背景:电风暴(ES)是一种异质性的临床紧急情况,可伴有恶性室性心律失常,例如室颤(VF),室性心动过速(VT),需要心脏除颤。ES是一种具有高死亡率的危及生命的疾病。在急性心肌梗塞(MI)的情况下成功管理ES有望被随叫随到的医生所知,以降低院内死亡率。
方法:一名57岁的男性出现急性发作性胸痛,被发现患有后ST段抬高型心肌梗死(STEMI),并发急性右心室MI,继发于右冠状动脉近端完全闭塞(RCA)。患者以复发性VF的形式发展为ES,并通过电除颤成功管理。胺碘酮和艾司洛尔的抗心律失常治疗,气管插管,镇静,电解质更换,容量复苏,舒适护理,心理干预,和经皮冠状动脉介入治疗(PCI)闭塞的心外膜动脉。随着这些干预措施的快速连续使用以及大量RCA血栓的抽吸,患者被逆转为血流动力学稳定,没有进一步的VF发作,并在住院指数中幸存下来。
结论:ES是一种罕见但致命的急性MI并发症。上夜班的居民应该有更好的准备和装备来应对这种罕见的情况。我们希望我们的成功经验可以使护理ES恶化的急性MI患者的随叫随到的医生受益。
Electrical storm (ES) is a heterogeneous clinical emergency that can present with malignant ventricular arrhythmias such as ventricular fibrillation (VF), ventricular tachycardia (VT), requiring the need for cardiac defibrillation. ES is a life-threatening condition with a high mortality rate. Successfully managing ES in the setting of acute myocardial infarction (MI) is expected to be known by physicians on call to reduce in-hospital mortality.
A 57-year-old man presenting with acute onset chest pain was found to have an infero-posterior ST-segment elevation myocardial infarction (STEMI) complicated by acute right ventricular MI secondary to total occlusion of the proximal right coronary artery (RCA). The patient developed ES in the form of recurrent VF that was managed successfully with electrical defibrillation, antiarrhythmic therapy with amiodarone and esmolol, endotracheal intubation, sedation, electrolyte replacement, volume resuscitation, comfort care, psychological intervention, and percutaneous coronary intervention (PCI) of the occluded epicardial artery. With these interventions used in quick succession and with the aspiration of a massive RCA thrombus, the patient was reversed to hemodynamic stability, did not have further episodes of VF, and survived the index hospitalization.
ES is a rare but fatal complication of acute MI. Residents on night shifts should be better prepared and equipped to deal with this rare condition. We hope our successful experience can benefit physicians on call who take care of acute MI patients that deteriorate with ES.