Ali GUR, Mehmet Ediz SARİHAN

Case report: coronary embolism with st segment elevation in a patient with double valve replacement

Bu olgu sunumunda acil servise göğüs ağrısı şikayeti ile başvuran inferior derivasyonlarda ST segment elevasyonu olan, özgeçmişinde aort ve mitral kapak değişim öyküsü olan yapılan koroner anjiyografide koroner emboli tespit edilen hastayı sunmayı amaçladık. Yirmi beş yaşında erkek hasta göğüs ağrısı şikayeti ile acil servisimize başvurdu. Hastanın ani başlayan sıkıştırır tarzda göğüs ağrısı mevcuttu. Hastanın özgeçmişinde 2 yıl önce aort ve mitral kapak değişim öyküsü vardı. Bu nedenle düzenli olarak warfarin kullanıyormuş. Hastanın fizik muayenesi doğaldı. Hastanın çekilen elektrokardiyogramında (EKG) II, III ve aVF derivasyonlarında ST segment elevasyonu mevcuttu. Hastanın troponin değeri 6.8 ?g/L (üst limit 0.01 ng/ml), CK-MB 159 U/L (üst limit 25 U/L), CK 1225 U/L (üst limit 170 U/L) olarak yüksekti. Hastanın INR değeri ise warfarin kullanımına rağmen 1.2 idi. Hastanın medikal tedavisi acil serviste başlanarak kardiyoloji konsültasyonu istendi. Kardiyoloji tarafından hasta acil koroner anjiyografiye alındı. Hastanın koroner anjiografisinde sirkümflex arterde Om2 dalı sonrası %99 tıkanıklığa yol açan trombüs tespit edildi. Hastaya trombüs aspirasyonu uygulandı ve medikal tedavisine koroner yoğun bakımda devam edildi. Hastanın takiplerinde kan tetkiklerinin ve kliniğinin düzelmesi üzerine hasta şifa ile taburcu edildi. Acil servise göğüs ağrısı şikayeti ile başvuran, özgeçmişinde kapak değişim öyküsü bulunan, elektrokardiyogramında ST segment elevasyonu tespit edilen hastalarda koroner emboli olabileceği akılda tutulmalıdır.

Olgu sunumu: st segment elevasyonlu mi ile gelen çift kapak değişimi olan hastada koroner emboli

This report describes a case of coronary embolism with ST segment elevation in a patient with aortic and mitral valve replacement admitted to our emergency department with complaining chest pain. A 25- year- old male was admitted to our emergency department complaining chest pain. The patient's chest pain was sudden, onset and compressive style. In his medical history he had aortic and mitral valve replacement two years ago. He was using warfarin regularly. His physical examination was normal. The ECG showed ST segment elevation in leads II, III and aVF. In laboratory analysis, creatine kinase MB (CK-MB) was 159 U/L (upper limit 25 U/L), troponin-I was 6.8 ng/ml (upper limit 0.01 ng/ml) and CK was 1225 U/L (upper limit 170 U/L). International normalized ratio (INR) was 1.2 although the patient was receiving warfarin treatment. Medical treatment was started in the emergency department immediately and cardiology consultation was requested. Coronary angiography was made to the patient by cardiologist. The patient's coronary angiography showed thrombus which caused %99 occlusion of circumflex artery (Cx) after OM2 branch. Thrombus aspiration was performed and treatment was contiuned at coronary intensive care unit. In his follow-up examination ECG changes was occurred. The patient's ECG showed normal sinus rhythm. In his following blood tests; troponin-I, CK and CK-MB decreased normal levels. After warfarin dosage adjustment the INR increased to 3.7. The patient continued to improve clinically and was discharged home. Coronary embolism should be suspected in patients with complaining chest pain, medical history of valve replacement and ST segment elevation.

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