Khan Zahid, Besis George, Tomson Joseph
Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR.
Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR.
Cureus. 2022 Sep 12;14(9):e29096. doi: 10.7759/cureus.29096. eCollection 2022 Sep.
Cardiac resynchronization therapy-defibrillator (CRT-D) and/or cardiac resynchronization therapy-pacemaker (CRT-P) play an important role in improving cardiac synchronization and reducing the risk of ventricular fibrillation arrest (VFA) in patients with severe left ventricular systolic dysfunction (LVSD). Patients with LVSD may notice worsening symptoms when CRT-D or CRT-P is in dyssynchrony. We present a case of 59-year-old patient who presented with worsening shortness of breath (SOB) and progressive exertional dyspnea for the past few weeks accompanied by pink, frothy sputum, occasional urinary incontinence and urge. He was known to have severe LVSD with an ejection fraction of 10% and had CRT-D in situ. Clinical examination revealed bilateral crepitation and normal heart sounds. A chest radiograph showed pulmonary oedema. An electrocardiogram (ECG) showed atrial fibrillation (AF)/flutter with wide QRS complexes. The patient was treated for acute pulmonary oedema and had CRT-D reprogrammed to achieve biventricular synchrony. He was treated with intravenous furosemide and alternate day metolazone initially. He showed significant subjective and objective improvement and was planned for outpatient synchronized intra-device cardioversion. This case is important because patients with severe LVSD with malfunctioning cardiac resynchronization therapy can result in worsening heart failure (HF) leading to higher morbidity and mortality.
心脏再同步化治疗除颤器（CRT-D）和/或心脏再同步化治疗起搏器（CRT-P）在改善心脏同步性以及降低严重左心室收缩功能障碍（LVSD）患者发生心室颤动骤停（VFA）风险方面发挥着重要作用。当CRT-D或CRT-P不同步时，LVSD患者可能会注意到症状恶化。我们报告一例59岁患者，在过去几周出现气短（SOB）加重和进行性劳力性呼吸困难，伴有粉红色泡沫痰、偶尔的尿失禁和尿急。已知他患有严重LVSD，射血分数为10%，体内植入了CRT-D。临床检查发现双侧捻发音，心音正常。胸部X线片显示肺水肿。心电图（ECG）显示房颤（AF）/房扑伴宽QRS波群。该患者接受了急性肺水肿治疗，并对CRT-D进行重新编程以实现双心室同步。最初给予静脉注射呋塞米和隔日服用美托拉宗治疗。他在主观和客观上都有显著改善，并计划进行门诊设备内同步心脏复律。这个病例很重要，因为严重LVSD且心脏再同步化治疗功能异常的患者可能会导致心力衰竭（HF）恶化，从而导致更高的发病率和死亡率。
