Coronary artery disease incidence increases annually, while the average age of patients suffering from acute coronary syndromes is decreasing. Patients without obstructive coronary artery disease have also been proven to have a high risk of angina, meanwhile, patients with acute myocardial infarction are also complicated with perfusion disorder even after revascularization of coronary arteries and major branches. Which coronary microvascular dysfunction takes great responsibility of? We presented a 25-year-old man with a 17-year history of smoking and a 10-year history of drinking who underwent persistent severe chest pain for 1 hour. After immediate electrocardiogram and serum myocardial enzymes assay in emergency room, this young man was finally diagnosed as acute myocardial infarction. Emergency percutaneous coronary intervention was ready to perform through the green channel of chest pain center. Coronary angiogram showed total occlusion in the proximal left anterior descending coronary artery, distal left circumflex coronary artery and right coronary artery with TIMI 0 flow. After repeated balloon dilatation and intracoronary administration, the patient was then sent to CCU for further rehabilitation with pharmacotherapy. Coronary angiography was taken again 8 days later to reappraised the left anterior descending coronary artery, distal left circumflex coronary artery and right coronary artery as no blocking with TIMI 2 flow suggesting coronary microvascular dysfunction. Follow-up examination also confirmed myocardial infarction with coronary microvascular dysfunction. Afterwards, prescriptions including dietary and therapeutic lifestyle strategies were given for long-term rehabilitation. Follow-up indicated total remission of symptom and gradual improvement of cardiac function. Without hereditary factor, age factor or chronic disease factors, this young patient was attacked by acute myocardial infarction due to the over-consumption of his health. The more important thing was that acute myocardial infarction combined with coronary microvascular dysfunction suggested a poor prognosis which need earlier and more effective interventions urgently.
Keywords: Acute myocardial infarction; Coronary microvascular dysfunction; TIMI flow