- 期刊
Acute Myocardial Infarction Caused by Acute Ascending Aortic Dissection
急性升主動脈剝離引發急性心肌梗塞
摘要
急性升主動脈剝離造成急性心肌梗塞是非常少見的情況。急性心肌梗塞因冠狀動脈的血栓阻塞和次發於主動脈剝離二者的臨床表徵很相似但治療方式卻是不同。後者緊急手術是治療首選，而血栓溶解治療是絕對禁忌。我們報告一個44歲的男性突然發生急性前胸痛。經急診診斷為急性下壁心肌梗塞並接受血栓溶解治療及隨後冠狀動脈介入性治療。然而在心導管過程中懷疑有主動脈剝離而後被心臟超音波所確定。這病人緊急接受心臟手術來修復主動脈壁並對右冠狀動脈近端做繞道。在3個月後做冠狀動脈攝影追蹤，顯示通暢的右冠狀動脈。這個病例使我們學習到對急性心肌梗塞的病人，必須將主動脈剝離可能性謹記在心。假使有任何懷疑，心臟超音波可當做一個安全、迅速的工具來偵測這種可能性。
並列摘要
Acute myocardial infarction (AMI) secondary to acute ascending aortic dissection is a rare condition. The clinical presentations are similar but treatment strategies are different between AMI due to thrombotic occlusion of coronary arteries and that secondary to aortic dissection. In the latter, emergency surgery is the first choice and thrombolytic therapy is absolutely contraindicated. We report a 44-year-old man, who suddenly developed acute anterior chest pain. The diagnosis at emergency room was inferior wall AMI and the patient was treated with thrombolysis followed by coronary intervention. However, aortic dissection was suspected during cardiac catheterization and then comfirmed by echocardiography. The patient underwent emergent cardiac surgery to repair the aortic wall and bypass the proximal portion of right coronary artery (RCA). The follow-up coronary angiogram 3 months later showed patent RCA. From this case, we learn that in patients with an AMI, the possibility of aortic dissection should be kept in mind. If there is any suspicion, echocardiography can serve as a safe and quick tool to detect the possibility.
延伸閱讀
- Su, H. M., Voon, W. C., Lin, C. C., Chen, Y. F., Lin, T. H., Lai, W. T., & Sheu, S. H. (2004). 急性心肌梗塞的病人在接受早期成功的血栓溶解治療後發生心室中膈缺損－病例報告. The Kaohsiung Journal of Medical Sciences, 20(5), 235-239. https://www.airitilibrary.com/Article/Detail?DocID=02575655-200405-20-5-235-239-a
- Wu, K. Y., & Lai, J. H. (2016). 創傷性左冠動脈主幹枝剝離併急性心肌梗塞. 內科學誌, 27(5), 261-266. https://doi.org/10.6314/JIMT.2016.27(5).05
- 陳遠浩、賴聰煌、趙治中、方晃（1979）。心室中隔缺損併發主動脈閉鎖不全一病例報告。Acta Paediatrica Sinica，20(2)，110-114。https://www.airitilibrary.com/Article/Detail?DocID=00016578-197906-20-2-110-114-a
- Hung, C. H., & Kao, C. C. (2010). 無胸痛表現之急性主動脈剝離合併心衰竭. Journal of Emergency Medicine, Taiwan, 12(4), 123-126. https://www.airitilibrary.com/Article/Detail?DocID=15623386-201012-201102120054-201102120054-123-126
- 陳明豐（1989）。冠狀動脈心臟病－心肌梗塞。健康世界，(158)，27-29。https://doi.org/10.6454/HW.198902.0027