Renilla González Alfredo, Lozano Martinez-Luengas Iñigo, Secades González Sandra, Alvarez Pichel Irene, Alvarez Martinez Paloma, Santamarta Liébana Elena, Díaz Molina Beatriz
Cardiology Department, Hospital Universitario Central de Asturias, Julián Claveria s/n 33005, Oviedo, Spain.
J Med Case Rep. 2011;5:382. doi: 10.1186/1752-1947-5-382. Epub 2011 Aug 16.
Cardiogenic shock is very uncommon in healthy people. The differential diagnosis for patients with acute heart failure in previously healthy hearts includes acute myocardial infarction and myocarditis. However, many drugs can also depress myocardial function. Propofol and fentanyl are frequently used during different medical procedures. The cardiovascular depressive effect of both drugs has been well established, but the development of cardiogenic shock is very rare when these agents are used.
After a minor surgical intervention, a 32-year-old Caucasian woman with no significant medical history went into sudden hemodynamic deterioration due to acute heart failure. An urgent echocardiogram showed severe biventricular dysfunction and an estimated left ventricular ejection fraction of 20%. Extracorporeal life support and mechanical ventilation were required. Five days later her ventricular function had fully recovered, which allowed the progressive withdrawal of medical treatment. Prior to her hospital discharge, cardiac MRI showed neither edema nor pathological deposits on the delayed contrast enhancement sequences. At her six-month follow-up examination, the patient was asymptomatic and did not require treatment.
Although there are many causes of cardiogenic shock, the presence of abrupt hemodynamic deterioration and the absence of a clear cause could be related to the use of propofol and fentanyl.
心源性休克在健康人群中非常罕见。既往健康心脏出现急性心力衰竭患者的鉴别诊断包括急性心肌梗死和心肌炎。然而，许多药物也可抑制心肌功能。丙泊酚和芬太尼在不同医疗操作中经常使用。这两种药物的心血管抑制作用已得到充分证实，但使用这些药物时发生心源性休克的情况非常罕见。
一名32岁无重大病史的白种女性在一次小手术干预后，因急性心力衰竭突然出现血流动力学恶化。紧急超声心动图显示严重的双心室功能障碍，估计左心室射血分数为20%。需要体外生命支持和机械通气。五天后她的心室功能完全恢复，从而可以逐步停用药物治疗。在出院前，心脏磁共振成像在延迟对比增强序列上既未显示水肿也未显示病理性沉积物。在她六个月的随访检查中，患者无症状且无需治疗。
尽管心源性休克有多种病因，但突然出现的血流动力学恶化且无明确病因可能与丙泊酚和芬太尼的使用有关。
