Hsing Deyin D, Madikians Andranik
Division of Pediatric Critical Care, Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, CA, USA.
Pediatr Emerg Care. 2005 Nov;21(11):755-9. doi: 10.1097/01.pec.0000186431.00012.93.
Sudden cardiac deaths in previously healthy children are frequently due to undiagnosed cardiovascular diseases, either congenital or acquired. In an uncommon clinical entity known as commotio cordis, sudden death from cardiac arrest can occur in young athletes after a blunt blow to the chest, in the absence of preexisting cardiovascular disease. We present a case in which the clinician's high index of suspicion leads to the diagnosis of acute myocarditis in a patient whose sudden cardiac deterioration was initially attributed to the result of recent blunt chest trauma.
A case report and review of literature via MEDLINE (1996-2004) search using the key words "myocarditis," "commotio cordis," and "myocardial contusion."
A 12-year-old boy was admitted with elevated cardiac enzymes and respiratory distress after being hit in the chest with a dodgeball. Shortly after admission, the patient developed refractory ventricular arrhythmia, which was thought to be the result of blunt chest trauma. Further evaluation with endomyocardial biopsy, however, demonstrated acute myocarditis as the true etiology, for which the patient received immunosuppressive treatment. Unfortunately, the patient eventually required cardiac transplantation because of progressive irreversible cardiac dysfunction due to myocarditis.
Although acute myocarditis, commotio cordis, and myocardial contusion can all present with malignant ventricular arrhythmia, other clinical features and approaches to management of each disease are very different. This case illustrates the importance of having a broad differential diagnosis in mind when presented with a previously healthy child in sudden cardiogenic shock.
既往健康儿童的心脏性猝死常常归因于未被诊断出的先天性或后天性心血管疾病。在一种名为心脏震荡的罕见临床病症中，年轻运动员在胸部受到钝击后，在没有先前存在的心血管疾病的情况下，可能会因心脏骤停而猝死。我们报告一例，临床医生高度怀疑，从而诊断出一名心脏突然恶化最初被归因于近期胸部钝性外伤的患者患有急性心肌炎。
通过使用关键词“心肌炎”“心脏震荡”和“心肌挫伤”对MEDLINE（1996 - 2004年）进行检索，报告一例病例并回顾文献。
一名12岁男孩在被躲避球击中胸部后，因心肌酶升高和呼吸窘迫入院。入院后不久，患者出现难治性室性心律失常，当时认为是胸部钝性外伤所致。然而，通过心内膜心肌活检进一步评估显示，急性心肌炎才是真正的病因，患者接受了免疫抑制治疗。不幸的是，由于心肌炎导致进行性不可逆的心脏功能障碍，患者最终需要进行心脏移植。
虽然急性心肌炎、心脏震荡和心肌挫伤都可能表现为恶性室性心律失常，但每种疾病的其他临床特征和治疗方法却大不相同。该病例说明了当面对一名先前健康的儿童突然发生心源性休克时，进行广泛鉴别诊断的重要性。
