Acute mesenteric ischemia secondary to complete AV block and acute systolic heart failure: a case report.

IF 2 Q2 EMERGENCY MEDICINE International Journal of Emergency Medicine Pub Date : 2024-10-08 DOI:10.1186/s12245-024-00737-8

Jian Cui

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Abstract

Background: Acute mesenteric ischemia (AMI) usually presents with abrupt and severe abdominal pain associated with nausea and vomiting. This case is notable due to the occurrence of AMI secondary to acute systolic heart failure caused by new onset complete heart block.

Case presentation: A 65-year-old male presented with sudden onset epigastric pain. ECG showed complete AV block and acute ischemia, and a subsequent CTA revealed complete occlusion of the mid superior mesenteric artery. His emergent left heart catheterization showed non-occlusive coronary artery disease. The patient underwent emergent laparotomy and SMA thrombectomy. Postoperative complications included worsening congestive heart failure and persistent bradycardia, requiring a permanent pacemaker. The patient was discharged to a skilled nursing facility in stable condition.

Conclusions: This case highlights the diagnostic challenges of AMI in the setting of acute heart failure and new onset AV block mimicking acute cardiac events and emphasizes the importance of a multidisciplinary approach in managing such complex cases.

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继发于完全性房室传导阻滞和急性收缩性心力衰竭的急性肠系膜缺血：病例报告。

背景：急性肠系膜缺血（AMI急性肠系膜缺血（AMI）通常表现为突发性剧烈腹痛，伴有恶心和呕吐。本病例值得注意的是，它是由新发完全性心脏传导阻滞引起的急性收缩性心力衰竭继发的急性肠系膜缺血：一名 65 岁的男性因突发上腹痛就诊。心电图显示完全性房室传导阻滞和急性缺血，随后的 CTA 显示肠系膜上动脉中段完全闭塞。急诊左心导管检查显示患者患有非闭塞性冠状动脉疾病。患者接受了急诊开腹手术和 SMA 血栓切除术。术后并发症包括充血性心力衰竭恶化和持续性心动过缓，需要安装永久起搏器。患者出院后入住专业护理机构，病情稳定：本病例凸显了在急性心力衰竭和新发房室传导阻滞模仿急性心脏事件的情况下诊断急性心肌梗死的挑战，并强调了多学科方法在管理此类复杂病例中的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Emergency Medicine EMERGENCY MEDICINE-

CiteScore

4.60

自引率

0.00%

发文量

审稿时长

13 weeks

期刊介绍： The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.