每日一题_2024.12.01

A previously healthy 32-year-old woman presented with a 2-hour history of severe chest pain at rest. An electrocardiogram showed ST-segment elevations in leads II, III, and aVF with reciprocal ST-segment depressions in leads I and aVL. An initial troponin I level was normal. Owing to concern for acute coronary syndrome, emergency coronary angiography was performed, which showed an abrupt caliber change extending from the proximal to the distal right coronary artery. What is the most likely etiology of arterial injury?

一位之前健康的32岁女性，出现了休息时2小时的严重胸痛。心电图显示II、III和aVF导联ST段抬高，I和aVL导联出现相应的ST段压低。初始肌钙蛋白I水平正常。由于担心急性冠状动脉综合征，进行了紧急冠状动脉造影，结果显示从近端到远端右冠状动脉突然的口径变化。动脉损伤最可能的病因是：

A. Atherosclerotic plaque rupture and distal occlusion动脉粥样硬化斑块破裂和远端闭塞

B. Atherosclerotic stenosis动脉粥样硬化狭窄

C. Coronary arteritis冠状动脉炎

D. Dissection动脉夹层

E. Vasospasm血管痉挛

答案解析：

冠状动脉造影的表现与自发性冠状动脉夹层一致。还偶然注意到左回旋支异常起源于右冠状动脉瓣。自发性冠状动脉夹层是急性冠状动脉综合征的一个不常见的原因，主要影响没有典型心血管风险因素的女性。大多数患有这种情况的患者可以在远端动脉血流正常时进行药物治疗，就像这个案例中没有放置支架一样。

正确答案：D