心脏渗漏：定时炸弹！
Leaking heart: ticking time bomb!
作者信息
Marella Punnaiah, Hussein Hassan, Rajpurohit Naveen, Garg Rajeev
机构信息
Department of Internal Medicine, Banner Estrella Medical Center, Phoenix, AZ, USA.
Department of Internal Medicine, West Valley Medical Center, Goodyear, AZ, USA.
出版信息
N Am J Med Sci. 2013 Oct;5(10):620-2. doi: 10.4103/1947-2714.120802.
CONTEXT
Cardiac rupture is a very important but under-recognized complication of acute myocardial infarction and usually happens within a week of the event. Sometimes it can be subacute and may not be typical of an acute blow out rupture. Hence careful evaluation is needed as a missed or delayed diagnosis can be fatal. An emergent echocardiogram may aid in immediate diagnosis. Surgery is the only treatment option and is mandatory despite the high mortality risk.
CASE REPORT
An elderly male presented with dizziness and hypotension. Based on the timeline of his symptomatology, electrocardiographic abnormalities and labs, a subacute cardiac rupture was suspected in the emergency room itself. A high index of suspicion is needed to diagnose cardiac rupture.
CONCLUSION
Subacute cases can be missed easily as presentation may not be dramatic. They can rapidly progress to a blowout rupture increasing mortality risk heavily even with surgical treatment.
背景
心脏破裂是急性心肌梗死一种非常重要但未得到充分认识的并发症，通常发生在急性心肌梗死事件发生后的一周内。有时它可能是亚急性的，可能并不具有典型急性爆裂性破裂的特征。因此，需要仔细评估，因为漏诊或延迟诊断可能是致命的。紧急超声心动图可能有助于立即诊断。手术是唯一的治疗选择，尽管死亡率风险很高，但却是必不可少的。
病例报告
一名老年男性出现头晕和低血压症状。根据其症状发作时间、心电图异常及实验室检查结果，急诊室就怀疑是亚急性心脏破裂。诊断心脏破裂需要高度的怀疑指数。
结论
亚急性病例很容易被漏诊，因为其表现可能并不明显。它们可能迅速进展为爆裂性破裂，即使进行手术治疗，也会大幅增加死亡风险。
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