Kumar Anupam A, Tran Lena E, Rali Aniket S, Perez Alexander, Hoffman Robert, Schlendorf Kelly
Division of Cardiovascular Diseases, Vanderbilt University Medical Center Nashville, TN, US.
Department of Internal Medicine, Vanderbilt University Medical Center Nashville,TN, US.
Card Fail Rev. 2022 Jun 20;8:e19. doi: 10.15420/cfr.2022.05. eCollection 2022 Jan.
A 46-year-old man with systolic heart failure, end-stage renal disease on dialysis, ventricular tachycardia and pulmonary sarcoidosis presented with decompensated heart failure and cardiogenic shock of unknown aetiology. The hospital course was complicated by worsening shock requiring inotropic and mechanical circulatory support, as well as eventual dual heart and kidney transplantation. Cardiac imaging was used to assess the aetiology of the patient's non-ischaemic cardiomyopathy, including a PET scan and cardiac MRI. Imaging demonstrated findings consistent with left ventricular non-compaction, but was inconclusive for cardiac sarcoidosis. After eventual heart transplantation, histopathology of the patient's explanted heart showed evidence of both non-compaction and cardiac sarcoidosis. In this case report, the authors review the pathophysiology of both cardiac sarcoidosis and left ventricular non-compaction, and highlight a multimodality approach to the diagnosis of non-ischaemic cardiomyopathy.
一名46岁男性，患有收缩性心力衰竭、终末期肾病且正在接受透析、室性心动过速和肺结节病，因病因不明的失代偿性心力衰竭和心源性休克入院。住院期间病情复杂，休克不断恶化，需要使用正性肌力药物和机械循环支持，最终接受了心脏和肾脏联合移植。心脏成像用于评估患者非缺血性心肌病的病因，包括PET扫描和心脏MRI。成像结果显示与左心室心肌致密化不全相符，但对于心脏结节病的诊断尚无定论。最终心脏移植后，患者切除心脏的组织病理学检查显示存在心肌致密化不全和心脏结节病。在本病例报告中，作者回顾了心脏结节病和左心室心肌致密化不全的病理生理学，并强调了采用多模态方法诊断非缺血性心肌病。
