Nishiwaki Takuro, Yamamoto Norihiko, Hirokawa Yoshihumi, Takei Yoshiyuki
Department of Gastroenterology and hepatology, Mie Daigaku Igakubu Fuzoku Byoin, Tsu, Mie, Japan.
Department of Oncologic Pathology, Mie University, Tsu, Mie, Japan.
BMJ Case Rep. 2018 Oct 25;2018:bcr-2018-224785. doi: 10.1136/bcr-2018-224785.
A 72-year-old man, who had been diagnosed as having hepatocellular carcinoma (HCC) with multiple extrahepatic metastasis, complained a general fatigue which appeared 2 weeks before admission. Because bradycardia was detected on physical examination, ECG was performed which revealed the complete atrioventricular (AV) block. We stopped Ca-blocker and β-blocker, but the bradycardia persisted. He was admitted to our hospital for an emergent pacemaker implantation. On admission, he complained dyspnoea. After the surgery, he died due to deterioration of heart failure. The autopsy revealed cardiac metastasis of HCC on AV node, so it was suspected that cardiac metastasis caused the AV block. We thought that the cause of his death was the exacerbation of heart failure associated with bradycardia. It was likely that complete AV block as a very rare complication caused by cardiac metastasis of HCC influenced the prognosis of this patient.
一名72岁男性，被诊断为肝细胞癌（HCC）伴多发肝外转移，入院前2周出现全身乏力。体格检查发现心动过缓，遂行心电图检查，结果显示完全性房室传导阻滞。我们停用了钙通道阻滞剂和β受体阻滞剂，但心动过缓仍持续存在。他因紧急植入起搏器入住我院。入院时，他主诉呼吸困难。术后，他因心力衰竭恶化死亡。尸检发现HCC心脏转移至房室结，因此怀疑心脏转移导致了房室传导阻滞。我们认为他的死亡原因是与心动过缓相关的心力衰竭加重。很可能是HCC心脏转移引起的极为罕见的并发症——完全性房室传导阻滞影响了该患者的预后。
