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咳嗽性晕厥：心脏压塞诊断的一个线索。

Cough induced syncope: A hint to cardiac tamponade diagnosis.

作者信息

Ramirez Roberto, Lasam Glenmore

机构信息

Roberto Ramirez, Glenmore Lasam, Department of Medicine, Atlantic Health System-Overlook Medical Center, Summit, NJ 07901, United States.

出版信息

World J Cardiol. 2017 May 26;9(5):466-469. doi: 10.4330/wjc.v9.i5.466.

DOI:10.4330/wjc.v9.i5.466
PMID:28603595
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5442416/
Abstract

We report a case of a 75-year-old male with history of lung adenocarcinoma who presented with shortness of breath and frequent episodes of cough-induced syncope. A large pericardial effusion was found on echocardiogram suggestive of cardiac tamponade. Pericardiocentesis was done which improved the dyspnea and eventually resolved the syncope. There are only two other cases reported in the literature with cough-induced syncope in the setting of pericardial effusion or cardiac tamponade. Our clinical vignette also highlights the importance of pulsus paradoxus identification in patients with cough induced syncope to rule out cardiac tamponade since this is the most sensitive physical finding for its diagnosis.

摘要

我们报告一例75岁男性，有肺腺癌病史，出现呼吸急促和频繁的咳嗽性晕厥发作。超声心动图发现大量心包积液，提示心脏压塞。进行了心包穿刺术，改善了呼吸困难并最终缓解了晕厥。文献中仅报道了另外两例在心包积液或心脏压塞情况下出现咳嗽性晕厥的病例。我们的临床病例也强调了在咳嗽性晕厥患者中识别奇脉以排除心脏压塞的重要性，因为这是其诊断最敏感的体格检查发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d3d/5442416/f183ac77de4a/WJC-9-466-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d3d/5442416/d1449832d69d/WJC-9-466-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d3d/5442416/7b03df917f6e/WJC-9-466-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d3d/5442416/f183ac77de4a/WJC-9-466-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d3d/5442416/d1449832d69d/WJC-9-466-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d3d/5442416/7b03df917f6e/WJC-9-466-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d3d/5442416/f183ac77de4a/WJC-9-466-g003.jpg

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1
Cough induced syncope: A hint to cardiac tamponade diagnosis.咳嗽性晕厥：心脏压塞诊断的一个线索。
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本文引用的文献

1
Unusual presentation of pericardial effusion.心包积液的不寻常表现。
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The syndrome of cardiac tamponade with "small" pericardial effusion.伴有“少量”心包积液的心包填塞综合征
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Sensitivity and specificity of echocardiographic evidence of tamponade: implications for ventricular interdependence and pulsus paradoxus.心包填塞超声心动图证据的敏感性和特异性：对心室相互依存和奇脉的影响
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Does this patient with a pericardial effusion have cardiac tamponade?这位心包积液患者是否存在心脏压塞？
JAMA. 2007 Apr 25;297(16):1810-8. doi: 10.1001/jama.297.16.1810.
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Cough syncope from constrictive pericarditis: a case report.缩窄性心包炎所致咳嗽性晕厥：一例报告
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Diastolic atrial compression: a sensitive echocardiographic sign of cardiac tamponade.
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