Mottard N, Mewton N, Bonnefoy E, Abdellaoui M, Revel D, Kirkorian G
Intensive Care Unit, Hopital Cardiologique Louis Pradel, Lyon, France.
Anaesth Intensive Care. 2008 Sep;36(5):739-42. doi: 10.1177/0310057X0803600520.
We report a case of myocarditis mimicking acute lateral myocardial infarction and treated as such initially, which was complicated by ventricular fibrillation a few hours after admission to the intensive care unit. The correct diagnosis was rapidly made using a low-dose delayed-enhanced cardiac multidetector computed tomography scan performed immediately after a normal coronary angiogram, demonstrating typical myocardial late hyperenhancement and good correlation with delayed enhanced magnetic resonance imaging. This case suggests that myocarditis can be accurately diagnosed by delayed-enhanced cardiac multidetector computed tomography in an emergency setting. The other lesson from this case is that patients presenting with severe clinical symptoms, important ECG signs and high myocardial enzyme levels should be closely monitored for at least 72 hours, even when myocardial infarction has been excluded.
我们报告一例心肌炎病例,该病例最初表现类似急性侧壁心肌梗死并按此进行治疗,在入住重症监护病房数小时后并发心室颤动。在冠状动脉造影正常后立即进行低剂量延迟增强心脏多排计算机断层扫描,迅速做出了正确诊断,显示出典型的心肌晚期强化,且与延迟增强磁共振成像具有良好的相关性。该病例表明,在紧急情况下,延迟增强心脏多排计算机断层扫描可准确诊断心肌炎。该病例的另一个教训是,即使已排除心肌梗死,对于出现严重临床症状、重要心电图表现和高心肌酶水平的患者,也应至少密切监测72小时。