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病例报告:床旁超声心动图在诊断心肌梗死后室间隔破裂中的应用

A Case Report: Point-of-care Ultrasound in the Diagnosis of Post-Myocardial Infarction Ventricular Septal Rupture.

作者信息

Portuguese Andrew J, Abdulla Khaled H, Vornovitsky Michael, DeAngelis John

机构信息

University of Rochester Medical Center, Department of Medicine, Rochester, New York.

University of Rochester Medical Center, Department of Cardiology, Rochester, New York.

出版信息

Clin Pract Cases Emerg Med. 2020 Aug;4(3):407-410. doi: 10.5811/cpcem.2020.4.47073.

Abstract

INTRODUCTION

Ventricular septal rupture (VSR) is a rare complication of ST-elevation myocardial infarction (STEMI), typically discovered post-revascularization.

CASE REPORT

We present the first case of VSR detected on point-of-care ultrasound (POCUS) in the emergency department immediately prior to emergent angiography, with management positively affected by this discovery. The VSR was quickly confirmed via right heart catheterization. Subsequently, hemodynamic stability was achieved using an intra-aortic balloon pump. A delayed surgical VSR repair, with concomitant coronary artery bypass grafting, was implemented for definitive management.

CONCLUSION

This case highlights the utility of POCUS in a STEMI patient with a suspected mechanical complication.

摘要

引言

室间隔破裂(VSR)是ST段抬高型心肌梗死(STEMI)的一种罕见并发症,通常在血管重建术后被发现。

病例报告

我们报告了首例在急诊血管造影术前即刻通过床旁超声(POCUS)在急诊科检测到的VSR病例,这一发现对治疗产生了积极影响。通过右心导管检查迅速确诊了VSR。随后,使用主动脉内球囊泵实现了血流动力学稳定。为进行确定性治疗,实施了延迟的外科VSR修复术并同期进行冠状动脉旁路移植术。

结论

本病例突出了POCUS在疑似机械性并发症的STEMI患者中的应用价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/66bb/7434273/1de425cbd6fc/cpcem-04-407-g001.jpg

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