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一名中年成人出现胸痛和休克伴严重左心室流出道梗阻的病例报告。

A case report of severe left ventricular outflow tract obstruction in a middle-aged adult with chest pain and shock.

作者信息

Chen Chengzhi, Yang Xiaoyan, Hu Yao

机构信息

Department of Cardiology, Liuyang People Hospital, Liuyang, 410300, China.

出版信息

Heliyon. 2024 Aug 3;10(16):e35337. doi: 10.1016/j.heliyon.2024.e35337. eCollection 2024 Aug 30.

DOI:10.1016/j.heliyon.2024.e35337
PMID:39220982
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11364267/
Abstract

Severe left ventricular outflow tract obstruction (LVOTO) of hypertrophic cardiomyopathy is an acutely life-threatening, must-not miss, cardiology emergency that infrequently presents to the emergency department (ED). Patients with this condition usually manifest chest pain, syncope, cardiogenic shock, and severe ischemia. LVOTO is easy misdiagnosed as acute coronary syndrome. In our patient, the ECG showed a significant ST-segment depression and a 0/0 mmHg blood pressure when the peak left ventricular outflow tract gradient was abruptly increased by provocable activities. However, the patient had normal coronaries on cardiac catheterization, and, upon being immediately treated with intravenous esmolol, his symptoms were relieved and blood pressure was normal after 30 minutes. This case highlights, not only that early and exact diagnosis of LVOTO is crucial, but also the importance of the therapeutic strategies used.

摘要

肥厚型心肌病所致的严重左心室流出道梗阻（LVOTO）是一种急性危及生命、绝不能漏诊的心血管急症，很少出现在急诊科（ED）。患有这种疾病的患者通常表现为胸痛、晕厥、心源性休克和严重缺血。LVOTO很容易被误诊为急性冠状动脉综合征。在我们的患者中，当通过激发活动使左心室流出道峰值梯度突然增加时，心电图显示ST段明显压低，血压为0/0 mmHg。然而，该患者心脏导管检查显示冠状动脉正常，在立即接受静脉注射艾司洛尔治疗后，30分钟后症状缓解，血压恢复正常。这个病例不仅强调了LVOTO早期准确诊断的重要性，还凸显了所采用治疗策略的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fbd/11364267/6fa300c97110/fx8.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fbd/11364267/6fa300c97110/fx8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fbd/11364267/3ba1e1f63afe/fx1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fbd/11364267/afc0b53b29d4/fx2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fbd/11364267/49bc73cbd673/fx3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fbd/11364267/043bb483203b/fx4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fbd/11364267/be6d3957b25d/fx5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fbd/11364267/34f1594ee34d/fx6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fbd/11364267/0543b2b28ffe/fx7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fbd/11364267/6fa300c97110/fx8.jpg

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Dynamic improvement of an acute exacerbated subaortic pressure gradient after intravenous propranolol and cibenzoline, recorded using a pressure wire: a case report.使用压力导丝记录静脉注射普萘洛尔和西苯唑啉后急性加重的主动脉下压力梯度的动态改善：病例报告
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