心肌灌注显像引导下行PCI治疗的Graves甲亢合并冠心病一例

Graves'hyperthyroidism complicated with coronary heart disease treated by percutaneous coronary intervention under the guidance of myocardial perfusion imaging:a case report

笔者介绍了一例因心悸、胸闷、憋气入院的Graves甲状腺功能亢进症(简称甲亢)合并冠心病的病例。其Graves甲亢诊断明确,且合并高龄、高血压、糖尿病、高脂血症等冠心病的高危因素。行两日法静息+三磷酸腺苷负荷心肌灌注显像(MPI)发现患者存在大范围心肌缺血,其冠心病危险度分层为高危,权衡利弊后建议其行冠状动脉造影。经皮冠状动脉介入治疗术后患者血运重建良好且无甲亢危象发生。本研究旨在提示甲亢合并可疑冠心病患者在排除相关禁忌后应采用核医学MPI进行冠心病危险度分层,以进一步指导治疗方案。

A patient hospitalized with palpitation,chest tightness,and shortness of breath was reported in this study.She was definitively diagnosed with Graves'hyperthyroidism and had several risk factors of coronary heart disease(CHD),including old age,hypertension,diabetes,and hyperlipidemia.Resting and ATP stressing myocardial perfusion imaging were applied in 2 days to determine whether CHD exists in this patient.Results confirmed that the patient has extensive myocardial ischemia and a high risk of cardiac adverse events.Thus,coronary angiography was suggested.Revascularization was achieved after percutaneous coronary intervention,and no hyperthyroidism crisis occurred.MPI is recommended for patients with hyperthyroidism and suspected CHD after excluding correlative contraindications to facilitate the risk stratification of CHD and guide further treatment strategies.