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一名在重症监护病房接受治疗的年轻患者的急性心力衰竭——诊断陷阱

Acute Heart Failure in a Young Patient Treated in ICU-Diagnostic Pitfalls.

作者信息

Surówka Łukasz, Andruszkiewicz Paweł, Budnik Monika, Kowalik Robert, Milner Agnieszka, Zawadka Mateusz

机构信息

2nd Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, 02-097 Warsaw, Poland.

Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland.

出版信息

Clin Pract. 2024 Sep 24;14(5):1953-1959. doi: 10.3390/clinpract14050155.

Abstract

and human herpesvirus 6 (HHV-6) are uncommon aetiological agents in respiratory tract infections and are rarely associated with cardiogenic shock. This case report presents a rare instance of severe cardiomyopathy linked to these infections in a 19-year-old Asian female. The case highlights the importance of considering a broad differential diagnosis in acute heart failure, especially in young adults. The patient was admitted with chest pain and diagnosed with ST-elevation myocardial infarction (STEMI) based on electrocardiography. She subsequently developed heart failure, with a marked reduction in myocardial contractility and a left ventricular ejection fraction (LVEF) of 20%. Treatment included broad-spectrum antibiotics and inotropic support guided by hemodynamic monitoring, leading to clinical improvement. The patient was discharged in a significantly improved condition following a stay in the intensive care unit (ICU). This case emphasizes the importance of considering Takotsubo syndrome in differential diagnoses, especially in ICU patients presenting with cardiogenic shock, to improve outcomes and reduce mortality through timely and appropriate management. Inotropic support, often used in the ICU to treat hypoperfusion, may worsen outcomes in patients with Takotsubo syndrome by exacerbating basal hypercontractility and prolonging the acute phase through catecholamine receptor activation.

摘要

人类疱疹病毒6型(HHV - 6)是呼吸道感染中不常见的病原体,很少与心源性休克相关。本病例报告展示了一名19岁亚洲女性因这些感染导致严重心肌病的罕见病例。该病例强调了在急性心力衰竭中,尤其是在年轻人中,考虑广泛鉴别诊断的重要性。患者因胸痛入院,基于心电图诊断为ST段抬高型心肌梗死(STEMI)。随后她发展为心力衰竭,心肌收缩力显著降低,左心室射血分数(LVEF)为20%。治疗包括广谱抗生素和在血流动力学监测指导下的强心支持,临床症状得到改善。患者在重症监护病房(ICU)住院后出院时病情明显好转。本病例强调了在鉴别诊断中考虑应激性心肌病的重要性,尤其是在出现心源性休克的ICU患者中,通过及时恰当的管理改善预后并降低死亡率。ICU中常用于治疗灌注不足的强心支持,可能会因加剧基础高收缩性并通过儿茶酚胺受体激活延长急性期,从而使应激性心肌病患者的预后恶化。

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