Journal of Clinical Cases

A Case of MINOCA Associated With Swimming

Fu Fei, Fan Jun and Yang Lixia

Department
Clinical College of the 92nd Hospital of the PLA Joint Logistic Support Force, Kunming Medical University, Kunming, Yunnan 650032

Corresponding Author: Yang Lixia

Abstract

1.1 The patient was 24 years old with body mass 72 kg, height 175 cm and body mass index 21kg / m 2. One day before the onset of the preheart area pain, dull pain, lasting for several minutes to several hours. Accompanied by palpitation symptoms, no cough, expectoration, no muscle soreness and other symptoms. He went to the emergency department of our hospital with electrocardiogram indicating “extensive anterior wall T wave high tip, AVL pathological Q wave, ST segment elevation 0.1-0.2mv”, and “CK 1862U / L, CKMB 50U / L, TnI 0.0042 mg / L”, which was considered as acute coronary syndrome. hospitalization was recommended, but the patient refused to be hospitalized. On the second day of onset, the patient went to our hospital again due to chest pain and palpitation, consistent with the initial visit. The myocardial enzyme spectrum was reviewed “CK 1212U / L, CKMB 35U / L, TnI 0.0038 mg/L”, and he was hospitalized for further treatment. Previous history of myocarditis (18 years ago). Physical examination for admission: body temperature: 36.6℃, pulse: 106 times / min, breath: 19 times / min, blood pressure: 116 / 76mmHg, SPO 2:98%. It was clear, a little wet rales could be heard in the lower lungs, with complete heart rhythm, no noise in the auscultation area of the valve, no friction sound of the pericardium, and mild edema in both lower limbs.
1.2 Disease changes and main treatment : After the first day of admission (d1), another electrocardiogram indicated “sinus tachycardia (heart rate 106 times / min), V1-V6 T wave high tip, AVL pathological Q wave, ST elevation 0.1-0.2mv”, review of myocardial zymogram (see Table 1), WBC: 12.97 * 10 ^ 9 / L, N%: 71.9%, lymphocyte percentage: 21.5%,CRP:3.90mg/L, BNP: 8 pg / ml, and temporary tanshinone to improve circulatory therapy. In d2, cardiac ultrasound indicated no obvious abnormality, coronary angiography indicated “left trunk: no obvious abnormality; anterior descending branch: 30% stenosis, middle muscle bridge; spiral branch: small; RCA: large, near lining not smooth”. And d3, nicdil was given to improve coronary microcirculation and vitamin C anti-oxidative stress therapy. In d5, myocardial core scanning was performed for the clavicle implantation. The results indicated that when the left ventricular heart cavity was slightly larger, the radioactivity of the lower left ventricular myocardial was sparse, and the myocardial perfusion of the lower left ventricular myocardial decreased in the resting state. And d6, review of myocardial enzyme dropped to normal. And d11, symptoms disappeared, normal indicators, and he was discharged from recovery.
1.3 Follow-up discharge regular oral Nick dil tablets. At follow-up after 1 month, ECG indicated “sinus rhythm; T wave high tip (heart rate 61 beats / min)”, test “BNP 12.4pg/ml, CK 78U / L, CKMB 8U / L” and cardiac ultrasound “LA 31mm LV49mm EF65.1%”. Three months after discharge, myocardial nuclear scan was reviewed and myocardial perfusion returned to normal.