max CK 1200の小さな急性心筋梗塞症に心破裂を合併した1例

A Case of Oozing Rupture after Acute Myocardial Infarction with a Maximal Serum CK Level of 1200

患者は73歳，女性．胸痛を主訴に夜間当センターを受診し，後側壁急性心筋梗塞と診断された．緊急冠動脈造影では左回旋枝近位部の血栓と鈍縁枝の閉塞を認め，tPAによる再灌流療法を行ったが鈍縁枝は閉塞したままであった．max CK1,209mU/mlで，心臓リハビリ経過中にcardiac oozing ruptureを来し心タンポナーデ状態になったため，外科的修復を行い後日軽快退院することができた．一般に心筋梗塞に伴う心破裂は左前下行枝病変，高齢，女性，初回梗塞，血行再建不成功症例などに多いとされ，本症例のように回旋枝の分枝閉塞による小さな心筋梗塞での発症は稀である．分枝閉塞やmax CK値が高くなくても，致命的合併症であるcardiac ruptureが起こりうるので，いかなる急性心筋梗塞症例も急性期の十分な管理が必要である．

A 73-year-old female was admitted to our medical center one hour after sudden onset of chest oppression. Under the diagnosis of posterolateral acute myocardial infarction, emergent coronary angiography revealed thrombus at a proximal lesion of the left circumflex coronary artery and occlusion at the obtuse margin branch. After intracoronary injection of tissue plasminogen activator(t-PA), the patient was administered to the coronary care unit. The peak CK value reached 1,209 mU/ml. On the 5th day an oozing cardiac rupture and cardiac tamponade were found, so she was surgically repaired. In general, concerning cardiac oozing rupture with acute myocardial infarction, factors of left anterior descending artery proximal lesion, no history of previous myocardial infarction, older age, female gender, t-PA administration and high C-reacting protein level were pointed out. Such a case as this of cardiac oozing rupture with acute myocardial infarction of the left circumflex branch lesion and low grade elevation of maximal CK is rare. Any type of myocardial infarction even if a case is due to a small branch lesion or when the peak CK value is low would be able to cause cardiac oozing rupture, so we should take much care on encountering any type of acute myocardial infarction especially when it is in the acute phase.