Cachia Richard, Taieb Jérome, Bun Sok-Sithikun, Dabry Thibaut, Trevisan Lory, Jouve Bernard
Service de Cardiologie, CH d'Aix en Provence.
Service de Cardiologie, CHU de Nice.
Ann Cardiol Angeiol (Paris). 2022 Jun;71(3):176-180. doi: 10.1016/j.ancard.2021.09.005. Epub 2021 Dec 23.
A 20-year-old patient is admitted to the emergency room for chest pain occurring in the context of recurrent left complete pneumothorax. Ultrasensitive troponinemia is elevated to 20 times normal. Myocardial distress is attributed to pneumothorax following the negativity of cardiological examinations (EKG, TTE, cardiac MRI). The pneumothorax is drained with a favorable evolution. This is the first reported case of pneumothorax associated with a significant elevation of troponin without ECG change, TakoTsubo syndrome, or myocardial inflammation. Several mechanisms are considered: rotation of the myocardium around its axis, increase in pulmonary vascular resistance with overload of right ventricular pressure, disturbance of coronary blood flow on significant mediastinal compression with decrease in systolo-diastolic myocardial perfusion.
一名20岁患者因反复出现左侧完全性气胸而胸痛，被收入急诊室。超敏肌钙蛋白血症升高至正常水平的20倍。在心脏检查（心电图、经胸超声心动图、心脏磁共振成像）均为阴性后，心肌窘迫归因于气胸。气胸经引流后病情好转。这是首例报告的气胸伴肌钙蛋白显著升高而无心电图改变、应激性心肌病或心肌炎症的病例。考虑了几种机制：心肌绕其轴旋转、肺血管阻力增加伴右心室压力过载、显著纵隔受压时冠状动脉血流紊乱伴收缩期-舒张期心肌灌注减少。
