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钝性胸部创伤后心肌梗死:一例报告。

Myocardial infarction following a blunt chest trauma: A case report.

作者信息

Li Xiangdong, Wang Zhiyuan, Yang Yushuang, Meng Fanbo, He Yuquan, Yang Ping

机构信息

Cardiology Department.

Ultrasound Department, China-Japan Union Hospital of JiLin University, Changchun, Jilin, China.

出版信息

Medicine (Baltimore). 2019 Jan;98(4):e14103. doi: 10.1097/MD.0000000000014103.

Abstract

RATIONALE

Blunt cardiac injury (BCI) is a common complication after blunt chest trauma, which can lead to mild arrhythmia, severe chamber or valvular rupture, or even death. Myocardial infarction following blunt chest trauma is a rare but fatal condition.

PATIENT CONCERNS

A 38-year-old, previously healthy, man was admitted to our hospital with a complaint of dyspnea. He had a history of being hit in the chest by a high-speed screw while working in a factory 3 months before he was admitted to the hospital.

DIAGNOSIS

After performing coronary angiography and echocardiography, he was finally diagnosed with myocardial infarction.

INTERVENTIONS

He received optimized medications, including diuretics, β-blockers, and cardiac stimulants.

OUTCOMES

At the 4-year follow-up, the patient was diagnosed as having chronic heart failure with a reduced ejection fraction.

LESSONS

Owing to the first doctor's lack of experience and knowledge with this case, the patient was misdiagnosed and treatment was delayed, which subsequently led to heart failure.BCI can lead to myocardial infarction if patients are misdiagnosed and treatment is delayed. Thus, surgeons and physicians should consider cardiac complications in patients with chest trauma to reduce the incidence of its misdiagnosis.

摘要

理论依据

钝性心脏损伤(BCI)是钝性胸部创伤后的常见并发症,可导致轻度心律失常、严重的心腔或瓣膜破裂,甚至死亡。钝性胸部创伤后心肌梗死是一种罕见但致命的情况。

患者情况

一名38岁、既往健康的男性因呼吸困难入院。他在入院前3个月于工厂工作时胸部被高速螺丝击中。

诊断

在进行冠状动脉造影和超声心动图检查后,他最终被诊断为心肌梗死。

干预措施

他接受了优化药物治疗,包括利尿剂、β受体阻滞剂和心脏兴奋剂。

结果

在4年随访时,患者被诊断为射血分数降低的慢性心力衰竭。

经验教训

由于首诊医生对此病例缺乏经验和认识,患者被误诊且治疗延误,随后导致心力衰竭。如果患者被误诊且治疗延误,BCI可导致心肌梗死。因此,外科医生和内科医生应考虑胸部创伤患者的心脏并发症,以降低误诊发生率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae13/6358399/2c8aead24ad0/medi-98-e14103-g001.jpg

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