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结肠镜检查后与弥漫性肺泡出血相关的应激性心肌病。

Stress cardiomyopathy associated with diffuse alveolar hemorrhage after colonoscopy.

作者信息

Hwang Jin Kyung, Jang Jae-Young, Kim Weon

机构信息

Division of Cardiology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.

出版信息

Chonnam Med J. 2013 Aug;49(2):91-5. doi: 10.4068/cmj.2013.49.2.91. Epub 2013 Aug 22.

DOI:10.4068/cmj.2013.49.2.91
PMID:24010073
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3759689/
Abstract

Stress cardiomyopathy (SCM) is usually precipitated by a physiologically or psychologically stressful event. Although it occurs only rarely, hypoxia- and hypercapnia-induced sympathetic activation may also cause SCM. We present the case of a 37-year-old woman affected with SCM after a routine colonoscopy. During the procedure, she aspirated residual polyethylene glycol from her stomach. Hypotension, resting dyspnea, and hemoptysis were subsequently observed. Laboratory findings revealed elevated cardiac enzymes, and a transthoracic echocardiogram revealed left ventricular (LV) global hypokinesia. She was ultimately diagnosed with diffuse alveolar hemorrhage-associated SCM. After successful treatment with a ventilator and corticosteroids, her LV systolic function and dimensions normalized and she was discharged without complications.

摘要

应激性心肌病（SCM）通常由生理或心理应激事件诱发。尽管其发生率很低，但缺氧和高碳酸血症诱导的交感神经激活也可能导致SCM。我们报告一例37岁女性在常规结肠镜检查后发生SCM的病例。检查过程中，她从胃中吸入了残留的聚乙二醇。随后观察到低血压、静息性呼吸困难和咯血。实验室检查结果显示心肌酶升高，经胸超声心动图显示左心室（LV）整体运动减弱。她最终被诊断为弥漫性肺泡出血相关性SCM。在使用呼吸机和皮质类固醇成功治疗后，她的左心室收缩功能和尺寸恢复正常，出院时无并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/69f1/3759689/0905222a303f/cmj-49-91-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/69f1/3759689/35f8d2f250b8/cmj-49-91-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/69f1/3759689/5c935bb28528/cmj-49-91-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/69f1/3759689/0905222a303f/cmj-49-91-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/69f1/3759689/35f8d2f250b8/cmj-49-91-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/69f1/3759689/5c935bb28528/cmj-49-91-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/69f1/3759689/0905222a303f/cmj-49-91-g003.jpg

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本文引用的文献

1
High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: a new model of Takotsubo cardiomyopathy.高水平循环肾上腺素以β2-肾上腺素能受体/Gi 依赖性方式触发心尖心脏抑制：Takotsubo 心肌病的新模式。
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Overtures to takotsubo's cardiomyopathy.应激性心肌病的诱因。
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Haemosiderin-laden macrophages in the bronchoalveolar lavage fluid of patients with diffuse alveolar damage.弥漫性肺泡损伤患者支气管肺泡灌洗液中含铁血黄素巨噬细胞。
Eur Respir J. 2009 Jun;33(6):1361-6. doi: 10.1183/09031936.00119108. Epub 2009 Jan 7.
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Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review.应激性心肌病或短暂性左心室心尖气球样变综合征：一项系统综述。
Int J Cardiol. 2008 Mar 14;124(3):283-92. doi: 10.1016/j.ijcard.2007.07.002. Epub 2007 Jul 24.
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A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).一份关于结肠镜检查前肠道准备的共识文件：由美国结肠和直肠外科医师协会（ASCRS）、美国胃肠内镜学会（ASGE）以及美国胃肠和内镜外科医师协会（SAGES）的一个特别工作组编写。
Dis Colon Rectum. 2006 Jun;49(6):792-809. doi: 10.1007/s10350-006-0536-z.
8
Therapy for pulmonary aspiration of a polyethylene glycol solution.聚乙二醇溶液肺部误吸的治疗
J Pediatr Gastroenterol Nutr. 2003 Aug;37(2):192-4. doi: 10.1097/00005176-200308000-00020.
9
Diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients.造血干细胞移植受者的弥漫性肺泡出血
Am J Respir Crit Care Med. 2002 Sep 1;166(5):641-5. doi: 10.1164/rccm.200112-141cc.
10
Life-threatening respiratory failure following accidental infusion of polyethylene glycol electrolyte solution into the lung.意外将聚乙二醇电解质溶液输注到肺内后出现危及生命的呼吸衰竭。
J Toxicol Clin Toxicol. 2001;39(1):105-7. doi: 10.1081/clt-100102888.