頁籤選單縮合
題 名 | 以非特異症狀表現的急性細菌性心內膜炎:病例報告=Acute Bacterial Endocarditis Presented with Nonspecific Symptoms: A Case Report |
---|---|
作 者 | 陳鼎達; 鍾嫈嫈; 郭靖海; | 書刊名 | 中華民國家庭醫學雜誌 |
卷 期 | 8:2 1998.06[民87.06] |
頁 次 | 頁94-101 |
分類號 | 415.31 |
關鍵詞 | 細菌性心內膜炎; Infective endocarditis; Aortic valve vegetation; Aortic valve regurgitation; Congestive heart failure; Sudden cardiac death; |
語 文 | 中文(Chinese) |
中文摘要 | 基層醫師在門診中常遇到各式各樣的非特異症狀表現及多重主訴。在評估、診斷 的過程中,除了最常見的身心症之外,必須不可忘記一些會危及生命的急症、提高警覺,及 早診斷、處理或轉診,以免延誤病情。我們報告一例感染性心內膜炎併發心臟衰竭,並猝死 的病例:一名六十一歲,無心臟疾病史的男性,近月來食慾減退,失眠及體重減輕,經治療 後並未改善,反而出現反覆輕度發燒、潮進性呼吸困難和血痰,經基層醫療診所轉診至本院 家庭醫學科門診。臨床檢查發現有輕度貧血、主動脈瓣閉鎖不全及僧帽瓣閉鎖不全的心雜音 和心臟衰竭,初步診斷為心內膜炎併發心臟衰竭,病人隨即被送轉往急診處置;經胸式心臟 超音波發現左心室擴大、主動脈瓣有植生、並有嚴重的主動脈瓣及僧帽瓣膜逆流、和收縮功 能低下;雖然立刻給予積極內科治療及準備外科治療,但病情劇變,猝死在急診室中。希望 藉本篇病例報告喚起基層醫師對感染性心內膜炎提高警覺,及早懷疑與轉診,以爭取最佳的 治療時機。 |
英文摘要 | Primary care doctors are usually presented with patients having non- specific symptoms and multiple complaints in their clinics. In the process of evaluation of these syndromes, one should bear in mind those potentially life-threatening conditions that may underlie. Once suspected, every effort should be made to manage them appropriately, or th refer patients to a tertiary center as soon as possible. We report one case of infective endocarditis that was complicated with sever heart failure and died suddenly: A 61-year-old male, who was not known to have any cardiovascular disease before, was referred from a primary care clinic because of unexplained poor appetite, insomnia, and weight loss for a month. Despite repeated medical treatment, he developed recurrent low-grade fever, weakness, progressive dyspnea, and bloody sputum. At our Family Medicine Clinic, clinical examination revealed mild anemia, aortic and mitral regurgitation murmurs, and heart failre. Under the impression of infective endocarditis with congestive heart failure, the patient was sent to the emergency room where transthoracic echocardiography found left ventricular hypertrophy, aortic valve vegetation with severe valvular regurgitation, and impaired systolic function. Although radical medical and surgical treatment was planned and started immediately, the patient died suddenly soon. This report is presented in the hope of arousing more attention to infective endocarditis by primary care physicians so that early suspicion and referral can be made to strive for the best outcome. |
本系統中英文摘要資訊取自各篇刊載內容。