以急性心肌梗死、反复心衰为主要表现的重度主动脉瓣狭窄一例病例分享
Severe Aortic Stenosis with Acute Myocardial Infarction and Refractory Heart Failure as the Main Clinical Manifestations: A Case Report

DOI: 10.12677/ACRVM.2019.72005, PP. 29-35

Keywords: 主动脉瓣狭窄，急性非ST段抬高型心肌梗死，心力衰竭
Aortic Stenosis, Acute Non-ST-Segment Elevation Myocardial Infarction, Heart Failure

Full-Text   Cite this paper   Add to My Lib

Abstract:

主动脉瓣狭窄是临床上常见的一种心脏瓣膜病，其主要原因有先天性、老年性及风湿性。心绞痛、晕厥和劳力性呼吸困难是典型主动脉瓣狭窄的常见三联征，也可因心排量降低出现焦躁不安、疲乏、呼吸困难性发绀、左心衰及肺水肿，严重肺动脉高压时，可出现右心衰。治疗以手术为主，时机的掌握与患者预后关系密切。本文报道1例因急性非ST段抬高型心肌梗死、心力衰竭反复3次入院的老年患者，住院期间心脏彩超提示其主动脉瓣狭窄进行性加重，经瓣膜置换术后症状治愈。提示及时识别主动脉瓣狭窄患者临床症状对于指导主动脉瓣狭窄的诊断、治疗具有重要临床意义。
Aortic stenosis, a clinically common valvular heart disease, is congenital, senile, and rheumatic. As people aging, the incidence of senile aortic stenosis increases. Angina, syncope, and exertional dyspnea are common triads of typical aortic stenosis. However, due to the decrease in cardiac output, there may also be anxiety, fatigue, and difficulty in breathing happened simultaneously as by-side effects, which will cause heart failure and pulmonary edema. When severe pulmonary hypertension occurs, right heart failure may occur. Surgery is the main treatment for aortic stenosis, and the timing is closely related to the prognosis of patients. This article demonstrates the general diagnosis and treatment received by an elderly patient with acute non-ST-segment elevation myocardial infarction and heart failure during the three times admissions to hospital. Colour Doppler echocardiography during hospitalization prompted a progressive aggravation of aortic stenosis, and the symptoms were cured after valve replacement. It is highly suggested that timely identification of clinical symptoms of patients with aortic stenosis has important clinical significances on guiding the diagnosis and treatment of aortic stenosis.

References

[1]	陈灏珠. 实用内科学[M]. 北京: 人民卫生出版社, 2014.
[2]	Maganti, K., Rigolin, V.H., Sarano, M.E. and Bonow, R.O. (2010) Valvular Heart Disease: Diagnosis and Management. Mayo Clinic Proceedings, 85, 483-500. https://doi.org/10.4065/mcp.2009.0706
[3]	Supino, P.G., Borer, J.S., Preibisz, J. and Bornstein, A. (2006) The Epidemiology of Valvular Heart Disease: A Growing Public Health Problem. Heart Failure Clinics, 2, 379-393. https://doi.org/10.1016/j.hfc.2006.09.010
[4]	Chiappini, B., Bergonzini, M., Gallieri, S., et al. (2003) Clinical Outcome of Aortic Valve Replacement in the Elderly. Cardiovascular Surgery, 11, 359-365. https://doi.org/10.1016/S0967-2109(03)00104-2
[5]	王炳勋, 徐泽升. 主动脉瓣重度狭窄误诊为急性心肌梗死1例[J]. 疑难病杂志, 2009, 8(9): 570.
[6]	Nassimiha, D., Aronow, W.S., Ahn, C. and Goldman, M.E. (2001) Rate of Progression of Valvular Aortic Stenosis in Patients ≥60 Years of Age. The American Journal of Cardiology, 87, 807-809. https://doi.org/10.1016/S0002-9149(00)01513-7
[7]	张玮玮, 刘昕, 赵迎, 等. 主动脉瓣狭窄导致急性心肌梗死1例[J]. 中国临床保健杂志, 2009, 12(1): 75.
[8]	齐欣, 王瑞萍, 钱贻简. 老年人钙化性主动脉瓣狭窄并发心肌梗死临床和病理特点[J]. 中华内科杂志, 2000, 39(2): 88-90.
[9]	Michail, M., Davies, J.E., Cameron, J.D., Parker, K.H. and Brown, A.J. (2018) Pathophysiological Coronary and Microcirculatory Flow Alterations in Aortic Stenosis. Nature Reviews Cardiology, 15, 420-431. https://doi.org/10.1038/s41569-018-0011-2
[10]	Weil, B.R., Suzuki, G., Young, R.F., Iyer, V. and Canty Jr., J.M. (2018) Troponin Release and Reversible Left Ventricular Dysfunction after Transient Pressure Overload. Journal of the American College of Cardiology, 71, 2906-2916. https://doi.org/10.1016/j.jacc.2018.04.029
[11]	Otto, C.M., Kuusisto, J., Reichenbach, D.D., Gown, A.M. and O’Brien, K.D. (1994) Characterization of the Early Lesion of ‘Degenerative’ Valvular Aortic Stenosis. Histological and Immunohistochemical Studies. Circulation, 90, 844-853. https://doi.org/10.1161/01.CIR.90.2.844
[12]	师瑞, 周晓莉. 钙化性主动脉瓣疾病的研究进展[J]. 心血管病学进展, 2018, 39(5): 60-64.
[13]	郑皓元, 李树森. 钙化性主动脉瓣狭窄的病理机制及治疗研究进展[J]. 中国医师进修杂志, 2018, 41(2): 174-178.
[14]	Kirsten, T., Roldan, C.A., Qualls, C.R. and Crawford, M.H. (2002) Aortic Valve Sclerosis, Mitral Annular Calcium, and Aortic Root Sclerosis as Markers of Atherosclerosis in Men. The American Journal of Cardiology, 89, 1030-1034. https://doi.org/10.1016/S0002-9149(02)02270-1
[15]	Peltonen, T., Ohukainen, P., Ruskoaho, H. and Rys？, J. (2017) Targeting Vasoactive Peptides for Managing Calcific Aortic Valve Disease. Annals of Medicine, 49, 63-74. https://doi.org/10.1080/07853890.2016.1231933
[16]	李莹莹, 柴坷, 罗瑶, 等. 老年人中重度钙化性主动脉瓣狭窄合并冠心病的心肌病理特点分析[J]. 中华老年医学杂志, 2018, 37(3): 245-249.

Full-Text