Case 02 (2024): Acute ST-segment elevation myocardial infarction during pregnancy caused by coronary artery dissection: a case report
孔令英 1贺鹏康 2李建平 2王东信 3洪涛 2孙瑜 1陈倩 1魏玉梅 1张鸿 3杨慧霞 1刘菲
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作者信息
1. 北京大学第一医院妇产生殖医学中心，北京 100034
2. 北京大学第一医院心血管内科，北京 100034
3. 北京大学第一医院麻醉科，北京 100034
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摘要
本文报道1例冠状动脉夹层导致孕妇急性ST段抬高型心肌梗死的病例。孕妇41岁，1岁时曾行心脏瓣膜手术，无高血压、糖尿病、吸烟、饮酒及冠状动脉性心脏病家族史等危险因素。2021年6月1日孕31周+1突发胸痛4 h，急诊转至北京大学第一医院。心电图提示Ⅰ、aVL、V2～V6导联ST段抬高；血生化检查示高敏心肌肌钙蛋白I、肌酸激酶-MB升高；超声心动图提示节段性室壁运动不良（心尖部），左心室功能减低，诊断为急性前壁ST段抬高型心肌梗死。急诊行冠状动脉造影和经皮冠状动脉介入术，确诊冠状动脉夹层，术后予抗血小板、抗凝及支持治疗。孕34周+3急性前壁ST段抬高型心肌梗死病情相对稳定，行剖宫产顺利分娩。产后定期心内科随诊，出院2年随访心功能基本正常。 This article presents a case of acute ST-segment elevation myocardial infarction (STEMI) in a pregnant woman caused by coronary artery dissection. The 41-year-old patient had undergone cardiac valve surgery at the age of 1 and had no risk factors such as hypertension, diabetes, smoking, alcohol use, or a family history of coronary artery disease. At 31+1 weeks of gestation, she experienced sudden chest pain for 4 hours and was emergently referred to Peking University First Hospital on June 1, 2021. Electrocardiogram revealed ST-segment elevation in leads I, aVL, and V2 to V6. Biochemical assays showed elevated levels of high-sensitivity cardiac troponin I and creatine kinase-MB. Echocardiography indicated segmental ventricular wall motion abnormalities (apical) and reduced left ventricular function, confirming the diagnosis of acute anterior wall STEMI. The patient promptly underwent emergency coronary angiography and percutaneous coronary intervention and confirmed coronary artery dissection. Postoperative care included antiplatelet, anticoagulation, and supportive treatment. At 34+3 weeks of gestation, with the condition of acute anterior wall STEMI being relatively stable, a cesarean section was successfully performed. Regular cardiology follow-ups were scheduled postpartum, and cardiac function was normal in two years after discharge.
Abstract
This article presents a case of acute ST-segment elevation myocardial infarction (STEMI) in a pregnant woman caused by coronary artery dissection. The 41-year-old patient had undergone cardiac valve surgery at the age of 1 and had no risk factors such as hypertension, diabetes, smoking, alcohol use, or a family history of coronary artery disease. At 31+1 weeks of gestation, she experienced sudden chest pain for 4 hours and was emergently referred to Peking University First Hospital on June 1, 2021. Electrocardiogram revealed ST-segment elevation in leads I, aVL, and V2 to V6. Biochemical assays showed elevated levels of high-sensitivity cardiac troponin I and creatine kinase-MB. Echocardiography indicated segmental ventricular wall motion abnormalities (apical) and reduced left ventricular function, confirming the diagnosis of acute anterior wall STEMI. The patient promptly underwent emergency coronary angiography and percutaneous coronary intervention and confirmed coronary artery dissection. Postoperative care included antiplatelet, anticoagulation, and supportive treatment. At 34+3 weeks of gestation, with the condition of acute anterior wall STEMI being relatively stable, a cesarean section was successfully performed. Regular cardiology follow-ups were scheduled postpartum, and cardiac function was normal in two years after discharge.
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