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严重脱水诱发的矛盾性心力衰竭：容积缺失性心脏中的心室内动力性阻塞和重度二尖瓣反流。

Paradoxical heart failure precipitated by profound dehydration: intraventricular dynamic obstruction and significant mitral regurgitation in a volume-depleted heart.

机构信息

Cardiology Division, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.

出版信息

Yonsei Med J. 2013 Jul;54(4):1058-61. doi: 10.3349/ymj.2013.54.4.1058.

DOI:10.3349/ymj.2013.54.4.1058
PMID:23709446
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3663219/
Abstract

Occurrence of dynamic left ventricular outflow tract (LVOT) obstruction is not infrequent in critically ill patients, and it is associated with potential danger. Here, we report a case of transient heart failure with hemodynamic deterioration paradoxically induced by extreme dehydration. This article describes clinical features of the patient and echocardiographic findings of dynamic LVOT obstruction and significant mitral regurgitation caused by systolic anterior motion of the mitral valve in a volume-depleted heart.

摘要

危重症患者中动态左心室流出道（LVOT）梗阻的发生率并不少见，且与潜在危险相关。在此，我们报告了一例因极度脱水导致心源性休克和血流动力学恶化的心力衰竭患者。本文描述了该患者的临床特征以及超声心动图发现，在容量耗竭的心脏中，由于二尖瓣收缩期前向运动导致动态 LVOT 梗阻和严重二尖瓣反流。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1662/3663219/2263c5f92e20/ymj-54-1058-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1662/3663219/7b0a0501a37d/ymj-54-1058-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1662/3663219/b03dcaea7c10/ymj-54-1058-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1662/3663219/2263c5f92e20/ymj-54-1058-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1662/3663219/7b0a0501a37d/ymj-54-1058-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1662/3663219/b03dcaea7c10/ymj-54-1058-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1662/3663219/2263c5f92e20/ymj-54-1058-g003.jpg

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本文引用的文献

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Crit Care Med. 2009 Feb;37(2):729-34. doi: 10.1097/CCM.0b013e3181958710.
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Dynamic left ventricular outflow tract obstruction without basal septal hypertrophy, caused by catecholamine therapy and volume depletion.由儿茶酚胺治疗和血容量减少引起的无基底间隔肥厚的动态左心室流出道梗阻。
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Cardiogenic shock.
临床整合多器官床边即时超声用于鉴别呼吸困难、胸痛或休克：一项关键分析性综述。
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The Unusual Suspect: Anemia-induced Systolic Anterior Motion of the Mitral Valve and Intraventricular Dynamic Obstruction in a Hyperdynamic Heart as Unexpected Causes of Exertional Dyspnea after Cardiac Surgery.异常嫌疑：贫血诱发二尖瓣收缩期前向运动及高动力型心脏的心室内动态梗阻，作为心脏手术后劳力性呼吸困难的意外原因
Korean J Thorac Cardiovasc Surg. 2013 Dec;46(6):457-60. doi: 10.5090/kjtcs.2013.46.6.457. Epub 2013 Dec 6.
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Cardiogenic shock accompanied by dynamic left ventricular outflow tract obstruction and myocardial bridging after transient complete atrioventricular block mimicking ST-elevation myocardial infarction: a case report.短暂完全性房室传导阻滞模拟ST段抬高型心肌梗死后出现的心源性休克伴动态左心室流出道梗阻及心肌桥：一例报告
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