【Ventricular Septal Defect after Acute Myocardial Infarction 急性心肌梗死后室间隔缺损】
Holosystolic adj.全收缩期的
Precordium n.心前区
Akinesis n.运动不能
Turbulent adj.紊乱的
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
【译文】一名既往健康76岁男性，因持续胸痛一周伴迅速加重的劳力性呼吸困难至急诊就诊。患者血压为70/40mmHg，并且出现体循环低灌注体征。心脏听诊提示在整个心前区闻及粗糙的全收缩期杂音。心电图提示下壁导联ST段抬高，符合急性或亚急性心肌梗塞表现。经胸超声心动图提示总体左心室收缩功能保留及下壁心肌运动不能，右心室扩张并且功能严重受损，界线清楚的大面积室间隔缺损伴有大范围左至右的室间隔血流紊乱（在NEJM.org观看视频）。冠脉血管造影显示右冠状动脉闭塞。尽管给予患者支持治疗包括主动脉内球囊反搏，因持续的心源性休克而进行急诊外科手术。由于梗塞组织脆弱，未能关闭室间隔缺损。患者死于进行性心力衰竭。
【医学单词记忆之道】
1. 医学单词记忆
trans-前缀通过
transthoracic adj.经胸的
transesophageal adj.经食道的
transcatheter n.经导管
2. 常用医学词组
dyspnea on exertion 劳力性呼吸困难
systemic hypoperfusion 体循环低灌注
cardiac auscultation 心脏听诊
holosystolic murmur 全收缩期杂音
transthoracic echocardiography
经胸超声心动图
interventricular septal defect 室间隔缺损
coronary angiography 冠脉造影
right coronary artery 右冠状动脉
cardiogenic shock 心源性休克
intraaortic balloon pump 主动脉内球囊反搏
【医学英语延伸阅读】
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
参考文献
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. 哈里森内科学第十八版
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