ホルモン製剤により左右両冠動脈に血栓形成を認めた急性心筋梗塞の1例

Acute Myocardial Infarction due to Intracoronary Thrombosis in Two Major Coronary Arteries

　症例は44歳，女性．胸痛を主訴に来院．心電図上Ⅲ，aⅤ^F，Ⅴ¹にST上昇，Ⅴ₂〜Ⅴ₅にST低下を認めたため，急性心筋梗塞と考え，緊急冠動脈造影（CAG）を施行．右冠動脈と左前下行枝に同時に不完全閉塞を示す陰影欠損を認め，その像から血栓が強く疑われた．ただちに血栓溶解剤（t-PA）を両冠動脈に投与したところ血栓像の退縮を認め，さらに翌日のCAGでは血栓像は完全に消失していた．本例は42歳時乳ガン根治術を施行され，その後ホルモン療法として女性ホルモン製剤を投与されていた．今回の冠動脈内血栓の発現にホルモン製剤の関連が強く示唆された．

A 44-year-old woman was admitted to our hospital because of an oppressive feeling in the chest lasting for one hour. She had had an operation for breast cancer and had been medicated daily with 30 mg of Tamoxifen (TAM) and 1200 mg of Medroxyprogesterone (MPA). Emergent coronary angiograms on admission revealed an intracoronary thrombus in the right coronary artery and the left anterior descending coronary artery. Tissue-type plasminogen activator (t-PA) was adminis-tered to both coronary arteries. Immediately, the throm-bus diminished in diameter.