Disseminierte Koronararterienverschlüsse und fulminante Lungenembolie bei einer 40-jährigen Patientin

Autor: H Kahles, H Kehren, H Trobisch
Rok vydání: 2006
Předmět:
Zdroj: DMW - Deutsche Medizinische Wochenschrift. 131:672-675
ISSN: 1439-4413
0012-0472
DOI: 10.1055/s-2006-933713
Popis: HISTORY AND ADMISSION FINDINGS A 40-year-old woman was admitted to the emergency room because of severe angina pectoris and dyspnoe at rest. She developed ventricular fibrillation a few minutes later from which she had to be resuscitated . After intubation and controlled ventilation immediate angiocardiography was performed while she was still in cardiogenic shock. Coronary angiography ten days before had been unremarkable. DIAGNOSTIC FINDINGS AND THERAPY The second coronary angiogram revealed severe thrombotic lesion at the origin of the left anterior descending branch (LAD) and total occlusions of the peripheral LAD and of the first marginal branch. After intracoronary application of 10 mg abciximab and coronary stent implantation in the origin of the LAD the patient had good clinical improvement. Massive pulmonary embolism two days later, despite of effective heparinization and inhibition of platelet aggregation (as measured by partial thromboplastin time), was treated successfully by regional injection of 100 mg tissue plasminogen activator (t-PA). Tests for possible hypercoagulability showed no detectable changes in the clotting and fibrinolytic system with a normal platelet count. In a standardized aggregation test of platelets hyperaggregation in response to ADP and epinephrine, also at low test doses, revealed the presence of a sticky platelet syndrome. CONCLUSION This case history suggests that enhanced platelet aggregation associated with sticky platelet syndrome may provoke myocardial infarction even in angiographically normal coronary arteries.
Databáze: OpenAIRE
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