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心跳,快和慢
Beating, Fast and Slow


Sandeep M. Jani ... 心脑血管疾病 • 2017.07.06

心内膜心肌活检拨云见日,确诊少见心血管疾病


曹云山*,谢萍

甘肃省人民医院心内科

* 通讯作者

 

疾病的鉴别诊断犹如福尔摩斯判案,有时候病情错综复杂,要求我们不能放过丝毫的蛛丝马迹。

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本刊的这一栏目中,某真实患者的信息按阶段(粗体)呈现给一名临床专家,后者对这些信息做出回应并和读者分享其推理(普通字体)。作者随后做出评论。

 

一名52岁男性在其初级保健医师处就诊时主诉劳力性胸部不适和呼吸困难2周,胸部不适症状描述为未向其他部位放射的胸部中心满胀感;患者在静息状态下无此类症状;无头晕无晕厥。

对于这一年龄人群的劳力性胸部不适和呼吸困难,心脏原因是(尤其是心肌缺血)最令人担忧的问题。其他需要考虑的心脏疾病包括缓慢性心律失常、心肌病所致心力衰竭、心脏瓣膜疾病、急性心肌炎或心包炎。应询问患者可提示近期患病毒性疾病的症状。其他可能的原因包括肺疾病(如慢性阻塞性肺疾病、反应性气道疾病和间质性肺疾病),以及一些可能促发独立于冠脉疾病缺血的全身性原因,如贫血和甲状腺功能亢进。由于患者的症状表现为亚急性,故肺栓塞和主动脉夹层不大可能。





作者信息

Sandeep M. Jani, M.D., M.P.H., Brahmajee K. Nallamothu, M.D., M.P.H., Leslie T. Cooper, M.D., Andrew Smith, M.D., and Reza Fazel, M.D.
From the MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (S.M.J.); Ann Arbor Veterans Affairs Medical Center and the Department of Internal Medicine, University of Michigan Medical School — both in Ann Arbor (B.K.N.); the Division of Cardiology, Mayo Clinic, Rochester, MN (L.T.C.); the Division of Cardiology, Emory University, Atlanta (A.S.); and the Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston (R.F.).Address reprint requests to Dr. Fazel at the Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis St., Boston,

 

参考文献

1. Heymans S, Eriksson U, Lehtonen J, Cooper LT Jr.. The quest for new approaches in myocarditis and inflammatory cardiomyopathy. J Am Coll Cardiol 2016;68:2348-2364

2. Cooper LT Jr, ElAmm C. Giant cell myocarditis: diagnosis and treatment. Herz 2012;37:632-636

3. Cooper LT Jr, Hare JM, Tazelaar HD, et al. Usefulness of immunosuppression for giant cell myocarditis. Am J Cardiol 2008;102:1535-1539

4. Okura Y, Dec GW, Hare JM, et al. A clinical and histopathologic comparison of cardiac sarcoidosis and idiopathic giant cell myocarditis. J Am Coll Cardiol 2003;41:322-329

5. Cooper LT Jr, Berry GJ, Shabetai R. Idiopathic giant-cell myocarditis — natural history and treatment. N Engl J Med 1997;336:1860-1866

6. Kandolin R, Lehtonen J, Salmenkivi K, Räisänen-Sokolowski A, Lommi J, Kupari M. Diagnosis, treatment, and outcome of giant-cell myocarditis in the era of combined immunosuppression. Circ Heart Fail 2013;6:15-22

7. Skouri HN, Dec GW, Friedrich MG, Cooper LT. Noninvasive imaging in myocarditis. J Am Coll Cardiol 2006;48:2085-2093

8. Kadkhodayan A, Chareonthaitawee P, Raman SV, Cooper LT. Imaging of inflammation in unexplained cardiomyopathy. JACC Cardiovasc Imaging 2016;9:603-617

9. Cooper LT, Baughman KL, Feldman AM, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 2007;116:2216-2233

10. Shields RC, Tazelaar HD, Berry GJ, Cooper LT Jr.. The role of right ventricular endomyocardial biopsy for idiopathic giant cell myocarditis. J Card Fail 2002;8:74-78

11. Cooper LT Jr.. Giant cell myocarditis: diagnosis and treatment. Herz 2000;25:291-298

12. Maleszewski JJ, Orellana VM, Hodge DO, Kuhl U, Schultheiss H-P, Cooper LT. Long-term risk of recurrence, morbidity and mortality in giant cell myocarditis. Am J Cardiol 2015;115:1733-1738

13. Scott RL, Ratliff NB, Starling RC, Young JB. Recurrence of giant cell myocarditis in cardiac allograft. J Heart Lung Transplant 2001;20:375-380

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15. Eid SM, Schamp D, Halushka MK, Barouch LA. Resolution of giant cell myocarditis after extended ventricular assistance. Arch Pathol Lab Med 2009;133:138-141

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