coronary aneurysm
Introduction
Introduction to coronary aneurysms Local or diffuse dilatation of the coronary arteries, more than twice the local original diameter, with a single or multiple tumor-like changes called coronary aneurysms. Clinical manifestations are diverse and non-specific. This depends mainly on the pathological changes of the aneurysm itself and whether there are complications. Its clinical manifestations may be symptoms and signs of angina or acute myocardial infarction. Heart failure can also occur in the mouth. Kawasaki disease patients may be accompanied by persistent high fever, generally lasting more than 5 days, pharyngitis, hand and foot peeling, multiple erythema and cervical lymphadenopathy, bilateral conjunctivitis. basic knowledge The proportion of illness: 0.0055% Susceptible people: no specific population Mode of infection: non-infectious Complications: acute myocardial infarction
Cause
Cause of coronary aneurysm
(1) Causes of the disease
Coronary aneurysms are classified into congenital and acquired.
1. The middle layer of the arterial wall of congenital coronary aneurysm is segmental absent, muscle fiber dysplasia, abnormal tissue arrangement, diseased blood vessels are expanding and thinning, and aneurysms are formed, or the cause is still unclear, so that the arterial wall is Cystic necrosis and degeneration, especially in the middle layer, severe damage to the elastic fibers, weakening the arterial wall and forming an aneurysm, and an aneurysm formed by coronary artery spasm.
2. Acquired coronary aneurysm
(1) Coronary atherosclerosis: the most common cause of coronary aneurysms, accounting for 52% of aneurysms, mostly in the 50 years of age, mainly due to lipid metabolism disorders, hyperlipidemia, especially low density lipids The abnormal increase of protein causes lipids to first deposit on the endothelial layer of the blood vessel wall, causing destruction and fibrosis of endothelial cells, which in turn involves the middle layer of elastic fibers and the whole layer of blood vessels, which causes the nutrition of blood vessels to be impeded, resulting in tearing of the intima of the wall. Degeneration of the wall, local atrophy, fragile aneurysm.
(2) Mucocutanous lymph node syndrome (MLNS): This disease mainly affects children under 6 years of age, but can also affect young people, 60% of whom have cardiac malformations, such as coronary aneurysms, coronary artery stenosis, Myocarditis or myocardial infarction can also cause papillary muscle dysfunction, and mitral regurgitation occurs.
(3) Other causes: In addition to the above common causes, coronary aneurysms can also be seen in advanced syphilis, endocardial infection after embolism, trauma, new organisms, scleroderma, etc., and can also be secondary to coronary artery formation. Postoperative or intracardiac surgery, such as: endocardial biopsy, coronary artery bypass and heart transplantation.
(4) secondary to severe cyanosis congenital heart disease: patients with severe cyanosis congenital heart disease, if live to adulthood, due to long-term low oxygen saturation, the coronary artery will diffusely expand.
(5) Aortic stenosis: In the case of stenosis of the aortic valve, coronary perfusion is not in the diastolic phase, but mainly occurs in the systolic phase of the ventricle, resulting in abnormal expansion of the coronary artery.
(two) pathogenesis
Regardless of the cause of coronary aneurysm, coronary aneurysm can be localized or multiple, congenital occurs mostly in the bifurcation of the coronary artery, occurs in the right coronary artery, mostly without arteriosclerosis, but older patients can also There are cases of arteriosclerosis or calcification.
Acquired coronary aneurysms are more common in adults, mostly on the basis of extensive atherosclerosis, accompanied by stenosis or tumor-like dilation, mostly in the left coronary artery, young people, especially Kawasaki disease under 6 years old In 15% to 25% of patients with coronary aneurysms, Skikitura collected 170 patients with Kawasaki disease who underwent bypass therapy in Japan, and found that the left main trunk was 11.8%, the right coronary artery was 77.6%, and the left anterior descending artery was 87.6%. The circumflex artery is 25.9%, and about half of the patients' coronary aneurysms can resolve by themselves.
Histologically, the middle wall of the tumor wall can be seen. The affected blood vessels are locally thinned, abnormally expanded, and the vessel wall of the coronary aneurysm is dilated. The change of blood flow direction and retention due to irregularities of the inner wall and the destruction of endothelial cells. It is easy to form a thrombus to make the lumen thinner, narrow, and the myocardial insufficiency occurs. The detachment of the embolus can lead to acute myocardial infarction and even sudden death. A huge aneurysm can compress the adjacent coronary artery, which can also cause angina pectoris. A huge aneurysm can also occur as a "stealing blood" phenomenon. When the heart is dilated, coronary blood flows into the aneurysm. When contracting, the blood flow returns from the giant aneurysm to the coronary artery, causing insufficient blood supply to the distal myocardium. The coronary aneurysm ruptures to the pericardial cavity, and the acute pericardial tamponade and death, but less common, broken into the heart chamber, coronary sinus veins, pulmonary artery, the pathophysiological changes of coronary artery spasm, if the breach is large and break into the low pressure In the heart chamber, congestive heart failure can occur in severe cases.
Prevention
Coronary aneurysm prevention
1. Preventing various possible pathogenic factors, vigorously promoting prenatal and postnatal care, avoiding viral infection in early pregnancy, reducing the influence of adverse physical and chemical factors on the uterus, and performing prenatal genetics or chromosome examination if necessary to prevent Not yet.
2. Coronary aneurysms are often accompanied by coronary stenosis. Even without stenosis, abnormal aneurysm expansion changes the nature of blood flow, eddy currents and blood retention, so thrombosis and embolism also occur. Angina pectoris, acute myocardial infarction, and even sudden death, therefore, clinically diagnosed as coronary aneurysm, surgical treatment should be considered with or without symptoms, but surgical treatment of patients with Kawasaki disease should be carefully considered.
Complication
Coronary aneurysm complications Complications acute myocardial infarction
There may be complications such as coronary thromboembolism, acute myocardial infarction, and acute pericardial tamponade.
Symptom
Coronary aneurysm symptoms Common symptoms High heat dissection hematoma angina pectoris foot peeling neck lymph node enlargement heart failure
The clinical manifestations of coronary aneurysms are diverse and non-specific, depending on the pathological changes of the aneurysm itself and whether there are comorbidities. The coronary aneurysms themselves do not cause symptoms, sometimes large and without any symptoms. Only in the case of autopsy or coronary angiography, the clinical manifestations may be symptoms and signs of angina pectoris or acute myocardial infarction. Heart failure can also occur in the mouth, and acute pericardial tamponade and death in the pericardial cavity. Symptoms and signs of obstruction of the right ventricular outflow tract can also occur in coronary aneurysms.
Kawasaki disease patients may be accompanied by persistent high fever, generally lasting more than 5 days, pharyngitis, hand and foot peeling, multiple erythema and cervical lymphadenopathy, bilateral conjunctivitis.
Examine
Coronary aneurysm examination
1. Electrocardiogram: usually normal, can also be expressed as ST-T changes, or corresponding changes in acute myocardial infarction.
2. X-ray of the heart: Occasionally, abnormal changes in the contour of the heart can be found on the right heart, or the calcification of the aneurysm wall can be suspected.
3. Echocardiography, CT, and magnetic resonance are of great help in the correct diagnosis of coronary aneurysms.
4. Angiography or coronary angiography can provide the most accurate diagnosis, accurately provide coronary artery involvement, the size and location of the aneurysm, the condition of the distal vascular bed, and whether or not the coronary artery fistula is combined.
Diagnosis
Diagnosis and diagnosis of coronary aneurysm
Patients with coronary aneurysms often have no clinical symptoms, and the electrocardiogram can be normal. Physical examination can be without any positive signs, until complications (such as coronary thrombosis, myocardial infarction, etc.) appear corresponding clinical symptoms and signs, so the early stage of the disease Diagnosis is more difficult, the general young patients (especially around 20 years old) should think of the possibility of acute myocardial infarction, to further check the heart X-ray, echocardiography, etc., especially ascending aorta and selective coronary artery Contrast can provide direct imaging evidence, providing a basis for diagnosis and future surgical treatment.
Identification with coronary atherosclerotic heart disease, acute pericarditis, aortic aneurysm, etc.
