Parikh Rushi V, Boyd Jack, Lee David P, Witteles Ronald
Tex Heart Inst J. 2018 Feb 1;45(1):42-44. doi: 10.14503/THIJ-17-6208. eCollection 2018 Feb.
Methamphetamine abuse is an increasingly prevalent cause of pulmonary artery hypertension in the United States. Conversely, an atrial septal defect rarely presents late as pulmonary artery hypertension. We present the case of a 44-year-old methamphetamine abuser who had a 3-month history of worsening fatigue and near-syncope. She had elevated cardiac enzyme levels and right-sided heart strain. Angiographic findings suggested methamphetamine-induced pulmonary artery hypertension; however, we later heard S irregularities that raised suspicion of an atrial septal defect. Ultimately, the diagnosis was pulmonary artery hypertension and a large secundum atrial septal defect with left-to-right flow. One year after defect closure, the patient was asymptomatic. In addition to discussing this unexpected case of a secundum atrial septal defect masquerading as methamphetamine-induced pulmonary artery hypertension, we briefly review the natural history of atrial septal defects and emphasize the importance of thorough examination in avoiding diagnostic anchoring bias.
在美国，甲基苯丙胺滥用是肺动脉高压日益普遍的一个病因。相反，房间隔缺损很少以肺动脉高压的形式晚发。我们报告一例44岁甲基苯丙胺滥用者的病例，该患者有3个月疲劳加重和接近晕厥的病史。她的心肌酶水平升高且右心劳损。血管造影结果提示甲基苯丙胺所致的肺动脉高压；然而，后来我们听到了一些异常情况，这引发了对房间隔缺损的怀疑。最终诊断为肺动脉高压和一个伴有左向右分流的大型继发孔房间隔缺损。缺损闭合一年后，患者无症状。除了讨论这例伪装成甲基苯丙胺所致肺动脉高压的继发孔房间隔缺损的意外病例外，我们还简要回顾了房间隔缺损的自然病程，并强调了全面检查对于避免诊断性锚定偏倚的重要性。
