Eni Gedoni, Ramirez Allison, Faiz Roshan, Solano Jhiamluka
Internal Medicine, Scunthorpe General Hospital, Scunthorpe, GBR.
Internal Medicine, Hospital General San Francisco, Olancho, HND.
Cureus. 2024 Sep 6;16(9):e68766. doi: 10.7759/cureus.68766. eCollection 2024 Sep.
Ischaemic cardiomyopathy (ICM) represents a common complication of coronary artery disease (CAD). Ischaemia causes ventricular remodelling, leading to an irreversible loss of myocardial tissue and adequate contractility, primarily affecting the left ventricular ejection fraction (LVEF). We present the case of a 46-year-old male known as hypertensive presented to the hospital with a five-week history of progressive exertional dyspnoea, bilateral lower limb oedema subsequently involving his scrotum and penis. He reported reduced oral intake and occasional palpitations but denied chest pain, cough, fever, or haemoptysis. He had no personal history of cardiac disease, recent travels, or recreational drug use. Notably, he consumed approximately 12 units of alcohol weekly and was a non-smoker. On admission, he was treated for new-onset heart failure, and initial investigations showed acute kidney injury, raised troponin, and brain natriuretic peptide (BNP), and chest X-ray showed an enlarged heart size (cardiothoracic ratio (CTR), 0.56) with moderate right pleural effusion. Echocardiography revealed a severely dilated left ventricle with severely impaired systolic function (LVEF 16%), bi-atrial dilatation, borderline dilated right ventricle with impaired systolic function, and moderate tricuspid regurgitation. Cardiac MRI showed that the left ventricle was severely dilated with severely impaired systolic function with nonviable mid to apical inferior and inferoseptal transmural post-ischaemic scar with associated hypokinesia. Ischaemic cardiomyopathy may vary from asymptomatic to severely symptomatic, commonly when symptomatic patients will present with anginal chest pain and dyspnoea on exertion. In contrast, asymptomatic patients can sometimes have up to 80% of transient ischaemic events with no chest pain or associated symptoms. This case underscores the importance of considering asymptomatic coronary artery disease in clinical practice and highlights the need for novel interventions and markers for early ischemia detection.
缺血性心肌病（ICM）是冠状动脉疾病（CAD）的常见并发症。缺血导致心室重构，导致心肌组织不可逆丧失和收缩功能不足，主要影响左心室射血分数（LVEF）。我们报告了一例46岁男性高血压患者，因进行性劳力性呼吸困难5周入院，随后出现双侧下肢水肿，累及阴囊和阴茎。他自述食欲减退，偶尔有心悸，但否认胸痛、咳嗽、发热或咯血。他无心脏病个人史、近期旅行史或使用消遣性药物史。值得注意的是，他每周饮酒约12单位，不吸烟。入院时，他因新发心力衰竭接受治疗，初步检查显示急性肾损伤、肌钙蛋白升高、脑钠肽（BNP）升高，胸部X线显示心脏增大（心胸比（CTR），0.56），伴有中度右侧胸腔积液。超声心动图显示左心室严重扩张，收缩功能严重受损（LVEF 16%），双房扩张，右心室临界扩张伴收缩功能受损，中度三尖瓣反流。心脏磁共振成像显示左心室严重扩张，收缩功能严重受损，中至心尖下壁和下间隔透壁性缺血后瘢痕形成，伴有运动减弱。缺血性心肌病的症状可能从无症状到严重症状不等，有症状的患者通常会出现心绞痛性胸痛和劳力性呼吸困难。相比之下，无症状患者有时可能有高达80%的短暂性缺血事件而无胸痛或相关症状。该病例强调了在临床实践中考虑无症状冠状动脉疾病的重要性，并突出了对早期缺血检测的新型干预措施和标志物的需求。
