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yxfbbiedtj · Wysłany: Śro 13:39, 09 Mar 2011

Rheumatic heart disease complicated by atrial fibrillation in 2 cases of myocardial infarction with normal coronary arteries

Atrial fibrillation; myocardial infarction [in the ring CLC] R542.2 [Document code] D [Article ID] 1001-1439 (2003) 01-0052-01 patients and 1 female, 67 years old. With intermittent palpitations, chest tightness, 40 years, hold breath 5 years, increasing chest pain with 2d AGED. AGED examination: T36.6 ℃, P78 times / rain, R20 times / min, BP180/95mm-Hg (1mmHg = 0.133kPa). Slightly cyanotic lips,[link widoczny dla zalogowanych], lungs clear, absolutely irregular heart rhythm, the strength of the first heart sound ranging can be heard and the apex systolic murmur of grade Ⅲ and diastolic murmur, liver ribs 1cm, sword 3cm, tenderness, two lower extremity edema. One hospital, the ECG showed ST Ⅱ, UlF raise 0.5cm, T Ⅱ. Ⅲ, aVF, v. ~ Upside down, plus or minus two-way, R Ⅲ, avF reduction, Q Ⅲ widened. Myocardial enzymes show CK484IU / L, AST108IU / L, LDH1678IU / L, HBDH894IU / L, TNT> 3.0g / L, TNI16.2g / L. Diagnosis of acute myocardial infarction. To the anticoagulant, antiplatelet, dilate coronary, cardiac and other treatment, symptoms, myocardial enzymes gradually fell back to normal. Previous history of rheumatic heart patients 40 years, atrial fibrillation (AF), heart failure, history of 5 years. No history of angina. Echocardiography of left atrial enlargement, moderate mitral stenosis (1.25cm.) With mild regurgitation. 10 days after myocardial infarction in coronary artery (coronary artery) angiography and found normal coronary system. Left ventricular angiography showed the limitations of the left ventricular inferior wall aneurysm, LVEF50. Consider the Department of myocardial infarction due to embolism (emboli after autolysis). Example 2 male, 45 years old. Myocardial infarction in six months, found that half of heart valve disease, like coronary artery bypass plus valve surgery hospital. Patients six months ago, after physical activity, chest tightness, suffocation, crushing precordial pain. At the local hospital electrocardiogram,[link widoczny dla zalogowanych], myocardial enzymes examination, the diagnosis of acute anterior myocardial infarction. To anticoagulation, thrombolytic therapy, dilate coronary and other treatment. Echocardiography local hospital with moderate mitral stenosis and regurgitation, mild tricuspid regurgitation, moderate aortic valve regurgitation. AGED examination: T36.9 ℃, P76 times / min, R19 times / min,[link widoczny dla zalogowanych], BP115/60mmHg. Lip cyanosis, jugular vein engorgement, scattered in the wet end of the left lung 哕 tone, rhythm absolutely irregular, varying the strength of the first heart sound, the heart has expanded to the left sector, the apex could be heard and systolic murmur of grade Ⅲ and comfortable. Department of Cardiology,[link widoczny dla zalogowanych], Beijing Hospital (Beijing, 100730) ZHANG murmur, liver and ribs 6cm, sword 7cm, tenderness, swelling of both lower extremities is not. ① people diagnosed with coronary heart disease hospital, old anterior myocardial infarction, atrial fibrillation, the heart has expanded to the left sector, heart function Ⅲ. ② heart valve disease, mitral stenosis and regurgitation, aortic valve regurgitation. Who underwent coronary angiography showed coronary hospital system normal, coronary artery and good elasticity. Left ventricular anterior wall left ventricular angiography showed no movement,[link widoczny dla zalogowanych], significantly reduced left ventricular systolic, LVEF24. Considered to myocardial infarction coronary thrombosis caused by the (disappeared after emboli by thrombolysis). Discuss the occurrence of acute myocardial infarction is the major mechanism of coronary atherosclerosis, based on the narrow parts of the plaque rupture, secondary platelet aggregation and thrombosis, resulting in acute occlusion of coronary occlusion of coronary blood supply to areas of myocardial ischemia, hypoxia, in which the lesion coronary spasm acute coronary occlusion has also played a certain role. 2 cases of myocardial infarction in this paper were confirmed by coronary angiography in patients without coronary atherosclerosis performance, but with heart valve disease, atrial fibrillation, heart failure history. The 2 cases of myocardial infarction is likely to attach to valve disease or left atrium or left ventricle to coronary artery embolization of small clots off, causing acute coronary occlusion. Embolism caused by the events of myocardial infarction was 3 ~ 15n, the pathogenesis of myocardial infarction is relatively rare, and attaches importance to and prevention of valvular heart disease, thromboembolic events in patients with atrial fibrillation is still a very important significance, with adjustment permit such patients should be actively anticoagulant, antiplatelet therapy. Thrombosis myocardial infarction due to coronary atherosclerosis and myocardial infarction due to similar thrombolytic therapy should be as early as possible in order to improve prognosis.