Chen Shi-Jian, Zhang Chen, Meng Qing-Tao, Peng Yong, Chen Mao
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Medicine (Baltimore). 2016 Dec;95(52):e5757. doi: 10.1097/MD.0000000000005757.
Ventricular double rupture (VDR) is a rare but lethal mechanical complication of acute myocardial infarction (AMI). The early identification and timely treatment of VDR remain challenging problems. We present a case of AMI with VDR and briefly review the characteristics and prognosis of this life-threatening disease.
A 77-year-old male presented to our hospital with a 4-day history of severe dizziness, mild chest tightness, and dyspnea. An inferior AMI was diagnosed.
On the second hospital day, hypotension and a new cardiac murmur was found. The emergency echocardiographic study disclosed a ventricular septal defect. Soon after that the patient suddenly died of ventricular free-wall rupture.
In patients with AMI complicated by a septal perforation in the apical region, close to the septum-free wall junction, special attention should be paid to the great risk of VDR. Other high risk factors included advanced age, delayed reperfusion, and inferior infarction. Sufficient evaluation of the risk factors, close monitoring of vital signs, early identification of the specific symptoms, and timely treatment are the key points for the effective prediction and prevention of VDR.
心室双破裂（VDR）是急性心肌梗死（AMI）一种罕见但致命的机械性并发症。VDR的早期识别和及时治疗仍然是具有挑战性的问题。我们报告1例伴有VDR的AMI病例，并简要回顾这种危及生命疾病的特征和预后。
一名77岁男性因严重头晕、轻度胸闷和呼吸困难4天就诊于我院。诊断为下壁AMI。
入院第2天，发现患者出现低血压及新的心脏杂音。急诊超声心动图检查发现室间隔缺损。此后不久，患者突然死于心室游离壁破裂。
对于AMI合并心尖区靠近室间隔-游离壁交界处的间隔穿孔患者，应特别注意VDR的高风险。其他高危因素包括高龄、再灌注延迟和下壁梗死。充分评估危险因素、密切监测生命体征、早期识别特定症状以及及时治疗是有效预测和预防VDR的关键。
