Objective To evaluate the clinical manifestations and features of coronary angiography findings of myocardial infarction with polyarteritis nodosa. Methods The 8 patients documented in Peking Union Medical College Hospital who presented myocardial infraction with polyarteritis nodosa were reviewed. Results There were 5 men and 3 women, with the mean age of 38 years. 6 with angina pectotris and 1 with heart failure. 5 had ischemic ST-T changes of ECG, no severe arrhythmias except sinus tachycardia and atrial premature beat. 3 with LVEF≤50% , 6 with segmental "wall motion abnormalities, 2 with ventricular aneurysm, 2 with cardiomyopathy and 1 with pulmonary hypertension. Coronary angiography was done in 4 patients. All with right coronary artery disease, 3 with triple-vessel disease and 1 with double-vessel disease. The coronary angiography findings were: diffuse, dilatation, aneurysms and segmental stenosis. All these patients had other organ involvement symptom and abnormal findings of the artery angiography. Conclusions Polyarteritis nodosa can involve coronary artery and result in myocardial infarction. Multiple, diffuse, right coronary artery involvement, aneurysms with thrombosis and segmental stenosis are the characteristic changes of coronary angiography findings. When acute myocardial infarction happens in patients with low risk of coronary heart disease, polyarteritis nodosa should be considered.%目的 总结结节性多动脉炎累及冠状动脉导致心肌梗死患者的临床表现及冠状动脉受累特点.方法 对北京协和医院有病案记录的结节性多动脉炎合并心肌梗死的8例患者的临床症状、系统受累、实验室检查、冠状动脉及其他血管造影、超声心动图和病理检查等进行回顾性分析.结果 8例患者中男性5例,女性3例,年龄21 ～52岁,平均(37.6±11.7)岁.胸痛6例,心力衰竭1例.心电图缺血性ST-T改变5例,除窦性心动过速、房性期前收缩外,未见其他恶性心律失常.左心室射血分数降低(≤50％)3例,节段性室壁运动异常6例,室壁瘤形成2例,心肌病变2例,肺高压1例.4例有冠状动脉影像学检查资料,均累及右冠状动脉,3例为三支病变,1例为两支病变,其造影结果描述为冠状动脉弥漫性病变、冠状动脉扩张、多发动脉瘤以及节段性狭窄、闭塞.这些患者均有其他多部位血管受累的表现和动脉造影检查的异常.结论 结节性多动脉炎可累及冠状动脉导致心肌梗死,其冠状动脉受累常为多支病变、多有右冠状动脉受累,动脉瘤伴血栓形成和节段性狭窄.对冠心病低危心肌梗死的患者,需要完善血管检查,警惕结节性多动脉炎累及冠状动脉的情况.
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