CAJ | 학술논문

主动脉内球囊反搏成功救治酷似急性广泛前壁心肌梗死的重症心肌炎一例报道
주동맥내구낭반박성공구치혹사급성엄범전벽심기경사적중증심기염일례보도
One case report of successful treatment of severe myocarditis mimicking acute myocardial infarction by intra-aortic balloon counterpulsation

万方数据

上海交通大学学报（医学版）上海交通大學學報（醫學版） 상해교통대학학보（의학판）
JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY(MEDICAL SCIENCE)
2010年 1期 116-117 ,共2页

尹桂芝%张大东%胡伟%余强%陈跃光%许剑锋%金贤%顾俊%董建%归冬梅

윤계지%장대동%호위%여강%진약광%허검봉%금현%고준%동건%귀동매

重症心肌炎%急性心肌梗死%主动脉内球囊反搏重癥心肌炎%急性心肌梗死%主動脈內毬囊反搏
중증심기염%급성심기경사%주동맥내구낭반박
severe myocarditis%acute myocardial infarction%intra-aortic balloon counterpulsation

报道一例老年男性患者因"胸闷气急6h"就诊,发病前3 d曾发热,入院时出现心脏泵功能衰竭.患者无高血压、糖尿病、肥胖等冠心病危险因素,心电图表现为胸前导联sT-T异常,异常Q波,酷似急性广泛前壁心肌梗死,而磷酸肌酸激酶同工酶(CK-MB)和肌钙蛋白(TNI)明显升高,磷酸肌酸激酶(CK)正常,与急性心肌梗死的心脏标志物动态变化不相符,故予以急诊造影检查.结果显示:冠状动脉、肺动脉无异常,左心室造影提示左心室整体收缩功能减弱,确诊为急性重症心肌炎,予以主动脉内球囊反搏(IABP)辅助支持恢复血流动力学稳态.酷似心肌梗死的重症心肌炎有致命危险,且易误诊,应仔细询问病史,尽早血管造影及必要的IABP支持对于患者的及时诊治至关重要.
보도일례노년남성환자인"흉민기급6h"취진,발병전3 d증발열,입원시출현심장빙공능쇠갈.환자무고혈압、당뇨병、비반등관심병위험인소,심전도표현위흉전도련sT-T이상,이상Q파,혹사급성엄범전벽심기경사,이린산기산격매동공매(CK-MB)화기개단백(TNI)명현승고,린산기산격매(CK)정상,여급성심기경사적심장표지물동태변화불상부,고여이급진조영검사.결과 현시:관상동맥、폐동맥무이상,좌심실조영제시좌심실정체수축공능감약,학진위급성중증심기염,여이주동맥내구낭반박(IABP)보조지지회복혈류동역학은태.혹사심기경사적중증심기염유치명위험,차역오진,응자세순문병사,진조혈관조영급필요적IABP지지대우환자적급시진치지관중요.
An old male patient visited the hospital due to shortness of breath and palpitation for 6 h, with fever 3 days before and pump failure at admission. Having no risk factor of coronary diseases such as hypertension, diabetes mellitus and obesity, with ST-T changes and abnormal Q wave on ECC, the signs were compatible with those of acute anterior wall myocardial infarction, while the characteristics of cardiac biomarkers ( significant increase in Troponin I and creatine kinase's isoform, and normal creatine kinase) were not in accordance with those of acute myocardial infarction. Emergency angiography was performed, which indicated normal coronary artery, normal pulmonary artery and global systolic dysfunction of left ventricle. The diagnosis of acute severe myocarditis was established, and intra-aortic balloon pump (IABP) was employed to provide hemodynamic support. Severe myocarditis mimicking acute myocardial infarction may be fatal, and can be easily misdiagnosed. Careful analysis of clinical manifestations, early diagnostic angiography and possible IABP placement are important for the successful treatment.