Sano Yukie, Kato Toshimitsu, Takama Noriaki, Hisanaga Etsuko, Matsumoto Naohiro, Amanai Shiro, Ishibashi Yohei, Aihara Kazufumi, Nagasaka Takashi, Koitabashi Norimichi, Kaneko Yoshiaki, Yokoo Hideaki, Ishii Hideki
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
Department of Pathology, Gunma University Hospital, Maebashi, Japan.
J Cardiol Cases. 2022 Aug 28;26(6):395-398. doi: 10.1016/j.jccase.2022.08.008. eCollection 2022 Dec.
An 81-year-old man was admitted to the hospital because of decreased level of consciousness. He had bradycardia (27 beats/min). Electrocardiography showed ST-segment elevation in leads II, III, and aVF and ST-segment depression in leads aVL, V1. Transthoracic echocardiography (TTE) visualized reduced motion of the left ventricular (LV) inferior wall and right ventricular (RV) free wall. Coronary angiography revealed occlusion of the right coronary artery. A primary percutaneous coronary intervention was successfully performed with temporary pacemaker backup. On the third day, the sinus rhythm recovered, and the temporary pacemaker was removed. On the fifth day, a sudden cardiac arrest occurred. Extracorporeal cardiopulmonary resuscitation was performed. TTE showed a high-echoic effusion around the right ventricle, indicating a hematoma. The drainage was ineffective. He died on the eighth day. An autopsy showed the infarcted lesion and an intramural hematoma in the RV. However, no definite perforation of the myocardium was detected. The hematoma extended to the epicardium surface, indicative of oozing-type RV rupture induced by RV infarction. The oozing-type rupture induced by RV infarction might develop asymptomatically without influence on the vital signs of the patient. Frequent echocardiographic evaluation is essential in cases of RV infarction taking care of silent oozing-type rupture.
Inferior left ventricular infarction sometimes complicates right ventricular (RV) infarction. The typical manifestations of RV infarction include low blood pressure, low cardiac output, and elevated right atrium pressure. Although the frequency is low, fatal complications of oozing-type RV rupture might progress asymptomatically. Frequent echocardiographic screening is necessary to detect them.
一名81岁男性因意识水平下降入院。他有心动过缓（27次/分钟）。心电图显示Ⅱ、Ⅲ、aVF导联ST段抬高，aVL、V1导联ST段压低。经胸超声心动图（TTE）显示左心室下壁和右心室游离壁运动减弱。冠状动脉造影显示右冠状动脉闭塞。在临时起搏器备用的情况下成功进行了一次急诊经皮冠状动脉介入治疗。第三天，窦性心律恢复，临时起搏器被移除。第五天，发生心脏骤停。进行了体外心肺复苏。TTE显示右心室周围有高回声积液，提示血肿形成。引流无效。他在第八天死亡。尸检显示右心室有梗死灶和壁内血肿。然而，未检测到明确的心肌穿孔。血肿延伸至心外膜表面，提示由右心室梗死引起的渗出型右心室破裂。右心室梗死引起的渗出型破裂可能无症状地发展，而不影响患者的生命体征。对于右心室梗死患者，频繁的超声心动图评估对于发现无症状的渗出型破裂至关重要。
左心室下壁梗死有时会并发右心室梗死。右心室梗死的典型表现包括低血压、低心输出量和右心房压力升高。尽管发生率较低，但渗出型右心室破裂的致命并发症可能无症状地进展。需要频繁进行超声心动图筛查以检测到它们。
