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一名患有脓毒症性心肌病并伴有胎盘残留的患者出现鲨鱼鳍征：病例报告及文献综述

Shark Fin Sign in a Patient with Sepsis-induced Cardiomyopathy Associated with Retained Placenta: A Case Report and Review of the Literature.

作者信息

Ohnaga Yoshiyuki, Ono Ryohei, Aoki Kaoruko, Kato Hirotoshi, Iwahana Togo, Takaoka Hiroyuki, Omoto Akiko, Nakama Kaito, Kishimoto Takashi, Ikeda Jun-Ichiro, Kobayashi Yoshio

机构信息

Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan.

Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, Japan.

出版信息

Intern Med. 2025 Apr 1;64(7):1047-1052. doi: 10.2169/internalmedicine.3501-24. Epub 2024 Sep 4.

DOI:10.2169/internalmedicine.3501-24
PMID:39231682
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12021502/
Abstract

Retained placenta can lead to septic shock; however, sepsis-induced cardiomyopathy (SICM) due to retained placenta has not been reported previously. This report presents a rare case of SICM following septic shock due to retained placenta after miscarriage in a 40-year-old woman, accompanied by the "shark fin sign" on an electrocardiogram, a pattern typically linked to myocardial ischemia. She experienced ventricular tachycardia and required venoarterial extracorporeal membrane oxygenation; however, she was successfully treated. We also reviewed previous cases of shark fin sign in patients without myocardial infarction. A review showed that half of the cases experienced lethal arrhythmias, even without myocardial infarction.

摘要

胎盘残留可导致感染性休克；然而，此前尚未有因胎盘残留导致脓毒症性心肌病（SICM）的报道。本报告介绍了一例罕见病例，一名40岁女性流产后因胎盘残留发生感染性休克，继而引发SICM，其心电图出现“鲨鱼鳍征”，这一模式通常与心肌缺血有关。她出现室性心动过速，需要进行静脉-动脉体外膜肺氧合治疗；不过，她最终成功治愈。我们还回顾了既往无心肌梗死患者出现鲨鱼鳍征的病例。回顾显示，即使没有心肌梗死，半数病例也发生了致命性心律失常。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/73b994249325/1349-7235-64-1047-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/41d223451945/1349-7235-64-1047-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/5a128f49aa79/1349-7235-64-1047-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/0242519ae314/1349-7235-64-1047-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/b2c6009d44fb/1349-7235-64-1047-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/73b994249325/1349-7235-64-1047-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/41d223451945/1349-7235-64-1047-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/5a128f49aa79/1349-7235-64-1047-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/0242519ae314/1349-7235-64-1047-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/b2c6009d44fb/1349-7235-64-1047-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7df/12021502/73b994249325/1349-7235-64-1047-g005.jpg

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本文引用的文献

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Shark Fin Electrocardiogram: A Deadly Electrocardiogram Pattern in Takotsubo Cardiomyopathy During 15 Years of Follow-Up.鱼鳍样心电图：15年随访期间应激性心肌病中的一种致命心电图模式
Cureus. 2023 Mar 22;15(3):e36509. doi: 10.7759/cureus.36509. eCollection 2023 Mar.
3
Septic cardiomyopathy: A narrative review.脓毒症性心肌病：一篇叙述性综述。
Rev Port Cardiol. 2023 May;42(5):471-481. doi: 10.1016/j.repc.2021.05.020. Epub 2023 Mar 7.
4
Septic cardiomyopathy: Diagnosis and management.脓毒性心肌病：诊断与管理
J Intensive Med. 2021 Dec 27;2(1):8-16. doi: 10.1016/j.jointm.2021.11.004. eCollection 2022 Jan.
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Shark Fin Electrocardiogram in the Intensive Care Unit.重症监护病房中的鲨鱼鳍心电图。
Circulation. 2022 Oct 4;146(14):1099-1102. doi: 10.1161/CIRCULATIONAHA.122.062034. Epub 2022 Oct 3.
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Shark fin sign.鲨鱼鳍征
J Arrhythm. 2021 Jul 14;37(5):1362-1363. doi: 10.1002/joa3.12594. eCollection 2021 Oct.
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A 'shark'-masked electrocardiogram: case report of a Tako-Tsubo syndrome.一例“鲨鱼”面具样心电图：应激性心肌病病例报告
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Variant Angina with Spontaneously Documented Ischemia- and Tachycardia-induced "Lambda" Waves.变异型心绞痛伴自发性缺血和心动过速诱导的“λ”波。
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