Lucerna Alan, Lee James, Espinosa James
Program Director, Combined EM/IM Program, Rowan University SOM/Jefferson Health, Stratford, NJ, USA.
Emergency Medicine, Rowan University SOM/Jefferson Health, Stratford, NJ, USA.
Case Rep Emerg Med. 2018 Aug 2;2018:1853473. doi: 10.1155/2018/1853473. eCollection 2018.
Influenza is a contagious viral illness that usually presents with upper respiratory and pulmonary symptoms. While generally self-limited, pulmonary, renal, metabolic, neurologic, and cardiac complications have all been described in the literature. Here we describe a case of a 46-year-old male with multiple episodes of syncope, found to have severe bradycardia, sinus arrest, and positive influenza B, requiring permanent pacemaker placement. The viruses responsible for the flu can be differentiated into four types: A, B, C, and D. The two primary viruses responsible for the seasonal winter epidemic influenza in the United States are Human Influenza A and B viruses. It has been postulated that the influenza virus may be responsible for activating acute inflammatory cytokines, which then alter electrical conduction properties of endothelial cells. Although there have been cases of sinus arrest in association with influenza, some requiring pacemaker placement, our patient's presentation with multiple episodes of syncope with severe bradycardia and sinus arrest requiring permanent pacemaker placement, in association with influenza B, is very unusual and possibly unique. Since emergency physicians are at the forefront in the diagnosis, treatment, and disposition of these patients, awareness of influenza triggered cardiac events is essential and lifesaving, especially in unvaccinated patients.
流感是一种具有传染性的病毒性疾病，通常表现为上呼吸道和肺部症状。虽然一般为自限性疾病，但文献中已描述了其肺部、肾脏、代谢、神经和心脏并发症。在此，我们描述一例46岁男性病例，该患者多次发生晕厥，被发现有严重心动过缓、窦性停搏，且乙型流感病毒检测呈阳性，需要植入永久性起搏器。引起流感的病毒可分为四种类型：A、B、C和D。在美国，导致季节性冬季流行性感冒的两种主要病毒是甲型和乙型人流感病毒。据推测，流感病毒可能会激活急性炎症细胞因子，进而改变内皮细胞的电传导特性。虽然已有与流感相关的窦性停搏病例，有些需要植入起搏器，但我们的患者表现为多次晕厥，伴有严重心动过缓和窦性停搏，需要植入永久性起搏器，且与乙型流感相关，这种情况非常罕见，可能是独一无二的。由于急诊医生处于这些患者诊断、治疗和处置的前沿，认识到流感引发的心脏事件至关重要且能挽救生命，尤其是对于未接种疫苗的患者。
