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床旁超声检查识别出一名患有甲基苯丙胺相关性心肌病的年轻男性,在严重脓毒症时就诊于急诊科,出现失代偿性心力衰竭。

Point-of-Care Ultrasound Identifies Decompensated Heart Failure in a Young Male with Methamphetamine-Associated Cardiomyopathy Presenting in Severe Sepsis to the Emergency Department.

作者信息

Kinas David, Dalley Michael, Guidry Kayla, Newberry Mark A, Farcy David A

机构信息

Mount Sinai Medical Center, 4300 Alton rd., Miami Beach, FL 33140, USA.

FIU Herbert Wertheim College of Medicine, 1120 SW 8th st., Miami, FL 33199, USA.

出版信息

Case Rep Emerg Med. 2018 Oct 9;2018:2859676. doi: 10.1155/2018/2859676. eCollection 2018.

Abstract

We describe a case of a young male who presents to the emergency department with severe sepsis and decompensated heart failure with underlying Methamphetamine-Associated Cardiomyopathy that was previously undiagnosed. This presentation is unique because Methamphetamine-Associated Cardiomyopathy is an uncommonly reported condition that presented in a complex clinical scenario of severe sepsis and decompensated congestive heart failure. We discuss how we used point-of-care ultrasound (POCUS) in this case to identify an unsuspected disease process and how it changed our initial resuscitation strategy and management. Emergency physicians can utilize point-of-care ultrasound (POCUS) to help identify these high-risk patients in the emergency department and guide appropriate resuscitation. Methamphetamine-Associated Cardiomyopathy (MAC) is an infrequently described complication of methamphetamine abuse, most commonly presented as a nonischemic dilated cardiomyopathy. With the rise in methamphetamine abuse in the United States, complications from methamphetamine use are more commonly presenting to the emergency department. Proper education and rehabilitation, with a goal of abstinence from amphetamine use, may allow patients to potentially regain normal cardiac function. Since the majority of patients present late with severe cardiac dysfunction, early detection is essential amongst critically ill patients since recognition may significantly influence ED management.

摘要

我们描述了一例年轻男性病例,该患者因严重脓毒症和失代偿性心力衰竭就诊于急诊科,其潜在病因是先前未被诊断出的甲基苯丙胺相关性心肌病。该病例表现独特,因为甲基苯丙胺相关性心肌病是一种较少报道的病症,出现在严重脓毒症和失代偿性充血性心力衰竭的复杂临床情况中。我们讨论了在此病例中如何使用床旁超声(POCUS)来识别一个未被怀疑的疾病过程,以及它如何改变了我们最初的复苏策略和管理。急诊医生可以利用床旁超声(POCUS)来帮助在急诊科识别这些高危患者并指导适当的复苏。甲基苯丙胺相关性心肌病(MAC)是甲基苯丙胺滥用一种较少被描述的并发症,最常见的表现为非缺血性扩张型心肌病。随着美国甲基苯丙胺滥用情况的增加,使用甲基苯丙胺导致的并发症更频繁地出现在急诊科。以戒除苯丙胺使用为目标的适当教育和康复治疗,可能使患者有可能恢复正常心脏功能。由于大多数患者出现严重心脏功能障碍时已为时较晚,因此在重症患者中早期检测至关重要,因为识别可能会显著影响急诊科的管理。

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本文引用的文献

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