主动脉内球囊反搏成功救治酷似急性广泛前壁心肌梗死的重症心肌炎一例报道  

One case report of successful treatment of severe myocarditis mimicking acute myocardial infarction by intra-aortic balloon counterpulsation

作　　者：尹桂芝[1] 张大东[1] 胡伟[1] 余强[1] 陈跃光[1] 许剑锋[1] 金贤[1] 顾俊[1] 董建[1] 归冬梅[1] 

机构地区：[1]上海瑞金医院集团闵行区中心医院心内科,上海201100

出　　处：《上海交通大学学报（医学版）》2010年第1期116-117,共2页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：报道一例老年男性患者因"胸闷气急6 h"就诊,发病前3 d曾发热,入院时出现心脏泵功能衰竭。患者无高血压、糖尿病、肥胖等冠心病危险因素,心电图表现为胸前导联ST-T异常,异常Q波,酷似急性广泛前壁心肌梗死,而磷酸肌酸激酶同工酶(CK-MB)和肌钙蛋白(TNI)明显升高,磷酸肌酸激酶(CK)正常,与急性心肌梗死的心脏标志物动态变化不相符,故予以急诊造影检查。结果显示:冠状动脉、肺动脉无异常,左心室造影提示左心室整体收缩功能减弱,确诊为急性重症心肌炎,予以主动脉内球囊反搏(IABP)辅助支持恢复血流动力学稳态。酷似心肌梗死的重症心肌炎有致命危险,且易误诊,应仔细询问病史,尽早血管造影及必要的IABP支持对于患者的及时诊治至关重要。An old male patient visited the hospital due to shortness of breath and palpitation for 6 h, with fever 3 days before and pump failure at admission. Having no risk factor of coronary diseases such as hypertension, diabetes mellitus and obesity, with ST-T changes and abnormal Q wave on ECG, the signs were compatible with those of acute anterior wall myocardial infarction, while the characteristics of cardiac biomarkers （ significant increase in Troponin 1 and creatine kinase＇s isoform, and normal creatine kinase） were not in accordance with those of acute myocardial infarction. Emergency angiography was performed, which indicated normal coronary artery, normal pulmonary artery and global systolic dysfunction of left ventricle. The diagnosis of acute severe myocarditis was established, and intra-aortic balloon pump （IABP） was employed to provide hemodynamic support. Severe myocarditis mimicking acute myocardial infarction may be fatal, and can be easily misdiagnosed. Careful analysis of clinical manifestations, early diagnostic angiography and possible IABP placement are important for the successful treatment.

关 键 词：重症心肌炎 急性心肌梗死 主动脉内球囊反搏 

分 类 号：R473.5[医药卫生—护理学]