肺栓塞伪装成ST升高心肌梗塞和心室动脉冲动
1Cardiology Department, King's College Hospital NHS Foundation Trust, London, England, UK mayhoney.ohn@gmail.com.
BMJ case reports
|June 24, 2025
概括
本案例报告详细介绍了接受里瓦洛克萨班治疗的肺癌患者的肺栓塞 (PE),突出了潜在的直接口服抗凝剂失败. 它还展示了PE如何模仿心肌梗塞和心室性心力衰竭.
科学领域:
- 在瘤学瘤学.
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 转移性肺腺癌呈现出复杂的临床挑战.
- 肺栓塞 (PE) 是癌症患者的一种严重并发症.
- 直接口服抗凝剂 (DOAC) 通常用于静脉血栓塞栓症 (VTE) 预防和治疗.
研究的目的:
- 报告发生PE的病例,尽管使用Rivaroxaban治疗抗凝剂.
- 为了研究恩特雷克提尼布和里瓦罗克萨班之间的潜在药物相互作用.
- 为了说明PE的诊断挑战,模仿急性冠状动脉综合征和腹腔心动减速.
主要方法:
- 一个中年男性患有转移性肺腺癌的病例报告.
- 临床表现,诊断工作包括心电图,冠状动脉血管学,心声学和CTPA.
- 关于DOACs,恩特雷克提尼布和PE管理的当前文献的审查.
主要成果:
- 该患者出现了暗示心肌梗塞的症状,但冠状动脉没有阻塞.
- CT肺血管造影证实了肺栓塞.
- 患者患上持续的腹腔动心,需要集中治疗.
- 由于怀疑抗凝剂失效,里瓦罗克萨班被切换为未分离的肝素.
结论:
- 尽管使用治疗性抗凝血药物,肺栓塞也可能发生,这表明潜在的DOAC失败.
- 恩特雷克提尼布可能会降低里瓦罗克萨班的生物可用性,因此需要仔细监测药物相互作用.
- 勃起性勃起可以呈现异常,模仿ST升高心肌梗塞和心室动脉冲动,特别是在高风险患者中.
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