Cui Jian
Department of Emergency Medicine, Mercy Health St. Rita's Medical Center, 730 W. Market Street, Lima, OH, 45801, USA.
Int J Emerg Med. 2024 Oct 8;17(1):147. doi: 10.1186/s12245-024-00737-8.
Acute mesenteric ischemia (AMI) usually presents with abrupt and severe abdominal pain associated with nausea and vomiting. This case is notable due to the occurrence of AMI secondary to acute systolic heart failure caused by new onset complete heart block.
A 65-year-old male presented with sudden onset epigastric pain. ECG showed complete AV block and acute ischemia, and a subsequent CTA revealed complete occlusion of the mid superior mesenteric artery. His emergent left heart catheterization showed non-occlusive coronary artery disease. The patient underwent emergent laparotomy and SMA thrombectomy. Postoperative complications included worsening congestive heart failure and persistent bradycardia, requiring a permanent pacemaker. The patient was discharged to a skilled nursing facility in stable condition.
This case highlights the diagnostic challenges of AMI in the setting of acute heart failure and new onset AV block mimicking acute cardiac events and emphasizes the importance of a multidisciplinary approach in managing such complex cases.
急性肠系膜缺血（AMI）通常表现为突发的剧烈腹痛，并伴有恶心和呕吐。该病例因新发完全性心脏传导阻滞导致急性收缩性心力衰竭继发AMI而值得关注。
一名65岁男性突发上腹部疼痛。心电图显示完全性房室传导阻滞和急性缺血，随后的CT血管造影显示肠系膜上动脉中段完全闭塞。他紧急进行的左心导管检查显示为非闭塞性冠状动脉疾病。患者接受了紧急剖腹手术和肠系膜上动脉血栓切除术。术后并发症包括充血性心力衰竭恶化和持续性心动过缓，需要植入永久性起搏器。患者出院后入住熟练护理机构，病情稳定。
该病例突出了在急性心力衰竭和新发房室传导阻滞背景下，AMI的诊断挑战，这些情况会模仿急性心脏事件，并强调了多学科方法在处理此类复杂病例中的重要性。
