좌주간지 혈전에 의해 순차적으로 발병된 전벽 및 측벽 급성 심근경색의 1예
A case of acute anterior and lateral myocardial infarction altering with time from a large intracoronary thrombus on left main trunk
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초록
좌주간지의 관동맥내 혈전은 대개 전측벽 급성 심근경색증과 함께 심인성 쇼크를 유발하나, 시간 경과에 따라 부위가 다르게 나타나는 경우는 드물다. 저자들은 좌주간지의 관동맥내 진동하는 거대 혈전에 의해 전벽 심근경색증 후 다시 측벽 심근경색증이 유발되었으며 헤파린 정주치료 등의 보존적 요법 후 호전된 1예를 치험하였기에 보고하는 바이다.
Abstract
Plaque rupture is one of the main causes of acute myocardial infarction. Especially when the thrombus is located in the left main trunk coronary artery, it can effect the left anterior descending as well as circumflex coronary artery, resulting in myocardial necrosis of the anterior and lateral wall. Usually acute myocardial infarction due to left main trunk coronary artery occlusion occurs simultaneously in both anterior and lateral ST-segment elevation, associated with cardiogenic shock. However, rarely does the region alter with time. We report a 59-year old male who had been diagnosed with anterior wall acute myocardial infarction at a local hospital, but on transferral to our hospital 4 hours later, was diagnosed with lateral wall acute myocardial infarction based on electrocardiogram changes. Coronary angiography revealed a mobile, large thrombus on left main trunk with TIMI 3 flow. After heparinization for 5 days, follow-up coronary angiography revealed a complete resolution of previous thrombus.
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