of left anterior descending artery (LAD). We promptly administered nitroglycerin to alleviate the symptoms. Following the diagnosis of coronary microvascular dysfunction (CMD), he started calcium-channel blocker therapy and remained asymptomatic. One year later, we re-performed cardiac catheterization to further explore his condition. Acetylcholine provocation test was performed, which showed no epicardial coronary spasm. However, lactic acid elevation was observed in the coronary sinus blood sample. Additionally, a coronary physiological measurement in the LAD revealed a high index of microcirculatory resistance and low coronary flow reserve. Based on this series of clinical events, we inferred a significant contribution of CMD to the patient\'s condition.
UNASSIGNED: Coronary microvascular dysfunction (CMD) is increasingly recognized as an important cardiovascular disease, leading to myocardial ischemia, which is occasionally associated with takotsubo syndrome (TTS). In this report, we present a
case of spontaneous CMD associated with TTS. This
case emphasizes the significance of accurate diagnosis and appropriate treatment, highlighting the importance of recognizing CMD in patients with TTS.