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[一名44岁女性患者的房室传导阻滞和左心室壁运动障碍:一例罕见且有陷阱的病例报告]

[Atrioventricular block and left ventricular wall mobility disorder in a 44-year-old female patient : A case report of a rarity with pitfalls].

作者信息

Stempfl J, Schumacher F, Doering M, Wolf H, Streithoff F, Tacke J, Fahn H, Ehlermann P, Raake P, Klingel K, Elsner D, Groebner M

机构信息

3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland.

Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland.

出版信息

Internist (Berl). 2019 Sep;60(9):973-981. doi: 10.1007/s00108-019-0608-5.

Abstract

Eosinophilic myocarditis is a rare condition with good treatment options, which can be difficult to diagnose. The clinical presentation can vary from asymptomatic to life-threatening forms. This article describes the case of a 44-year-old woman who suffered from vertigo, chest pain and dyspnea. The woman presented with an intermittent atrioventricular (AV) block II Mobitz type II° and mild impairment of left ventricular ejection fraction. Hypereosinophilia in the peripheral blood, cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy led to the diagnosis of eosinophilic myocarditis, most likely as a result of an allergic reaction to Aspergillus fumigatus. A general treatment recommendation cannot be made due to the lack of evidence-based guidelines; however, recent scientific studies confirmed timely, high-dose steroid administration over several months to be the mainstay of treatment of eosinophilic myocarditis. The following article may be helpful in the early diagnosis and treatment of this underdiagnosed and insidious disease.

摘要

嗜酸性粒细胞性心肌炎是一种罕见疾病,虽有良好的治疗方案,但诊断可能存在困难。其临床表现多样,从无症状到危及生命的形式都有。本文描述了一名44岁女性的病例,她患有眩晕、胸痛和呼吸困难。该女性表现为间歇性二度莫氏II型房室传导阻滞以及左心室射血分数轻度受损。外周血嗜酸性粒细胞增多、心脏磁共振成像(MRI)和心内膜活检确诊为嗜酸性粒细胞性心肌炎,最有可能是对烟曲霉过敏反应所致。由于缺乏循证指南,无法给出一般性治疗建议;然而,近期科学研究证实,数月内及时给予高剂量类固醇是嗜酸性粒细胞性心肌炎治疗的主要方法。以下文章可能有助于这种诊断不足且隐匿性疾病的早期诊断和治疗。

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