Sheng Qiping, Wang Yingjie, Wu Zhiyang, Zhao Xiangyang, Wu Dawei, Li Zhi, Guo Xi
Department of Critical Care Medicine, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, Qingdao, Shandong, China.
Front Cardiovasc Med. 2024 Dec 20;11:1481498. doi: 10.3389/fcvm.2024.1481498. eCollection 2024.
Cardiac arrest during pregnancy is receiving increasing attention. However, there are few reports on cardiac arrest in nonpregnant women caused by abnormal uterine bleeding (AUB). We report a case in which extracorporeal cardiopulmonary resuscitation (ECPR) was used in a patient with cardiac arrest caused by AUB and coronary vasospasm.
A 52-year-old female patient presented to the emergency department because of sudden chest pain, with a history of hypertension, coronary heart disease and AUB for more than half a month. At the initial stage of admission, cardiac arrest occurred after the ECG demonstrated ST-segment elevation in leads II, III and a VF. ECPR was started after traditional cardiopulmonary resuscitation, and coronary angiography was performed with the support of extracorporeal membrane oxygenation (ECMO). The left and right coronary arteries were slender and narrow, which was relieved after the injection of 100 µg nitroglycerine through the left coronary artery. After performing a coronary angiogram, the patient was given long-acting nitrates and calcium channel blockers orally, and her chest pain did not reoccur. The patient was weaned from ECMO support after 4 days.
This clinical case highlights the challenges that clinicians face in accurately diagnosing and possibly treating AUB and coronary vasospasm-induced acute myocardial infarction because of its rare occurrence and serious adverse events. ECPR can effectively improve the success rate of cardiopulmonary resuscitation.
孕期心脏骤停日益受到关注。然而，关于非孕期妇女因异常子宫出血（AUB）导致心脏骤停的报道较少。我们报告一例因AUB和冠状动脉痉挛导致心脏骤停的患者使用体外心肺复苏（ECPR）的病例。
一名52岁女性患者因突发胸痛就诊于急诊科，有高血压、冠心病病史及AUB半个多月。入院初期，心电图显示Ⅱ、Ⅲ导联及aVF导联ST段抬高后发生心脏骤停。在传统心肺复苏后启动ECPR，并在体外膜肺氧合（ECMO）支持下进行冠状动脉造影。左右冠状动脉纤细且狭窄，经左冠状动脉注射100μg硝酸甘油后缓解。冠状动脉造影术后，患者口服长效硝酸盐类药物和钙通道阻滞剂，胸痛未再发作。4天后患者撤离ECMO支持。
该临床病例凸显了临床医生在准确诊断和可能治疗AUB及冠状动脉痉挛所致急性心肌梗死方面面临的挑战，因其发生率低且不良事件严重。ECPR可有效提高心肺复苏成功率。
