主动脉瓣狭窄患者应激性心肌病所致急性肺水肿：一例报告
Acute pulmonary edema due to stress cardiomyopathy in a patient with aortic stenosis: a case report.
作者信息
Bayer Monika F
机构信息
PO Box 18736 (at Stanford University) Stanford, California 94309, USA.
出版信息
Cases J. 2009 Dec 2;2:9128. doi: 10.1186/1757-1626-2-9128.
INTRODUCTION
Stress cardiomyopathy is a condition of chest pain, breathlessness, abnormal heart rhythms and sometimes congestive heart failure or shock precipitated by intense mental or physical stress.
CASE PRESENTATION
A 64-year-old male with a known diagnosis of moderate-to-severe aortic stenosis and advised that valve replacement was not urgent, presented with acute pulmonary edema following extraordinary mental distress. The patient was misdiagnosed as having a "massive heart attack" and died when managed by a traditional protocol for acute myocardial infarction/coronary artery disease, irrespective of his known aortic stenosis.
CONCLUSION
Intense mental stress poses a considerable risk, particularly to patients with significant aortic stenosis. As described here, it can precipitate acute pulmonary edema. Importantly, effective management of acute pulmonary edema due to stress cardiomyopathy in patients with known aortic stenosis requires its distinction from acute pulmonary edema caused by an acute myocardial infarction. Treatment options include primarily urgent rhythm and/or rate control, as well as cautious vasodilation.
引言
应激性心肌病是一种由强烈的精神或身体应激引发的胸痛、呼吸急促、心律失常，有时还会出现充血性心力衰竭或休克的病症。
病例介绍
一名64岁男性，已知患有中重度主动脉瓣狭窄，且被告知瓣膜置换并非紧急情况，在经历极度精神痛苦后出现急性肺水肿。该患者被误诊为“大面积心脏病发作”，并按照急性心肌梗死/冠状动脉疾病的传统治疗方案进行治疗，最终死亡，而未考虑其已知的主动脉瓣狭窄情况。
结论
强烈的精神应激会带来相当大的风险，尤其是对患有严重主动脉瓣狭窄的患者。如此处所述，它可引发急性肺水肿。重要的是，对于已知主动脉瓣狭窄的患者，因应激性心肌病导致的急性肺水肿的有效管理需要将其与急性心肌梗死引起的急性肺水肿区分开来。治疗选择主要包括紧急的心律和/或心率控制，以及谨慎的血管扩张。
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