与COVID-19相关的心肌膜炎和心脏吸管:一个诊断难题
Nirmol Amin Meah1, Hon-Ting Wai2, Kalyan Ram Bhamidipati3
1Foundation Trainee Whiston Hospital, Warrington Road, Prescot, Merseyside, L35 5DR.
The British journal of cardiology
|June 19, 2023
概括
一名45岁的男性患有心脏吸管,最初被怀疑是急性冠状动脉综合征,通过CTPA诊断出来. 经过心脏静脉注射可获得缓解,后来尽管最初的COVID-19检测结果呈阴性,但仍检测到SARS-CoV-2抗体.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
背景情况:
- 一名45岁的男性患有2型糖尿病,高血压和稳定的心痛,出现了日益恶化的呼吸短促和胸部紧张.
- 最初的症状包括一般的不适和富有成效的咳,检查显示心脏静音和肺部声音减少.
研究的目的:
- 在患有心血管风险因素的患者中调查急性呼吸困扰和胸部紧张的原因.
- 区分急性冠状动脉综合征,肺栓塞和其他导致心脏损伤的原因.
主要方法:
- 电心电图 (ECG) 用于对心脏进行评估.
- 托罗邦尼I和D-二次体的血液检测.
- 计算机断层扫描肺血管图 (CTPA) 用于肺血管和心周评估.
- 心声图用于心脏功能和流体评估.
- 为流体排水而进行心周切合.
- COVID-19 鼻抽样和血清抗体检测.
主要成果:
- 电脑心电图显示T波侧面变平,最初暗示急性冠状动脉综合征 (ACS).
- 热素I是负的,但D-二聚是阳性的,促使进一步调查.
- CTPA显示显著的心周溢出 (3.5厘米厚) 没有肺栓塞.
- 心声扫描证实了心脏的吸管,导致心脏衰竭.
- 超过1000毫升的液体被排出,导致显著的临床改善.
- 最初的COVID-19扫描结果呈阴性,但后来检测到对SARS-CoV-2的血清抗体.
结论:
- 引起心脏吸管的心周输液可以模仿急性冠状动脉综合征,这凸显了全面诊断工作的重要性.
- 没有肺栓塞的阳性D-二元值值得进一步调查,以寻找其他诊断方法,如心周溢血.
- 检测到SARS-CoV-2抗体表明可能,尽管无症状或亚临床,之前的COVID-19感染导致了心脏状况.
更多相关视频
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
6.3K
08:05Lung CT Segmentation to Identify Consolidations and Ground Glass Areas for Quantitative Assesment of SARS-CoV Pneumonia
Published on: December 19, 2020
14.2K
相关概念视频
01:19Pericarditis II: Clinical Features and Diagnostic Tests
12
Pericarditis is distinguished by inflammation of the pericardium, the fibrous sac that encases the heart. It can be acute, lasting less than six weeks, or chronic, persisting for over three months. Understanding its clinical manifestations and diagnostic findings is crucial for timely and effective management.Clinical ManifestationsWhile pericarditis can be asymptomatic, it usually presents with characteristic symptoms such as:Chest Pain: The most characteristic symptom of pericarditis is chest...
12
01:17Pericarditis III: Medical Management
16
The primary objectives of managing pericarditis are to determine the underlying cause, provide effective therapy for treatment and symptom relief, and promptly detect signs and symptoms of cardiac tamponade. The following outlines the essential aspects of medical management for pericarditis:ObjectivesDetermine the Cause: Identifying the underlying cause of pericarditis is crucial for targeted treatment. Causes include viral infections, autoimmune diseases, post-cardiac injury syndrome, and...
16
01:27Myocarditis II: Clinical Features and Diagnostic Tests
12
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
12
01:14Myocarditis III: Medical Management
9
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
9
01:25Pericarditis IV: Nursing Management
21
Pericarditis, an inflammation of the pericardium, necessitates diligent nursing management to ensure effective patient care and recovery. The initial step in managing pericarditis is a comprehensive patient medical assessment.The patient reports chest pain aggravated by breathing, coughing, and swallowing, which worsens when lying supine. The pain often improves when sitting up and leaning forward. Additional symptoms may include fever, malaise, and, in severe cases, signs of heart failure.
21
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
38
The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
38