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暴发性嗜酸性粒细胞性心肌炎中的Brugada综合征拟表型：病例系列

Brugada phenocopy in fulminant eosinophilic myocarditis: a case series.

作者信息

Kawauchi Dai, Yunoki Kei, Yoshino Tomohiro, Oka Takefumi

机构信息

Department of Cardiology, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0841, Japan.

出版信息

Eur Heart J Case Rep. 2024 Dec 2;8(12):ytae646. doi: 10.1093/ehjcr/ytae646. eCollection 2024 Dec.

DOI:10.1093/ehjcr/ytae646
PMID:39687534
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11647588/
Abstract

BACKGROUND

Brugada phenocopy (BrP) is a condition that induces reversible Brugada-like electrocardiographic (ECG) changes in patients without true Brugada syndrome. We present two cases of fulminant eosinophilic myocarditis that showed Type 1 Brugada ECG changes in the early phase of the clinical course.

CASE SUMMARY

Case 1 was a 76-year-old man who developed fulminant eosinophilic myocarditis with ventricular tachycardia while hospitalized for heart failure. Case 2 was a 60-year-old man who presented with cardiogenic shock and was diagnosed with fulminant eosinophilic myocarditis. Both patients showed a Type 1 Brugada ECG at onset, and their ventricular function was greatly reduced. Regarding mechanical circulatory support, Case 1 was treated with venous-arterial extracorporeal membrane oxygenation and intra-aortic balloon pumping. Case 2 had venous-arterial extracorporeal membrane oxygenation and Impella CP insertion. Steroid therapy was introduced in both cases. In Case 1, the Type 1 Brugada ECG took 7 days to improve. Left ventricular function improved with time but right heart function was poor and right heart enlargement remained. In Case 2, the Type 1 Brugada ECG improved on the second day, and left and right heart function improved over time.

DISCUSSION

We report two cases of fulminant eosinophilic myocarditis with Brugada-like ECG and severe right heart dysfunction. BrP in acute myocarditis may be an indicator of right heart failure and an important ECG marker in determining the indication for mechanical circulatory support and improvement of right heart function.

摘要

背景

Brugada 拟态（BrP）是一种在无真正 Brugada 综合征的患者中诱发可逆性 Brugada 样心电图（ECG）改变的病症。我们报告两例暴发性嗜酸性粒细胞性心肌炎病例，其在临床病程早期出现 1 型 Brugada 心电图改变。

病例摘要

病例 1 是一名 76 岁男性，因心力衰竭住院期间发生伴有室性心动过速的暴发性嗜酸性粒细胞性心肌炎。病例 2 是一名 60 岁男性，表现为心源性休克，被诊断为暴发性嗜酸性粒细胞性心肌炎。两名患者发病时均表现为 1 型 Brugada 心电图，且心室功能严重降低。关于机械循环支持，病例 1 接受了静脉 - 动脉体外膜肺氧合和主动脉内球囊反搏治疗。病例 2 接受了静脉 - 动脉体外膜肺氧合和 Impella CP 植入治疗。两例均采用了类固醇治疗。病例 1 中，1 型 Brugada 心电图在 7 天后有所改善。左心室功能随时间改善，但右心功能较差且右心扩大持续存在。病例 2 中，1 型 Brugada 心电图在第二天得到改善，左、右心功能随时间改善。

讨论

我们报告了两例伴有 Brugada 样心电图和严重右心功能不全的暴发性嗜酸性粒细胞性心肌炎病例。急性心肌炎中的 BrP 可能是右心衰竭的一个指标，也是确定机械循环支持指征和改善右心功能的重要心电图标志物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/7121250b85e3/ytae646f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/597ebd95f475/ytae646il2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/0c2d7b8d216e/ytae646f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/9d13c1942b0a/ytae646f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/d47d5b86284a/ytae646f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/df7cdc1c0717/ytae646f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/7121250b85e3/ytae646f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/597ebd95f475/ytae646il2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/0c2d7b8d216e/ytae646f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/9d13c1942b0a/ytae646f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/d47d5b86284a/ytae646f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/df7cdc1c0717/ytae646f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53d6/11647588/7121250b85e3/ytae646f5.jpg

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本文引用的文献

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Brugada phenocopy in pulmonary embolism - clinicopathological case study and literature review.肺栓塞中的 Brugada 表型——临床病理病例研究和文献复习。
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