Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
Am J Emerg Med. 2014 Apr;32(4):392.e1-2. doi: 10.1016/j.ajem.2013.10.024. Epub 2013 Oct 16.
An 80-year-old woman presented to the emergency department with failure to thrive and weakness for 14 days. Medical history was significant for polio. On admission her electrocardiogram showed atrial flutter, and cardiac enzymes were elevated. Echocardiogram revealed a high pulmonary artery pressure, but no other wall motion abnormalities or valvulopathies. Chest x-ray showed a large lucency likely representing a diaphragmatic hernia. Computed tomographic scan confirmed the hernia. Our patient remained in atrial flutter despite rate control, and thereafter surgery was consulted to evaluate the patient. She underwent hernia repair. After surgery, the patient was taken off rate control and monitored for 72 hours; she did not have any episode of atrial flutter and was discharged with follow up in a week showing no arrhythmia. Her flutter was caused directly by the mechanical effect of the large hiatal hernia pressing against her heart, as the flutter resolved after the operation.
一位 80 岁女性因 14 天的生长不良和虚弱而到急诊就诊。病史显著为小儿麻痹症。入院时，她的心电图显示心房颤动，心肌酶升高。超声心动图显示肺动脉压高，但无其他壁运动异常或瓣膜病。胸部 X 光片显示一个可能代表膈疝的大透光区。计算机断层扫描证实了疝的存在。尽管我们的患者进行了心率控制，但仍持续出现心房颤动，此后咨询了手术以评估患者。她接受了疝修补术。手术后，患者停止了心率控制，并监测了 72 小时；她没有出现任何心房颤动，并在一周后出院，没有心律失常。她的颤动是由巨大的食管裂孔疝直接压迫心脏的机械作用引起的，因为手术后颤动得到了缓解。
