多排CT图像后处理对心血管疾病鉴别诊断的价值

目的评价多层螺旋CT血管成像后处理技术在心脏疾病的应用价值。方法对临床有急性胸痛感觉的62例患者进行64层螺旋CT心胸联合血管成像,之后对扫描的所有原始数据进行多层面重组（MPR）、曲面重组（CPR）以及容积再现（VR）、最大密度投影（MIP）等图像重组以显示冠状动脉、肺动脉和胸主动脉等。分别统计64层螺旋CT心胸联合血管成像后处理检查和临床接诊对心血管疾病的诊断符合率。结果本组62例病例中有34例形成了冠状动脉斑块并狭窄,16例急性肺动脉栓塞,12例主动脉夹层,左房粘液瘤2例。其中46例临床初步诊断正确,临床初诊的符合率为74%;62例64层螺旋CT诊断正确,64层螺旋CT诊断符合率为100%。结论 64层螺旋CT后处理技术能够清晰地显示肺动脉、胸主动脉和冠状动脉,对肺动脉、胸主动脉和冠状动脉疾病作出正确诊断,是一种无创、可靠的检查方法,有一定推广价值。     

冠状动脉造影正常的急性心肌梗死

目的观察冠状动脉正常的急性心肌梗死(AMI)患者的临床和血管造影特点。方法2000年8月至2004年10月间,435例AMI患者中36例血管造影显示冠状动脉完全正常,分析患者的临床和冠状动脉造影特点及有关冠心病的危险因素。结果435例AMI患者中冠状动脉造影下正常者为36例,占8.2%。结论AMI患者中冠状动脉造影正常者并非少见,提示冠脉痉挛在心肌梗死的发病中可能起着十分重要的作用。急性血栓形成伴血栓自溶是其病理改变之一。     

Vertebral artery dissection diagnosed by non-invasive magnetic resonance imaging

A forty-year-old man developed right-sided neck discomfort whilst cycling to work. On admission to hospital he was found to have signs of bilateral cerebellar dysfunction. Magnetic resonance imaging of the brain demonstrated bilateral areas of cerebellar infarction. Doppler ultrasound of the vertebral arteries was abnormal and non-invasive gradient echo time of flight magnetic resonance angiography confirmed the clinical diagnosis of vertebral artery dissection. The patient was anticoagulated for a period of three months and made a full recovery.     

严重冠状动脉痉挛患者的临床特点分析及治疗随访

目的总结严重冠状动脉痉挛患者的临床特点,治疗方法及随访预后情况。方法选择确诊为冠状动脉痉挛的患者21例。了解患者的一般情况,包括年龄、性别、基础疾病、吸烟史及用药等,分析其临床特点、心电图、冠状动脉造影资料、诊断治疗及随访预后情况。结果严重冠状动脉痉挛患者以男性多见,占86％（18／21）;吸烟是主要的危险因素,占62％（13／21）;痉挛多发生于有固定狭窄的部位,占57％（12／21）,临床经过凶险,及时冠状动脉造影对早期明确诊断至关重要。钙离子拮抗剂是有效治疗的核心,其使用强调持续、足量,介入治疗不是有效的方法。冠状动脉痉挛急性发作期具有极高的危险性,但长期预后良好。结论冠状动脉痉挛临床常见,但易被忽视,及时诊断是防止致命事件的关键,钙离子拮抗剂是冠状动脉痉挛的核心用药,远期预后良好。     

An unexpected complication of exercise testing

A male patient 40 years of age died after diagnostic exercise testing for stable exercise induced angina, which had existed for two months. The ECG prior to the stress was normal and there had been no signs of unstable angina. The exercise test was discontinued at a load of 120 Watts because of angina without significant ECG changes. Subsequently shock developed with widening of the QRS complex. Immediate coronary angiography revealed an occluded main stem of the left coronary artery. Although recanalisation was achieved, the patient died. The risks of exercise testing and the appropriate precautions are discussed. Laboratories for stress testing of patients with suspected coronary diseases should be located in a hospital with facilities for coronary care.     

Coronary calcium score using CT in the diagnosis of 2 patients with acute chest pain

A 38-year-old man presented with severe retrosternal pain that had persisted for several days. Physical examination, resting ECG and circulating levels of cardiac markers were normal. The patient had continuous pain during a bicycle test, but no signs of myocardial ischaemia were found. A CT scan was performed, and the resulting CT calcium score was 40 Agatston units (AU; > 90th percentile). Coronary angiography showed severe coronary artery disease. An arterial bypass operation took place. Recovery was uncomplicated and the patient remained free of symptoms. A 55-year-old man experienced midsternal pain that lasted 20 minutes before spontaneously subsiding. The ECG and troponine levels were normal. One week later, there were no abnormalities during a bicycle test and the CT calcium score was 0 AU. Therefore, there was no indication of coronary artery disease and a watchful waiting approach was taken. After 1 year of follow-up, the patient remained free of symptoms. For patients aged 45 years or more with acute chest pain and a CT calcium score of 0 AU, further cardiac evaluation is unnecessary. For patients aged less than 45 years, a CT calcium score greater than o is abnormal and requires additional cardiac evaluation.     

Spontaneous coronary artery dissection in a 38-year-old: stenting and/or surgery?

Spontaneous coronary artery dissection is a rare but important differential diagnosis in fit young women presenting with chest pain.     

Left ventricle hydatid cyst mimicking acute coronary syndrome

Cardiac echinococcosis rarely mimics acute coronary syndrome. The diagnosis of cardiac hydatid cyst might be difficult on account of varying clinical presentations and nonspesific symptoms.?A 75-year-old female was admitted to our hospital with typical chest pain. The patient had no history of previous cardiac symptoms or any illness leading to heart disease. Her ECG revealed ischemic changes. However, her coronary angiography revealed noncritical plaques in the left anterior descending artery. The diagnosis of cardiac echinococcosis was identified using echocardiography, computed tomography and magnetic resonance imaging. The patient was referred to cardiac surgery for resection of the cyst; however, she refused surgery. Albendezol 800 mg/day was prescribed.     

平板运动试验可疑阳性患者的冠状动脉CT及冠状动脉造影结果的相关性研究

目的 探讨平板运动试验(TET)可疑阳性患者的冠状动脉造影(CAG)结果的特点.方法 2006年1月至2007年12月因胸痛住院的36例患者在人院行TET后均诊断为可疑阳性,同时在2周内行CAG检查和冠状动脉CT成像(CTA),并将斑块分为非钙化和钙化斑块.结果 36例患者中,23例经CAG证实为冠心病(阳性),13例冠状动脉无病变(阴性).23例冠心病患者中单支病变9例,双支病变5例,三支病变9例.23例TET可疑阳性冠心病患者CTA共检测52个斑块,其中非钙化斑块29个,钙化斑块23个.结论 TET在冠心病的诊断中因其方法简单、经济、无创,目前仍不失为一项重要检查方法.同时冠心病患者的斑块性质与TET可疑阳性具有相关性.     

A woman with acute upper abdominal pain

A 42-year-old woman came to the emergency department with acute abdominal pain. CT-scan showed an isolated dissection of the A. mesenterica superior and signs of ischaemic colitis. The patient was treated with endovascular stent placement in the artery and partial small bowel resection.     

Wartime determinants of arteriographically confirmed coronary artery disease in Beirut

This study investigates the association of wartime stress variables and coronary artery disease as determined by coronary angiography in Lebanon in 1986, a country with an ongoing civil war for over a decade. A total of 127 patients who underwent coronary angiography at the American University of Beirut Medical Center were individually matched on age and sex with visitor controls free from any evidence of clinical coronary artery disease. Arteriographic cases (greater than or equal to 70% maximal stenosis) were compared with two control groups: arteriographic controls (entirely normal coronaries) and visitor controls. Findings suggest that there is a relation between exposure to both acute and chronic war events and coronary artery disease in this patient population. The reporting of exposure to acute war events was significantly higher in cases compared with both visitor controls (odds ratio (OR) = 2.4, 95% confidence interval (Cl) 1.17-4.90) and arteriographic controls (OR = 2.8, 95% Cl 0.93-8.47). Crossing the "green-lines" that separate two belligerent sides, considered as an attribute of war-related chronic stress, was more frequent in cases compared with visitor controls (OR = 3.25, 95% Cl 1.54-6.89) and arteriographic controls (OR = 5.38, 95% Cl 1.65-17.6). The relation observed between wartime stress and coronary artery disease could not be explained by possible overreporting of stressful events in patients with suspected coronary artery disease or by an increase in clinical awareness for the disease for those under continuous stress. Adjusting for the effect of the well-established coronary artery disease risk factors did not alter the above findings.     

非冠状动脉粥样硬化性心肌梗死16例报告

目的探讨非冠状动脉粥样硬化性心肌梗死的病因及临床特点。方法笔者所在医院近4年收治非冠状动脉粥样硬化性心肌梗死16例,每例行心电图、超声心动图、血清心肌酶和冠状动脉造影检查。结果16例患者冠状动脉造影均未发现斑块和狭窄。结论非冠状动脉硬化性心肌梗死应尽早冠脉造影,病因治疗。     

A case in which coronary spasms were induced by ergonovine provocation at the sites of coronary artery ectasia

We experienced a patient in whom coronary spasms were induced by an ergonovine provocation test during coronary angiography at the sites of coronary artery ectasia. The patient was a 45-year-old male with chest pain at rest, which promptly disappeared when given sublingual nitroglycerin. Similar attacks occurred frequently even with the administration of drugs after admission, but no significant changes were observed in electrocardiography (ECG) during the attacks or by repeated Holter ECG. The results of exercise ECG and provocation tests such as Valsalva maneuver, hyperventilation, and cold pressor test were negative. Coronary angiography showed ectatic changes in the left coronary artery, and the coronary spasms were induced by ergonovine administration at the ectatic portion of the left anterior descending artery and left circumflex artery, and right coronary artery with chest symptoms similar to those observed during spontaneous attacks. However, there were no significant changes in ECG. This rare case suggests an involvement of spasms in the pathogenic mechanism of myocardial ischemia in coronary artery ectasia.     

糖尿病合并急性心肌梗死患者冠状动脉造影特点分析

目的 分析糖尿病合并急性心肌梗死患者冠状动脉造影特点.方法 对45例糖尿病合并急性心肌梗死患者(糖尿病组)与45例非糖尿病急性心肌梗死患者(非糖尿病组)的临床资料进行回顾性分析,比较两组患者心电图和冠状动脉造影结果,总结糖尿病合并急性心肌梗死患者的心肌梗死类型和冠状动脉病变特点.结果 糖尿病组冠状动脉三支病变和弥漫性病变较非糖尿病组明显增多[64.4%(29/45)比35.6%(16/45)和82.2%(37/45)比 40.0%(18/45),P<0.05],差异有统计学意义.糖尿病组中非ST段抬高心肌梗死较非糖尿病组多见[37.8%(17/45)比17.8%(8/45).P<0.05],差异有统计学意义.结论 糖尿病合并急性心肌梗死患者冠状动脉病变较重,三支病变和弥漫性病变多见,梗死类型以非ST段抬高心肌梗死为主.     

Dissection of cervical arteries as a cause of cerebral ischemia or cranial nerve dysfunction

Nine patients with dissections of the cervical arteries are presented. Dissections cause approximately three per cent of non-haemorrhagic stroke and are usually observed in young and middle-aged patients. Dissections very often give rise to head or neck pain. Carotid artery dissection may lead to lower cranial nerve dysfunction and an incomplete Horner's syndrome in case of subadventitial dissection, and to cerebral ischaemia in case of subintimal spread. Vertebral artery dissection may cause brain stem ischaemia (subintimal dissection) or in rare cases a subarachnoid haemorrhage (subadventitial spread). The history frequently reveals a (trivial) traumatic event. Diagnosis is usually established by angiography or MRI. The prognosis is good and recurrences are rare. Treatment with anticoagulants or acetylsalicylic acid seems recommendable, though scientifically unproven.     

Association between angiographic coronary stenosis morphology and acute coronary syndrome manifestation in patients with ischemic heart disease

AIM: Patients with acute coronary syndrome (ACS) often show complex morphology of coronary stenosis at angiography. In the present study we evaluated the association between different clinical forms of manifestation of acute coronary syndrome and the angiographic morphological patterns of coronary stenosis. PATIENTS AND METHODS: A total of 112 patients with angiographically verified single vessel coronary artery disease were divided into two groups: a control group of 44 patients with simple coronary stenosis at angiography and a study group of 66 patients with complex coronary stenosis. Angiographic analysis was performed using a modified Ambrose classification. The two groups were compared according to the manifestation and distribution of the acute coronary syndrome based on Braunwald classification. RESULTS: There were no statistically significant differences between the mean values of stenosis severity in the group with simple stenosis (79.8% +/- 10.7%) and the group with complex stenosis (82.7% +/- 8.2%) (P > 0.05). The incidence of current acute coronary syndrome - unstable angina or myocardial infarction - was higher in the group with complex stenosis (30.00% +/- 8.37% vs. 52.00% +/- 7.07%, P < 0.05). Patients with previous ACS were prevailing in the group with simple stenosis (70.00% +/- 8.37% vs. 48.00% +/- 7.07%, P < 0.05). CONCLUSION: Complex coronary stenosis is associated with higher prevalence of acute coronary syndrome in acute clinical stage while simple coronary stenosis is associated with higher prevalence of previous acute coronary syndrome. A possible metamorphosis of coronary stenoses is taken into consideration.     

脑利钠肽与超声心动图在川崎病诊断中的意义

目的探讨脑利钠肽(brain natriuretic peptide,BNP)与超声心动图在川崎病急性期及恢复期诊断中的临床意义。方法选取川崎病患儿35例为病例组,以发热、皮疹为主诉的肺炎支原体或病毒感染的48例患儿为对照组,测其急性期与恢复期脑利钠肽及左、右冠状动脉内径值,并做相关分析。结果川崎病患儿急性期脑利钠肽值明显高于恢复期,且差异有统计学意义;川崎病患儿恢复期冠状动脉内径值明显高于急性期,且差异有统计学意义。结论应用超声心动图检测冠状动脉扩张是在恢复期诊断川崎病的重要手段,而脑利钠肽可作为急性期诊断川崎病的生化指标之一。     

Haemorrhagic pericardial effusion in an asbestos worker

BACKGROUND: Occupational exposure to asbestos may cause pleural and lung disorders and, less frequently, diseases of the peritoneum and pericardium. An exceedingly small number of cases of benign pericardial effusion have been described so far in the medical literature. OBJECTIVES: To report a rare case of haemorrhagic pericardial effusion caused by occupational asbestos exposure in a patient with pre-existent aortic regurgitation, bilateral pleural plaques and no signs of interstitial lung involvement due to asbestosis. METHODS: A thorough clinical and instrumental evaluation (laboratory tests, tuberculin skin test, chest X-rays, transthoracic and transesophageal echocardiography, contrast coronary and aortic angiography, a histological examination of pericardial and pleural surgical specimens) was performed to examine all the known causes of pericardial effusion. RESULTS: The tests performed did not demonstrate any specific cause of pericardial effusion. Surgical assessment three months later, during an aortic valve replacement, showed no signs of aortic dissection or intraparietal hematoma. A nine-year follow up did not reveal any reoccurrence of pericardial effusion. CONCLUSIONS: Asbestos related pericardial effusion is rarely described in the medical literature but must be considered in patients with previous occupational asbestos exposure. There are no specific clinical or pathological aspects indicative of this etiology and the diagnosis remains one of exclusion. A thorough occupational history should be obtained in patients with pericardial effusion of unknown etiology.     

Takotsubo cardiomyopathy in an elderly patient with severe Alzheimer's disease: a case report

We report on an 80-year-old woman with Alzheimer's disease who presented with Takotsubo cardiomyopathy. As usual for this condition, our patient showed clinical symptoms of chest pain, electrocardiographic changes, elevated myocardial markers, and transient left ventricular apical ballooning in the absence of significant coronary artery disease. Because Takotsubo cardiomyopathy is frequently associated with emotional stress, which triggers an increase in circulating catecholamines, our case suggests that this event should not be neglected in Alzheimer's disease patients and promotes the adoption of a "prosthetic" approach for individuals with dementia.     

Postpartum myocardial infarct (apropos of a case)

We report the case of a 26 years old woman, who was hospitalized for an acute anterior myocardial infarction, which happened 17 days after delivery. The culprit lesion was a coronary dissection observed on the coronary angiogram which was performed on the 7th day. This dissection cicatrised spontaneously at the control coronarography performed 3 months later. Conventional medical treatment seems to be sufficient, although the use of thrombolysis in our case was safe and successful.