Baidu
map

NEJM:可卡因致冠状动脉血管痉挛-案例报道

2016-02-04 chenshuo译 MedSci原创

http://www.nejm.org/doi/full/10.1056/NEJMicm1503339

女性,58岁,因出现间歇性胸部疼痛2天而被送往医院急诊,每次疼痛发作持续时间为15分钟。曾通过舌下含服硝酸甘油、氢可酮和对乙酰氨基酚等药物进行缓解。


据了解,该患者既往有高血压和高血脂症病史,另外还有吸烟和喝酒史。



该患者主诉,在2个月前她也曾发作过类似的症状,当时冠状动脉造影显示冠状动脉解剖生理正常(请点击原始链接观看视频)。会诊医师诊断其患上了心包炎,出院后以秋水仙碱和布洛芬药物对其进行治疗。

心电图检查结果显示其心脏前壁T波倒置(如图A所示),而在这之前她的心电图检查中也曾发现有此现象。

在之前的检查中,她的肌钙蛋白I水平为0.04ng/ml(正常值为0-0.03ng/ml);而这次来院检查的结果上升到5.7ng/ml,并在6小时内达到高峰,随之回落至0.71ng/ml。

经胸作超声心动图检查(请观看视频2)显示心包积液,心室功能正常,未见异常室壁运动。最后,医生诊断其患有心肌炎,并应用糖皮质激素口服进行治疗。

住院期间第三天,该患者发生了心脏骤停。医生当即对其进行心肺复苏,5分钟后该患者循环恢复。当再次心电图检查结果显示外侧壁和下壁导联ST段明显抬高2毫米以及前壁ST段压低1-2毫米(如图B所示)。

急性冠状动脉造影(视频3)显示严重的冠状动脉痉挛,主要累及左主干和左前降支。

在尿检中,发现可卡因试验为阳性。由此可见,该患者在住院期间有使用过可卡因药物,从而导致了冠状动脉痉挛的发作。

不久后,该患者死于心肌梗死并发症。

原始出处:

Nureddin Almaddah, M.D., and Tokunbo O. Ajayi, M.D.Cocaine-Induced Coronary-Artery VasospasmN Engl J Med 2016; 374:e5February 4, 2016DOI: 10.1056/NEJMicm1503339


版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1971675, encodeId=231b19e1675c7, content=<a href='/topic/show?id=0ce689e223e' target=_blank style='color:#2F92EE;'>#血管痉挛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89722, encryptionId=0ce689e223e, topicName=血管痉挛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Sat Feb 13 15:32:00 CST 2016, time=2016-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708954, encodeId=ae131e0895440, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sat Jul 23 06:32:00 CST 2016, time=2016-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311739, encodeId=fa851311e39b5, content=<a href='/topic/show?id=624de11204a' target=_blank style='color:#2F92EE;'>#痉挛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71120, encryptionId=624de11204a, topicName=痉挛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7dc7399, createdName=apoenzyme, createdTime=Fri Feb 05 21:32:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481685, encodeId=91bf1481685a0, content=<a href='/topic/show?id=7099384244c' target=_blank style='color:#2F92EE;'>#可卡因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38424, encryptionId=7099384244c, topicName=可卡因)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cbbf7815801, createdName=12498b3em10(暂无昵称), createdTime=Fri Feb 05 21:32:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63479, encodeId=aa58634e981, content=受教了, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151021/IMG562795A9BB09E1503.jpg, createdBy=52b31658114, createdName=winter9345, createdTime=Fri Feb 05 21:21:00 CST 2016, time=2016-02-05, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1971675, encodeId=231b19e1675c7, content=<a href='/topic/show?id=0ce689e223e' target=_blank style='color:#2F92EE;'>#血管痉挛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89722, encryptionId=0ce689e223e, topicName=血管痉挛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Sat Feb 13 15:32:00 CST 2016, time=2016-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708954, encodeId=ae131e0895440, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sat Jul 23 06:32:00 CST 2016, time=2016-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311739, encodeId=fa851311e39b5, content=<a href='/topic/show?id=624de11204a' target=_blank style='color:#2F92EE;'>#痉挛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71120, encryptionId=624de11204a, topicName=痉挛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7dc7399, createdName=apoenzyme, createdTime=Fri Feb 05 21:32:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481685, encodeId=91bf1481685a0, content=<a href='/topic/show?id=7099384244c' target=_blank style='color:#2F92EE;'>#可卡因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38424, encryptionId=7099384244c, topicName=可卡因)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cbbf7815801, createdName=12498b3em10(暂无昵称), createdTime=Fri Feb 05 21:32:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63479, encodeId=aa58634e981, content=受教了, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151021/IMG562795A9BB09E1503.jpg, createdBy=52b31658114, createdName=winter9345, createdTime=Fri Feb 05 21:21:00 CST 2016, time=2016-02-05, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1971675, encodeId=231b19e1675c7, content=<a href='/topic/show?id=0ce689e223e' target=_blank style='color:#2F92EE;'>#血管痉挛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89722, encryptionId=0ce689e223e, topicName=血管痉挛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Sat Feb 13 15:32:00 CST 2016, time=2016-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708954, encodeId=ae131e0895440, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sat Jul 23 06:32:00 CST 2016, time=2016-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311739, encodeId=fa851311e39b5, content=<a href='/topic/show?id=624de11204a' target=_blank style='color:#2F92EE;'>#痉挛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71120, encryptionId=624de11204a, topicName=痉挛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7dc7399, createdName=apoenzyme, createdTime=Fri Feb 05 21:32:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481685, encodeId=91bf1481685a0, content=<a href='/topic/show?id=7099384244c' target=_blank style='color:#2F92EE;'>#可卡因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38424, encryptionId=7099384244c, topicName=可卡因)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cbbf7815801, createdName=12498b3em10(暂无昵称), createdTime=Fri Feb 05 21:32:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63479, encodeId=aa58634e981, content=受教了, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151021/IMG562795A9BB09E1503.jpg, createdBy=52b31658114, createdName=winter9345, createdTime=Fri Feb 05 21:21:00 CST 2016, time=2016-02-05, status=1, ipAttribution=)]
    2016-02-05 apoenzyme
  4. [GetPortalCommentsPageByObjectIdResponse(id=1971675, encodeId=231b19e1675c7, content=<a href='/topic/show?id=0ce689e223e' target=_blank style='color:#2F92EE;'>#血管痉挛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89722, encryptionId=0ce689e223e, topicName=血管痉挛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Sat Feb 13 15:32:00 CST 2016, time=2016-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708954, encodeId=ae131e0895440, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sat Jul 23 06:32:00 CST 2016, time=2016-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311739, encodeId=fa851311e39b5, content=<a href='/topic/show?id=624de11204a' target=_blank style='color:#2F92EE;'>#痉挛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71120, encryptionId=624de11204a, topicName=痉挛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7dc7399, createdName=apoenzyme, createdTime=Fri Feb 05 21:32:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481685, encodeId=91bf1481685a0, content=<a href='/topic/show?id=7099384244c' target=_blank style='color:#2F92EE;'>#可卡因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38424, encryptionId=7099384244c, topicName=可卡因)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cbbf7815801, createdName=12498b3em10(暂无昵称), createdTime=Fri Feb 05 21:32:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63479, encodeId=aa58634e981, content=受教了, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151021/IMG562795A9BB09E1503.jpg, createdBy=52b31658114, createdName=winter9345, createdTime=Fri Feb 05 21:21:00 CST 2016, time=2016-02-05, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1971675, encodeId=231b19e1675c7, content=<a href='/topic/show?id=0ce689e223e' target=_blank style='color:#2F92EE;'>#血管痉挛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89722, encryptionId=0ce689e223e, topicName=血管痉挛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Sat Feb 13 15:32:00 CST 2016, time=2016-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1708954, encodeId=ae131e0895440, content=<a href='/topic/show?id=1502333250f' target=_blank style='color:#2F92EE;'>#动脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33325, encryptionId=1502333250f, topicName=动脉血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sat Jul 23 06:32:00 CST 2016, time=2016-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311739, encodeId=fa851311e39b5, content=<a href='/topic/show?id=624de11204a' target=_blank style='color:#2F92EE;'>#痉挛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71120, encryptionId=624de11204a, topicName=痉挛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7dc7399, createdName=apoenzyme, createdTime=Fri Feb 05 21:32:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481685, encodeId=91bf1481685a0, content=<a href='/topic/show?id=7099384244c' target=_blank style='color:#2F92EE;'>#可卡因#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38424, encryptionId=7099384244c, topicName=可卡因)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cbbf7815801, createdName=12498b3em10(暂无昵称), createdTime=Fri Feb 05 21:32:00 CST 2016, time=2016-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=63479, encodeId=aa58634e981, content=受教了, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151021/IMG562795A9BB09E1503.jpg, createdBy=52b31658114, createdName=winter9345, createdTime=Fri Feb 05 21:21:00 CST 2016, time=2016-02-05, status=1, ipAttribution=)]
    2016-02-05 winter9345

    受教了

    0

相关资讯

JAMA Psychiatry:可卡因成瘾机制研究

药物成瘾是一种慢性的、复发的脑部疾病,其主要特征就是强迫性寻找和服用药物。作为一个与药物成瘾相关的特征,当服用可卡因时,冲动是一个风险因素且变得更为糟糕。与此相反,强迫性药物使用是这一疾病的主要特征。在可卡因使用者中,冲动和强迫都和不正常的额叶皮质纹状体区结构。大量证据已经证明冲动和强迫在药物成瘾的生理过程中起到了关键性的作用。但脑部网络和成瘾性的关系尚不明确。 为了检验可卡因与纹状体-皮质

Scientific reports:使用可卡因会增加HIV感染风险

近日,来自美国加州大学洛杉矶分校的研究人员提供了进一步的证据证明使用可卡因会干扰身体的免疫系统,导致使用者更易受到HIV病毒感染。 在这项最近发表在国际学术期刊scientific reports上的研究中,研究人员利用一种人源化小鼠模型研究了可卡因对免疫系统的影响,这种人源化小鼠模型是经过基因工程改造的,具有与人类类似的免疫系统。他们发现使用可卡因会导致使用者更容易感染HIV病毒。 &n

可卡因与可口可乐——双面古柯叶

作为世界主要毒品之一,可卡因受到禁毒人士的深恶痛绝;作为风靡全球的汽水,可口可乐受到各国人民的喜爱。这两个截然不同的产品,却有着千丝万缕的联系。把它们联系在一起的,就是本文的主角——古柯叶。古柯叶的前世今生:从药物到毒品一说可卡因,总会让人联想到毒品,大家免不了要大谈特谈一番。不过可卡因只是本文的配角啦。先来说说本文的主角,可卡因他娘——古柯叶。看看官方介绍:古柯,南美安地斯山脉斜坡上的一类灌木,

J Addict Med:停用或减少使用可卡因或可降低内皮素-1分泌

在临床和流行病学证据表明,服用可卡因与过早动脉粥样硬化的风险增加相关。本研究的目标是探索可卡因是否与内皮素-1分泌降低有关、可卡因是否与冠状动脉斑块进展放缓有关等。 在2014年3月-6月期间,研究者对来自马里兰州的57名使用可卡因的黑人(冠脉狭窄<50%)进行了评估,在6个月的随访调查中,研究人员让受试者停用或减少可卡因的使用看是否降低endothelin-1(ET-1)水平以及在6个月的随访

PNAS:可卡因摄入过量如何导致脑细胞死亡?

近日,来自美国约翰斯霍普金斯大学医学院的研究人员利用小鼠进行研究发现高剂量可卡因会通过触发过度自噬导致脑细胞死亡,同时他们还发现了一种小分子化合物能够改善这一情况。相关研究结果发表在国际学术期刊PNAS上。 在1990年发现脑细胞使用一氧化氮进行细胞交流之后,Solomon Snyder教授及其研究团队就一直致力于后续工作的研究。他们在2013年发现一氧化氮能够结合GAPDH参与可卡因诱导的

J Neurosci:可卡因影响记忆力的分子机理

近日,一项刊登于国际杂志Journal of Neuroscience上的研究论文中,来自华盛顿州立大学的研究人员通过研究发现了大脑中的一种新型机制,其在个体大脑药物成瘾记忆中扮演着重要的角色,该研究发现或为开发新型靶向疗法来改变或消除这种机制从而使得降低个体对药物成瘾的强迫性提供了一定的帮助和希望。研究者Barbara Sorg表示,关闭这种机制或许可以逐步减少个体情感上的影响或情绪记忆的内容,

Baidu
map
Baidu
map
Baidu
map