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[厌食症伴窦性心动过缓:一例报告]

[Anorexia with sinus bradycardia: a case report].

作者信息

Wang Fang-fang, Xu Ling, Chen Bao-xia, Cui Ming, Zhang Yuan

机构信息

Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health; Key Laboratory of Molecular Cardiovascular Sciences,Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191, China.

出版信息

Beijing Da Xue Xue Bao Yi Xue Ban. 2016 Feb 18;48(1):180-2.

Abstract

As anorexia patients always go to the psychiatric clinic, little is concerned about the occurrence of sinus bradycardia in these patients for cardiologists and psychiatrists. The aim of this paper is to discuss the relationship between anorexia and sinus bradycardia, and the feature analysis, differential diagnosis and therapeutic principles of this type of sinus bradycardia. We report a case of sinus bradycardia in an anorexia patient with the clinical manifestations, laboratory exams, auxiliary exams, therapeutic methods, and her prognosis, who was admitted to Peking University Third Hospital recently. The patient was a 19-year-old female, who had the manifestation of anorexia. She lost obvious weight in a short time (about 15 kg in 6 months), and her body mass index was 14.8 kg/m(2). The patient felt apparent palpitation, chest depression and short breath, without dizziness, amaurosis or unconsciousness. Vitals on presentation were notable for hypotension, and bradycardia. The initial exam was significant for emaciation, but without lethargy or lower extremity edema. The electrocardiogram showed sinus bradycardia with her heart rate being 32 beats per minute. The laboratory work -up revealed her normal blood routine, electrolytes and liver function. But in her thyroid function test, the free thyroid (FT) hormones 3 was 0.91 ng/L (2.3-4.2 ng/L),and FT4 was 8.2 ng/L (8.9-18.0 ng/L), which were all lower; yet the thyroid stimulating hormone (TSH) was normal 1.48 IU/mL (0.55-4.78 IU/mL). Ultrasound revealed her normal thyroid. Anorexia is an eating disorder characterized by extremely low body weight, fear of gaining weight or distorted perception of body image, and amenorrhea. Anorexia patients who lose weight apparently in short time enhance the excitability of the parasympathetic nerve, and inhibit the sympathetic nerve which lead to the appearance of sinus bradycardia, and functional abnormalities of multiple systems such as hypothyroidism. But this kind of sinus bradycardia and hypothyroidism have good prognosis. And asymptomatic sinus bradycardia with reversible causes, because of the great prognosis, they do not need special treatment. Multiple medical and psychiatric disciplines were consulted, and then, family care, nutritional support and psychiatric therapy were given, and she did not need thyroid hormone replacement therapy. The patient's overall clinical status improved gradually during her hospital stay and her heart rate was recovered to 55 beats per minute.

摘要

由于厌食症患者常前往精神科就诊,心脏病专家和精神科医生很少关注这些患者中窦性心动过缓的发生情况。本文旨在探讨厌食症与窦性心动过缓之间的关系,以及此类窦性心动过缓的特征分析、鉴别诊断和治疗原则。我们报告了一例近期入住北京大学第三医院的厌食症患者发生窦性心动过缓的病例,包括其临床表现、实验室检查、辅助检查、治疗方法及预后情况。该患者为一名19岁女性,有厌食症表现。她在短时间内体重明显下降(6个月内约15千克),体重指数为14.8千克/米²。患者自觉明显心悸、胸闷、气短,无头晕、黑矇或意识丧失。入院时生命体征显示低血压和心动过缓。初次检查发现患者消瘦明显,但无嗜睡或下肢水肿。心电图显示窦性心动过缓,心率为每分钟32次。实验室检查显示血常规、电解质和肝功能正常。但甲状腺功能检查中,游离甲状腺激素3为0.91纳克/升(2.3 - 4.2纳克/升),游离甲状腺激素4为8.2纳克/升(8.9 - 18.0纳克/升),均偏低;而促甲状腺激素正常,为1.48国际单位/毫升(0.55 - 4.78国际单位/毫升)。超声检查显示甲状腺正常。厌食症是一种以极低体重、害怕体重增加或对身体形象的认知扭曲以及闭经为特征的饮食失调症。短期内明显体重减轻的厌食症患者会增强副交感神经的兴奋性,抑制交感神经,从而导致窦性心动过缓以及甲状腺功能减退等多个系统的功能异常。但这种窦性心动过缓及甲状腺功能减退预后良好。对于无症状的、病因可逆的窦性心动过缓,因其预后良好,无需特殊治疗。咨询了多个医学和精神学科后,给予了家庭护理、营养支持和心理治疗,患者无需甲状腺激素替代治疗。住院期间患者的整体临床状况逐渐改善,心率恢复到每分钟55次。

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