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心肌梗死合并心肌炎时出现的心源性休克病例报告:高级超声心动图参数的作用

Cardiogenic shock presenting in myocardial infarction with myocarditis case report: The role of advanced echocardiography parameter.

作者信息

Alsagaff Mochamad Yusuf, Devi Putu Dwipa Krisna, Budianto Christian Pramudita, Susilo Hendri

机构信息

Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia.

Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Airlangga University Hospital, Surabaya, Indonesia.

出版信息

SAGE Open Med Case Rep. 2023 Oct 24;11:2050313X231208513. doi: 10.1177/2050313X231208513. eCollection 2023.

Abstract

Myocarditis is distinguished by a wide array of nonspecific symptoms, including chest pain, dyspnea, and palpitations. These symptoms are accompanied by electrocardiographic abnormalities that exhibit similarities to those observed in myocardial infarction. However, the results of coronary angiography frequently, though not consistently, show normal findings. Therefore, the clinical diagnostic procedure often encounters difficulties and is susceptible to the misdiagnosis of myocardial infarction with nonobstructive coronary arteries. The signs of poor cardiac contractility are a common manifestation of myocarditis and can be evaluate with bedside echocardiography. Two-dimensional speckle tracking echocardiography bestows a precise left ventricle (LV) global and regional dysfunction . We present a case of a 40-year-old man with typical chest pain for 8 hours, and dyspnea. He had no significant medical history. This patient was first diagnosed with high lateral ST-elevation myocardial infarction (STEMI) with cardiogenic shock. Angiography examination revealed no significant obstruction of coronary vessels. However, serial left ventricle global longitudinal strain supports the diagnosis of myocarditis. After receiving the treatment for myocarditis, the patient makes a full recovery within 7 days.

摘要

心肌炎的特点是有一系列非特异性症状,包括胸痛、呼吸困难和心悸。这些症状伴有心电图异常,与心肌梗死中观察到的异常相似。然而,冠状动脉造影结果虽然并非总是如此,但常常显示正常。因此,临床诊断过程常常遇到困难,容易将非阻塞性冠状动脉的心肌梗死误诊。心脏收缩功能不良的体征是心肌炎的常见表现,可通过床边超声心动图进行评估。二维斑点追踪超声心动图可精确评估左心室整体和局部功能障碍。我们报告一例40岁男性,有8小时典型胸痛及呼吸困难症状。他没有重大病史。该患者最初被诊断为高位侧壁ST段抬高型心肌梗死(STEMI)并伴有心源性休克。血管造影检查显示冠状动脉无明显阻塞。然而,连续的左心室整体纵向应变支持心肌炎的诊断。接受心肌炎治疗后,患者在7天内完全康复。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb83/10599106/3d17f2488d15/10.1177_2050313X231208513-fig1.jpg

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