【Ventricular Septal Defect after Acute Myocardial Infarction 急性心肌梗死後室間隔缺損】
Holosystolic adj.全收縮期的
Precordium n.心前區
Akinesis n.運動不能
Turbulent adj.紊亂的
A previously healthy 76-year-old man with a 1-week history of continuous chest pain presented to the emergency department with rapidly progressive dyspnea on exertion. His blood pressure was 70/40 mm Hg, and he had signs of systemic hypoperfusion. Cardiac auscultation revealed a harsh holosystolic murmur, which was heard over the entire precordium. The electrocardiogram showed inferior ST-segment elevations that were consistent with acute or subacute myocardial infarction. Transthoracic echocardiography revealed a left ventricle with overall preserved systolic function and inferior akinesis, a dilated, severely impaired right ventricle, and a large, sharply demarcated interventricular septal defect with a large, turbulent left-to-right transseptal flow (see the video at NEJM.org). Coronary angiography revealed occlusion of the right coronary artery. Emergency surgical intervention was performed because of persistent cardiogenic shock despite supportive therapies, including intraaortic balloon pump. Closure of the septal defect was not successful owing to the fragility of the infarcted tissue. The patient died from progressive heart failure.1
【譯文】一名既往健康76歲男性，因持續胸痛一週伴迅速加重的勞力性呼吸困難至急診就診。患者血壓為70/40mmHg，並且出現體循環低灌注體徵。心臟聽診提示在整個心前區聞及粗糙的全收縮期雜音。心電圖提示下壁導聯ST段抬高，符合急性或亞急性心肌梗塞表現。經胸超聲心動圖提示總體左心室收縮功能保留及下壁心肌運動不能，右心室擴張並且功能嚴重受損，界線清楚的大面積室間隔缺損伴有大範圍左至右的室間隔血流紊亂（在NEJM.org觀看視頻）。冠脈血管造影顯示右冠狀動脈閉塞。儘管給予患者支持治療包括主動脈內球囊反搏，因持續的心源性休克而進行急診外科手術。由於梗塞組織脆弱，未能關閉室間隔缺損。患者死於進行性心力衰竭。
【醫學單詞記憶之道】
1. 醫學單詞記憶
trans-前綴通過
transthoracic adj.經胸的
transesophageal adj.經食道的
transcatheter n.經導管
2. 常用醫學詞組
dyspnea on exertion 勞力性呼吸困難
systemic hypoperfusion 體循環低灌注
cardiac auscultation 心臟聽診
holosystolic murmur 全收縮期雜音
transthoracic echocardiography
經胸超聲心動圖
interventricular septal defect 室間隔缺損
coronary angiography 冠脈造影
right coronary artery 右冠狀動脈
cardiogenic shock 心源性休克
intraaortic balloon pump 主動脈內球囊反搏
【醫學英語延伸閱讀】
Cardiogenic shock(CS) is characterized by systemic hypoperfusion due to severe depression of the cardiac index [<2.2 (L/min)/m2 ] and sustained systolic arterial hypotension (<90 mmHg) despite an elevated filling pressure [pulmonary capillary wedge pressure (PCWP) >18 mmHg]. It is associated with in-hospital mortality rates >50%. Circulatory failure based on cardiac dysfunction may be caused by primary myocardial failure, most commonly secondary to acute myocardial infarction(MI), and less frequently by cardiomyopathy or myocarditis, cardiac tamponade, or critical valvular heart disease. CS is the leading cause of death of patients hospitalized with MI. Early reperfusion therapy for acute MI decreases the incidence of CS. 2
參考文獻
1. Leonard M. Rademakers and Lokien X. Van Nunen. Ventricular Septal Defect after Acute Myocardial Infarction. N Engl J Med 2016; 374:e28.
2. Judith S. Hochman and David H. Ingbar. Cardiogenic Shock and Pulmonary Edema.P2232. 哈里森內科學第十八版
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