[格雷夫斯病继发急性自身免疫性心肌炎：一例报告]
[Acute autoimmune myocarditis secondary to Graves' disease: a case report].
作者信息
Demoulin R, Poyet R, Parsai C, Capilla E, Rohel G, Pons F, Jego C, Cellarier G R
机构信息
Service de Cardiologie et Maladies Vasculaires, Hôpital d'Instruction des Armées Sainte Anne, BCRM Toulon, BP 600, 83800 Toulon Armées Cedex 9, France.
Service de Cardiologie et Maladies Vasculaires, Hôpital d'Instruction des Armées Sainte Anne, BCRM Toulon, BP 600, 83800 Toulon Armées Cedex 9, France.
出版信息
Rev Med Interne. 2020 Mar;41(3):206-209. doi: 10.1016/j.revmed.2019.12.017. Epub 2020 Jan 22.
INTRODUCTION
Interactions between heart and thyroid are strong. Main cardiac complications of Graves' disease are supra-ventricular tachycardia or high output cardiac failure, without real myocardial involvement.
OBSERVATION
A 40-year-old man with history of refractory Graves' disease was hospitalized for an acute chest pain with elevated cardiac biomarkers and normal coronarography. Acute myocarditis was confirmed by cardiac MRI. We found no evidence for an infectious etiology. We retained the hypothesis of acute autoimmune myocarditis in the context of active Graves' disease.
CONCLUSION
Acute myocarditis is an exceptional complication of Graves' disease, with most likely an autoimmune mechanism. Possible occurrence of fulminant rhythmic or hemodynamic complications justify minimal cardiological check-up before introducing beta blockers.
引言
心脏与甲状腺之间存在密切相互作用。格雷夫斯病的主要心脏并发症是室上性心动过速或高输出量心力衰竭，而无真正的心肌受累。
观察
一名有难治性格雷夫斯病病史的40岁男性因急性胸痛入院，其心脏生物标志物升高而冠状动脉造影正常。心脏磁共振成像确诊为急性心肌炎。我们未发现感染病因的证据。我们保留了在活动性格雷夫斯病背景下急性自身免疫性心肌炎的假说。
结论
急性心肌炎是格雷夫斯病的一种罕见并发症，很可能由自身免疫机制引起。可能出现的暴发性节律或血流动力学并发症说明在使用β受体阻滞剂之前进行最低限度的心脏检查是合理的。
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