Merinopoulos I, Vassiliou V, Porter J N, Acton S, Braganza D R
Papworth Hospital, Cambridge, UK.
J R Coll Physicians Edinb. 2013;43(2):119-21. doi: 10.4997/JRCPE.2013.206.
A 61-year-old woman was admitted with general malaise, chest pain and breathlessness. During her inpatient stay she sustained a ventricular fibrillation (VF) arrest which was successfully terminated with direct current cardioversion. Cardiac investigations revealed poor left ventricular systolic function but unequivocally normal coronary arteries. During the course of her admission a macular rash developed and following investigations including a renal biopsy, a new diagnosis of systemic lupus erythematosus (SLE) and related myocarditis was reached. First presentation of lupus with myocarditis and VF is uncommon, however reaching the correct diagnosis is important as due to the reversible nature of the condition and improvement in left ventricular systolic function with medical therapy, an implantable cardioverter defibrillator (ICD) might not be appropriate. Our case report demonstrates the importance of screening for reversible conditions when considering ICD therapy for secondary prevention of malignant arrhythmias.
一名61岁女性因全身不适、胸痛和呼吸急促入院。住院期间，她发生了心室颤动（VF）骤停，通过直流电复律成功终止。心脏检查显示左心室收缩功能不佳，但冠状动脉明确正常。在住院过程中，出现了斑丘疹，经过包括肾活检在内的检查，确诊为系统性红斑狼疮（SLE）及相关心肌炎。狼疮首次表现为心肌炎和VF并不常见，然而做出正确诊断很重要，因为鉴于病情的可逆性以及药物治疗可改善左心室收缩功能，植入式心脏复律除颤器（ICD）可能并不合适。我们的病例报告表明，在考虑使用ICD治疗恶性心律失常二级预防时，筛查可逆性疾病的重要性。
