更多的证据表明女性的冠状动脉疾病是不同的

尤其是年轻女性,心脏病发作可能是由于糜烂引起的。

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埃里克·奥德拉斯/奥诺基/盖蒂图片社

几年来,心脏病学家已经知道coronary artery disease (CAD)在女人身上和在男人身上是完全不同的。Women's symptoms may be different,这个用于CAD的诊断测试可以给女人一个“错误”的答案,以及潜在的疾病本身可能非常不同.

it has become apparent that there is another difference in how CAD "behaves" in some women.在年轻女性身上心肌梗塞(心脏病发作),the coronary thrombosis (blood clot in a coronary artery) that produces the cardiac damage may be caused by aerosion一个atherosclerotic plaque,而不是更典型的rupture斑块的如果心脏病是由侵蚀引起的,symptoms may be more subtle and less typical than with a "usual" heart attack.and may be missed (or brushed off) by a doctor.因此,治疗可能延迟,结果可能更糟。

How Heart Attacks Typically Occur

Typically,急性冠脉综合征is caused by the rupture of a plaque.Plaque rupture generally is an acute and fairly distinct event that causes immediate consequences.The rupture exposes the "gunk" inside the plaque (cholesterol,calcium,炎症细胞,以及其他物质)进入血液-这通常会触发血块的快速形成。

经常,血栓导致冠状动脉完全(或几乎完全)阻塞,and blood flow to the portion of heart muscle supplied by that artery is shut off.这种梗阻常常导致急性冠脉综合征的突然和显著症状。心脏病发作的症状unstable angina,or even to心脏猝死.

What Makes Coronary Artery Erosion Different?

It appears that,especially in women who have heart attacks before age 50 (in particular,in pre-menopausal women),plaque rupture is oftennotthe cause of the blood clot.Instead,血栓可能是由erosionof the blood vessel wall.

断裂和侵蚀有什么区别?Well,a rupture of a plaque is like a pimple that pops open.(事实上,the stuff inside a typical zit is not entirely unlike the stuff inside an atherosclerotic plaque.) But an erosion is more like a shallow ulcer.与侵蚀有关的斑块可能很小,or there may not be a plaque beneath the erosion at all.

An erosion, just like a plaque rupture,会导致血块的形成。然而,因为侵蚀(与破裂相反)不是急性事件,the clot often forms much more gradually.Symptoms,therefore,也可以逐步发展,更微妙,通常是“非典型的”。

Why Is This Significant?

It has been known for many years that,while heart attacks in young women are uncommon,当她们真的发生时,这些女性往往比同龄男性有更糟糕的结局。These worse outcomes,现在出现,may be at least in part due to the fact that many of these heart attacks are caused by coronary artery erosion.

不仅冠状动脉糜烂的症状更容易被认为是烧心,焦虑或其他非心脏原因,but also the clots themselves may end up being more dangerous than clots that form due to rupture.As noted,the clots that form with erosion tend to develop less suddenly.由于这个原因(而且他们引起的症状通常并不十分令人震惊),这些血栓有时间成熟。所以,当心脏病发作的诊断变得明显时,the clots are more mature,更坚实,and much more difficult to reverse.

冠状动脉糜烂的诊断

Unfortunately,coronary artery erosions are very difficult to diagnose before they cause thrombosis.They are usually impossible to detect,for instance,在期间cardiac catheterizationstress/thallium testing.So coronary artery erosion is yet another kind ofcoronary artery disease associated with "normal" coronary arteries.

Who Gets Coronary Artery Erosions?

While anyone can develop coronary artery erosions,this appears to be a condition much more likely to be seen in premenopausal women,通常是绝经前吸烟者。所以,吸烟对任何人都是一个危险因素,it is an especially strong risk factor for coronary artery erosions.吸烟的年轻女性应该戒烟,这是一个很好的理由。

也有一些证据表明,在反复出现冠状动脉痉挛的妇女中,糜烂后的冠状动脉可能更常见。如在Prinzmetal's angina.

总结

年轻女性的冠心病通常与男性和老年女性的“经典冠心病”不同。认识到这一事实正促使人们努力充分了解这些差异,并制定更有效的治疗策略。

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文章来源
  • Genuardi L.Burzotta FVeralio R,等。Plaque Erosion Causing ST-segment Elevation Myocardial Infarction: Report of an Optical Coherence Tomography-documented Case and Concise Literature Review.2017年冠状动脉疾病;Doi: 10.1097/MCA.0000000000000463
  • Kramer MCA,Rittersma SZH德温特RJ等。Relationship of Thrombus Healing to Underlying Plaque Morphology in Sudden Coronary Death.J am Coll Cardiol 2009年;DOI:10.1016/j.jacc.2009.09.007.
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