一例冠状动脉血管痉挛患者因先天性冠状动脉夹层导致心肌梗死猝死。

IF 1.5 4区 医学 Q1 LAW Medicine, Science and the Law Pub Date : 2024-10-29 DOI:10.1177/00258024241290037
Samadhi Dandeniya Arachchi, Mary N Sheppard
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引用次数: 0

摘要

冠状动脉血管痉挛和冠状动脉夹层是非梗阻性冠状动脉心肌梗死(MINOCA)导致心脏性猝死(SCD)的两个公认原因。这是一例 50 岁女性在心脏血管造影术中术后死亡的病例,她有冠状动脉痉挛家族史,其母亲曾发生过心脏性猝死。她在手术过程中因先天性急性冠状动脉夹层而心跳骤停,后经 LMS/LCx 血管支架植入术治疗。然而,她在术后 4 天死亡。死后的心脏检查显示,整个左心室周壁均为跨壁出血性梗死,冠状动脉的宏观和微观均正常。冠状动脉血管痉挛是冠状动脉一过性收缩,导致血管部分或完全阻塞。确切的病理生理机制尚不清楚,但动脉粥样硬化、药物和遗传易感性是常见的关联因素。本病例强调了冠状动脉血管痉挛在母亲和女儿身上的密切遗传联系,以及先天性冠状动脉夹层的并发症,这是一种罕见但严重的并发症,在冠状动脉造影术中约占 0.1%。这是首例在患有血管痉挛的患者身上发生与手术相关的冠状动脉夹层的尸检报告,表明其原因是功能性的。法医需要了解冠状动脉血管痉挛和冠状动脉造影术并发症是急性心肌梗死的原因之一。对这种罕见病症进行详细的尸检可获得有价值的信息。
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A case of Sudden Cardiac Death with myocardial infarction due to iatrogenic coronary dissection in a patient with coronary vasospasm.

Coronary vasospasm and coronary artery dissection are two recognized causes of Sudden Cardiac Death [SCD] in association with Myocardial Infarction in Non-Obstructive Coronary Artery [MINOCA]. This is a case of post procedure death in a 50-year-old female during cardiac angiography, who had a family history of coronary spasm with sudden cardiac death in her mother. She went into cardiac arrest during the procedure with iatrogenic acute coronary dissection which was treated with LMS/LCx vessel stenting. However, she died in 4 days post procedure. Postmortem cardiac examination demonstrated a transmural hemorrhagic infarction of the entire circumferential wall of the left ventricle with normal coronaries both macroscopically and microscopically. Acute coronary dissection was confirmed histologically in the left main stem.Coronary vasospasm is transient constriction of coronary arteries, which causes partial or complete obstruction of the vessels. The exact pathophysiological mechanism is poorly understood, but atheroma, drugs and a genetic predisposition are common associations. This case highlights the strong genetic link of coronary vasospasm in both mother and daughter and also the complication of iatrogenic coronary dissection which is a rare, but serious complication reported in about 0.1% of coronary angiography. This is the first postmortem report of procedure-related dissection in a patient with vasospasm indicating the cause is functional. Forensic practitioners need to be aware of coronary vasospasm and the complications of coronary angiography as a cause of acute myocardial infarction. Detailed autopsy yields valuable information in this rare condition.

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来源期刊
Medicine, Science and the Law
Medicine, Science and the Law 医学-医学:法
CiteScore
2.90
自引率
6.70%
发文量
53
审稿时长
>12 weeks
期刊介绍: Medicine, Science and the Law is the official journal of the British Academy for Forensic Sciences (BAFS). It is a peer reviewed journal dedicated to advancing the knowledge of forensic science and medicine. The journal aims to inform its readers from a broad perspective and demonstrate the interrelated nature and scope of the forensic disciplines. Through a variety of authoritative research articles submitted from across the globe, it covers a range of topical medico-legal issues. The journal keeps its readers informed of developments and trends through reporting, discussing and debating current issues of importance in forensic practice.
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