Cardiogenic shock caused by left mid-ventricular obstruction in a patient with anorexia nervosa; A novel cardiac manifestation of refeeding syndrome.
Cardiogenic shock caused by left mid-ventricular obstruction in a patient with anorexia nervosa; A novel cardiac manifestation of refeeding syndrome.
复制标题
神经性厌食症患者左心室梗阻致心源性休克；
DOI：
10.1016/j.nut.2016.12.017
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发表时间：
2017
期刊：
影响因子：
4.4
通讯作者：
Sakata Y.
中科院分区：
文献类型：
--
作者：
Sakamoto Y;Kioka H;Hashimoto R;Takeda S;Ohtani T;Yamaguchi O;Wasa M;Nakatani S;Sakata Y.
目的重度营养不良患者在恢复营养时会出现再喂养综合征。它有时是致命的，特别是由于心脏受累，如充血性心力衰竭和心律失常。本研究的目的是报告一例神经性厌食症(AN)患者在重新进食过程中发生心源性休克的病例。心源性休克是由于一种以前未知的机制，即一过性的左室中段梗阻，经治疗后完全消失。方法46岁的女性，因运动性呼吸困难而住院，她遵循碳水化合物和脂肪缺乏的饮食10年。她入院时心脏收缩功能严重受损，被认为是再进食综合征的高危患者。结果静脉注射脂肪乳剂后，患者因心脏过度收缩引起的左室中段梗阻、左室壁增厚、血管内容量耗竭等意外机制而发生心源性休克。随着脂肪乳剂的停止和容量补充的开始，她立即从休克中恢复过来，超声心动图通过出院恢复到正常。结论该病例说明了一种在再喂养过程中心源性休克的新原因，在初期左心室收缩功能不全患者静脉注射脂肪乳剂时需要谨慎。
ObjectiveRefeeding syndrome occurs when reinstating nutrition to severely malnourished patients. It can sometimes be fatal, particularly as a result of cardiac involvement such as congestive heart failure and arrhythmias. The aim of this study was to report a case of cardiogenic shock that occurred during refeeding in a patient with anorexia nervosa (AN). The cardiogenic shock was due to a previously unrecognized mechanism, namely a transient left midventricular obstruction that completely disappeared after treatment.MethodsA 46-y-old woman with AN who had followed a carbohydrate- and a fat-deficient diet for >10 y was hospitalized for dyspnea on exertion. She had severely impaired cardiac systolic function on admission and was considered high risk for refeeding syndrome. During a stepwise increase of calories, she showed no electrolyte or mineral abnormalities characteristic of refeeding syndrome.ResultsAfter intravenous administration of a fat emulsion, the patient suffered from cardiogenic shock due to an unexpected mechanism, namely a left midventricular obstruction caused by cardiac hypercontraction, a thickened left ventricular wall, and intravascular volume depletion. With cessation of the fat emulsion and initiation of volume repletion she recovered from shock immediately and her echocardiogram returned to normal by discharge.ConclusionsThis case illustrated a novel cause of cardiogenic shock during refeeding and the need for caution during the intravenous administration of a fat emulsion in patients with initial left ventricular systolic dysfunction.