严重中暑合并应激性心肌病。
Severe heatstroke complicated with Takotsubo cardiomyopathy.
作者信息
Tada Yuusuke, Fukushima Hidetada, Watanabe Tomoo, Ito Shingo, Norimoto Kazunobu, Ueyama Tooru, Okuchi Kazuo
机构信息
Department of Emergency and Critical Care Medicine Nara Medical University Kashihara Nara Japan.
出版信息
Acute Med Surg. 2015 Aug 27;3(2):174-177. doi: 10.1002/ams2.151. eCollection 2016 Apr.
CASE
A 69 year-old female with history of schizophrenia was transported to our hospital by ambulance due to coma. On arrival, she was hypotensive and tachycardic with a Glasgow coma scale score of 3 and a rectal core temperature of 40°C. Heatstroke was strongly suspected as the cause of the coma and hypotension. Active external cooling with an electric fan and cooled IV fluid administration were started. Her electrocardiogram (EKG) showed ST elevation in V2-6, II, III and aVF. Echocardiography revealed apical ballooning, which indicated Takotsubo cardiomyopathy. Coronary angiography indicated normal coronary arteries.
OUTCOME
After admission to the intensive care unit, her cardiovascular status gradually improved and she was transferred to the psychiatric ward on day 36.
CONCLUSION
Heatstroke and Takotsubo cardiomyopathy can share the same pathophysiology. Close evaluation of hemodynamic status and myocardial damage is critical for survival.
病例
一名69岁有精神分裂症病史的女性因昏迷被救护车送往我院。入院时，她血压降低、心率加快，格拉斯哥昏迷量表评分为3分，直肠核心温度为40°C。强烈怀疑中暑是昏迷和低血压的原因。开始用电风扇进行主动体表降温并给予冷却的静脉输液。她的心电图（EKG）显示V2 - 6、II、III和aVF导联ST段抬高。超声心动图显示心尖部气球样改变，提示应激性心肌病。冠状动脉造影显示冠状动脉正常。
转归
入住重症监护病房后，她的心血管状况逐渐改善，并于第36天转至精神科病房。
结论
中暑和应激性心肌病可能具有相同的病理生理学机制。密切评估血流动力学状态和心肌损伤对生存至关重要。
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