急性ST段抬高型心肌梗死合并Stanford A型主动脉夹层2例

Two cases of ST-segment elevation myocardial infarction with concomitant Standford type A aortic dissection

1 病例资料病例1,男,39岁,因'突发腰背部及胸部疼痛7 h'于2015年9月25日入院。患者7 h前搬重物时突发腰背部疼痛,伴胸闷、胸痛、大汗,症状持续不缓解,急诊至当地医院,查心电图示窦性心动过缓,Ⅱ、Ⅲ、aVF导联病理性Q波,ST段抬高,Ⅰ、aVL、V3~V5导联ST段压低,考虑急性下壁心肌梗死,给予阿司匹林300 mg、氯吡格雷600 mg嚼服,并行冠状动脉(冠脉)造影,未发现右冠脉,行主动脉造影提示主动脉夹层.

ST-segment elevation myocardial infarction with concomitant aortic dissectionis an extremely critical illness with high mortality.Early and accurate diagnosis for thiscomplication is crucial.Two cases presented with chest pain were initially diagnosed as ST-segment elevation myocardial infarction.Case 1 was diagnosed as Standford type A aortic dissectionduring coronary angiographyaccidentally.Subsequent treatment was affectedbecause of the intraoperative use of antithrombotic drugs.Case 2 suffered acute myocardial infarction and received subsequentpercutaneous coronary intervention.Chest pain and dorsalgiareturned after surgery.Echocardiographyshowed aortic enlargement and aortic regurgitation,which was inconsistentwith clinical situation and was diagnosed as standford type A aortic dissection via multi-slice spiral CT angiography.Aortic dissection caused by interventional surgerywas possibly recognized via retrospective analysis of medical history.