보존적 치료로 호전된 단일 대각지 폐색 심근경색으로 인한 심근외벽 파열
Successful Healing of the Myocardial Rupture Complicated by the Occlusion of a Single Diagonal Branch
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
심실외벽 파열(left ventricle [LV] free wall rupture)과 심실중격 파열(ventricular septal rupture)을 포함하는 심근 파열은 급성 심근경색의 드물지만 치명적인 합병증이며 심근경색 후 약 3%의 환자에서 심근 파열이 발생할 수 있다[1]. 심실외벽 파열이 경벽심근경색증에서 발생하면 대개 ST 분절 상승 심근경색으로 나타나며[2] 이 경우 심막혈종(hemopericardium)과 심낭압전(cardiac tamponade)이 동반되면 높은 사망률을 보인다. 심실외벽 파열의 기전은 명확히 알려지지는 않았으나, 경색된 심실벽 주변 지역의 과운동성으로 인해 파열이 일어나는 것으로 추정된다.
Abstract
Myocardial rupture is a rare but lethal complication of myocardial infarction. Immediate conservative management is critical, but surgery should be considered if the patient’s hemodynamic state and degree of hemopericardium do not improve after pericardiocentesis. In this case, a 54-year old patient without underlying disease came to the emergency after experiencing chest pain for two weeks with suddenly aggravated severe dyspnea. The patient was found to have a hemopericardium with cardiac tamponade, so pericardiocentesis was immediately executed. Transthoracic echocardiogram revealed akinesia of the left ventricular muscle and focal wall thinning. The patient was diagnosed with complete occlusion of a single diagonal branch and ventricular free wall rupture using a coronary computed tomography scan. After conservative treatment, vital signs and cardiac function stabilized, and there was no definitive sequela. This case is clinically significant because myocardial rupture, a lethal complication of myocardial infarction, was successfully managed with non-surgical, conservative treatment.
참고문헌 (9)
- Honda S, "Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years", J Am Heart Assoc, 3, pp.e000984~ (2014)
- Gheorghe G, "Early evolution and complication of acute myocardial infarction with and without ST segment elevation. An observational study in the real world", Eur Heart J, 12, pp.26~27 (2010)
- Purcaro A, "Diagnostic criteria and management of subacute ventricular free wall rupture complicating acute myocardial infarction", Am J Cardiol, 80, pp.397~405 (1997)
- Reddy SG, "Frequency of rupture of the left ventricular free wall or ventricular septum among necropsy cases of fatal acute myocardial infarction since introduction of coronary care units", Am J Cardiol, 63, pp.906~911 (1989)
- Figueras J, "Left ventricular free wall rupture : clinical presentation and management", Heart, 83, pp.499~504 (2000)
- Olivia PB, "Cardiac rupture, a clinically predictable complication of acute myocardial infarction : report of 70 cases with clinicopathologic correlations", J Am Coll Cardiol, 22, pp.720~726 (1993)
- Ji Young Park, "Delayed Ventricular Septal Rupture after Percutaneous Coronary Intervention in Acute Myocardial Infarction", The Korean Journal of Internal Medicine, 20(3), pp.243~246 (2005), 대한내과학회
- Maessen J, "Post-infarction left ventricular free wall rupture(LVFW) : 70% survival with echocardiography and prompt intervention", J Am Coll Cardiol, 19, pp.354~ (1992)
- Figueras J, "Medical management of selected patients with left ventricular free wall rupture during acute myocardial infarction", J Am Coll Cardiol, 29, pp.512~518 (1997)