血栓塞栓症によると思われる脳梗塞，2枝同時急性心筋梗塞を合併した心房細動の1例

A Case of Atrial Fibrillation complicated with Cerebral Infarction and Acute Myocardial Infarction due to Thrombo-embolism

要旨　心房細動による血栓塞栓症が原因と思われる脳梗塞，2枝同時急性心筋梗塞を相次いで発症した1例を経験したので報告する．患者は79歳，男性．発作性心房細動の既往あり．今回，脳梗塞にて近医入院2日目に胸痛発作あり，当院転院．来院時心電図では，正常洞調律でV1からV5誘導にかけての著明なSTの上昇を認めた．来院7時間後より心房細動となり，以後除細動されず．冠動脈造影では，左前下行枝，左回旋枝末梢に途絶型の完全閉塞を認めた．血栓塞栓による脳梗塞に続発した左冠動脈2枝の同時閉塞による急性心筋梗塞と診断した．まず，左前下行枝にPTCA，左回旋枝に血栓溶解療法を行い，いずれも再潅流に成功した．慢性期の脳血管撮影，左回旋枝の造影ではいずれも正常所見で，左前下行枝にはPTCAに伴う再狭窄を認めた．脳塞栓による脳梗塞発症後に冠動脈塞栓に伴う急性心筋梗塞が続発する場合があり，注意が必要である．

Summary

　We report a case of cerebral infarction and acute myocardial infarction due to thromboembolism in a 79-year-old man with atrial fibrillation. He was admitted to a hospital near his house because of cerebral infarction. The day after admission, he experienced severe chest pain and was introduced to our hospital. The electrocardiogram at the time of admission showed normal sinus rhythms and elevation of the ST segment at the anterior chest leads. The electrocardiogram taken seven hours after admission showed sustained atrial fibrillation. The findings of the coronary arteriogram revealed total obstruction of the peripheral site of the left descending and circumflex coronary artery. We diagnosed acute myocardial infarction due to thromboembolismes of two branches of the left coronary artery. We performed balloon angioplasty on the left descending coronary artery and intracoronary thrombolysis on the left circumflex coronary artery, until we obtained reperfusion of the bilateral coronary arteries. Coronary angiography in the chronic stage showed normal findings for a lesion of the left circumflex coronary artery, but restenosis was found at the site of the lesion in the left descending coronary artery. Thus, in the course of cerebral infarction due to thromboembolism in a patient with atrial fibrillation, we should be aware of a possible complication such as acute myocardial infarction