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病因极为罕见的心力衰竭——3型血色素沉着症:一例报告

Heart failure of very rare aetiology-haemochromatosis Type 3: a case report.

作者信息

Montvilaitė-Laurinavičienė Aistė, Dirsienė Rūta, Neverauskaitė-Piliponienė Gintarė, Banišauskaitė Audra, Šukys Marius, Šakalytė Gintarė, Ereminienė Eglė

机构信息

Faculty of Medicine, Lithuanian University of Health Sciences, A. Mickevičiaus Str. 9, 44307 Kaunas, Lithuania.

Department of Cardiology, Lithuanian University of Health Sciences, Eivenių Str. 2, 50161 Kaunas, Lithuania.

出版信息

Eur Heart J Case Rep. 2024 Nov 29;8(12):ytae637. doi: 10.1093/ehjcr/ytae637. eCollection 2024 Dec.

Abstract

BACKGROUND

Haemochromatosis is a pathological condition characterized by the accumulation of iron in parenchymal organs, leading to toxic damage and dysfunction. Cardiac haemochromatosis represents one of the rare causes of severe heart failure (HF) that can be potentially prevented with targeted treatment.

CASE SUMMARY

We present the case of a 41-year-old female who was hospitalized for decompensated HF. Echocardiography revealed severe systolic dysfunction with a phenotype of dilated cardiomyopathy, accompanied by secondary moderate mitral regurgitation and severe tricuspid regurgitation (TR). To differentiate potential causes of HF, coronary angiography, cardiac magnetic resonance imaging (MRI), and endomyocardial biopsy were performed. Based on clinical findings, laboratory results, cardiac MRI, and endomyocardial biopsy data, a diagnosis of haemochromatosis was confirmed, and mutations in the gene, responsible for haemochromatosis Type 3, were identified. The patient was treated in accordance with the latest European Society of Cardiology HF guidelines, and specific treatment for haemochromatosis, including therapeutic phlebotomy and iron chelation therapy, was initiated, resulting in a significant positive outcome.

DISCUSSION

Investigating the aetiology of HF is essential, as even rare causes can be identified, and specific treatments are available that significantly improve prognosis and survival.

摘要

背景

血色素沉着症是一种病理状态,其特征是实质器官中铁的积累,导致毒性损伤和功能障碍。心脏血色素沉着症是严重心力衰竭(HF)的罕见原因之一,通过靶向治疗有可能预防。

病例摘要

我们报告一例41岁女性因失代偿性HF住院的病例。超声心动图显示严重的收缩功能障碍,表现为扩张型心肌病,伴有继发性中度二尖瓣反流和严重三尖瓣反流(TR)。为了鉴别HF的潜在病因,进行了冠状动脉造影、心脏磁共振成像(MRI)和心内膜活检。根据临床表现、实验室检查结果、心脏MRI和心内膜活检数据,确诊为血色素沉着症,并鉴定出导致3型血色素沉着症的基因中的突变。该患者按照最新的欧洲心脏病学会HF指南进行治疗,并开始了针对血色素沉着症的特异性治疗,包括治疗性放血和铁螯合疗法,取得了显著的积极效果。

讨论

调查HF的病因至关重要,因为即使是罕见病因也能被识别出来,而且有特定的治疗方法可以显著改善预后和生存率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ca4/11647590/6442a35f2e7e/ytae637il2.jpg

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