Ischämische Septumruptur – die Differenzialdiagnose zum Re-Infarkt: ein Anwendungsbeispiel für den präklinischen Ultraschall

Zusammenfassung

Die ischämische Septumruptur ist eine seltene, jedoch gefürchtete Komplikation nach einem Myokardinfarkt. Die folgende Kasuistik demonstriert eine solche Erkrankung als Differenzialdiagnose zum myokardialen Re-Infarkt. Bei verdächtiger Symptomatik konnte schließlich die richtige Diagnose mittels Ultraschall gestellt und eine adäquate Zielklinik ausgewählt werden. Innerklinisch wurde der Defekt mit einem bovinem Perikardpatch versorgt. Nach einem stationären Aufenthalt von 19 Tagen konnte die Patientin ohne größere Residuen nach Hause entlassen werden.

Abstract

Ventricular septum rupture is a rare, but severe complication after myocardial infarction. This case report discusses it as a differential diagnosis of myocardial reinfarction. Point of care ultrasound performed on a patient presenting with suspicious symptoms during transport in the emergency ambulance confirmed the diagnosis prior to hospitalisation. Respectively, the patient was transferred to a specialized hospital. Cardiac surgery was performed to fix the rupture using a bovine pericardial patch. After 19 days of in-patient stay the patient was discharged with only minimal residual damage.

Schlüsselwörter

Ventrikelseptumruptur - Myokardinfarkt - Re-Infarkt - Ultraschall - Point of Care - Präklinik

Keywords

ventricular septum rupture - myocardial infarction - prehospital emergency medicine - ultrasound - point of care - POCUS

Publication History

Received: 05 August 2021

Accepted after revision: 16 March 2022

Article published online:
30 May 2022

• Literatur

• 1 Ledakowicz-Polak A, Polak L, Zielinska M. Ventricular septal defect complicating acute myocardial infarction-still an unsolved problem in the invasive treatment era. Cardiovasc Pathol 2011; 20: 93-98 DOI: 10.1016/j.carpath.2010.01.008. (PMID: 20185340)
• 2 Jones BM, Kapadia SR, Smedira NG. et al. Ventricular septal rupture complicating acute myocardial infarction: a contemporary review. Eur Heart J 2014; 35: 2060-2068 DOI: 10.1093/eurheartj/ehu248. (PMID: 24970335)
• 3 Lee WY, Cardon L, Slodki SJ. Perforation of infarcted interventricular septum. Report of a case with prolonged survival, diagnosed ante mortem by cardiac catheterization, and review of the literature. Arch Intern Med 1962; 109: 731-741 DOI: 10.1001/archinte.1962.03620180093011. (PMID: 14463584)
• 4 Pilarczyk K, Bauer A, Boening A. et al. S3-Guideline: Recommendations for intra-aortic balloon pumping in cardiac surgery. Thorac Cardiovasc Surg 2015; 63 (Suppl. 02) S131-S196 DOI: 10.1055/s-0034-1395942. (PMID: 25588185)
• 5 Post F, Munzel T. Acute coronary syndrome. A diffuse diagnosis. Internist (Berl) 2010; 51: 953-962 DOI: 10.1007/s00108-009-2536-2. (PMID: 20640393)
• 6 Schachner T. Mechanische Komplikationen beim akuten Myokardinfarkt. Wien klin Mag 2019; 22: 162-165 DOI: 10.1007/s00740-019-0293-y.
• 7 Di Chiara A. Right bundle branch block during the acute phase of myocardial infarction: modern redefinitions of old concepts. Eur Heart J 2006; 27: 1-2 DOI: 10.1093/eurheartj/ehi552. (PMID: 16269420)
• 8 Mattu A. ECG Case of the Week – November 8, 2021. 2021 https://ecgweekly.com/2021/11/amal-mattus-ecg-case-of-the-week-november-8–2021/
• 9 Madias JE, Ashtiani R, Agarwal H. et al. Diagnosis of ventricular aneurysm and other severe segmental left ventricular dysfunction consequent to a myocardial infarction in the presence of right bundle branch block: ECG correlates of a positive diagnosis made via echocardiography and/or contrast ventriculography. Ann Noninvasive Electrocardiol 2005; 10: 53-59 DOI: 10.1111/j.1542-474X.2005.00590.x. (PMID: 15649238)
• 10 Amaral CB, Ralston DC, Becker TK. Prehospital point-of-care ultrasound: A transformative technology. SAGE Open Med 2020; 8: 2050312120932706 DOI: 10.1177/2050312120932706. (PMID: 32782792)
• 11 Botker MT, Jacobsen L, Rudolph SS. et al. The role of point of care ultrasound in prehospital critical care: a systematic review. Scand J Trauma Resusc Emerg Med 2018; 26: 51 DOI: 10.1186/s13049-018-0518-x. (PMID: 29940990)
• 12 Ketelaars R, Reijnders G, van Geffen GJ. et al. ABCDE of prehospital ultrasonography: a narrative review. Crit Ultrasound J 2018; 10: 17 DOI: 10.1186/s13089-018-0099-y. (PMID: 30088160)
• 13 Busche C, Busch HJ, Michels G. Point-of-Care Sonography in Emergency and Intensive Care Medicine. Dtsch Med Wochenschr 2018; 143: 161-164 DOI: 10.1055/s-0043-115604. (PMID: 29409085)
• 14 Manivel V, Lesnewski A, Shamim S. et al. CLUE: COVID-19 lung ultrasound in emergency department. Emerg Med Australas 2020; 32: 694-696 DOI: 10.1111/1742-6723.13546. (PMID: 32386264)
• 15 Michels G, Zinke H, Mockel M. et al. Recommendations for education in ultrasound in medical intensive care and emergency medicine: position paper of DGIIN, DEGUM and DGK. Med Klin Intensivmed Notfmed 2017; 112: 314-319 DOI: 10.1007/s00063-017-0285-x. (PMID: 28447145)
• 16 McCallum J, Vu E, Sweet D. et al. Assessment of Paramedic Ultrasound Curricula: A Systematic Review. Air Med J 2015; 34: 360-368 DOI: 10.1016/j.amj.2015.07.002. (PMID: 26611224)
• 17 Blehar DJ, Barton B, Gaspari RJ. Learning curves in emergency ultrasound education. Acad Emerg Med 2015; 22: 574-582 DOI: 10.1111/acem.12653. (PMID: 25903780)
• 18 El Sayed MJ, Zaghrini E. Prehospital emergency ultrasound: a review of current clinical applications, challenges, and future implications. Emerg Med Int 2013; 2013: 531674 DOI: 10.1155/2013/531674. (PMID: 24171113)
• 19 Soar J, Bottiger BW, Carli P. et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021; 161: 115-151 DOI: 10.1016/j.resuscitation.2021.02.010. (PMID: 34482004)
• 20 Mercer CB, Ball M, Cash RE. et al. Ultrasound Use in the Prehospital Setting for Trauma: A Systematic Review. Prehosp Emerg Care 2021; 25: 566-582 DOI: 10.1080/10903127.2020.1811815. (PMID: 32815755)
• 21 van der Weide L, Popal Z, Terra M. et al. Prehospital ultrasound in the management of trauma patients: Systematic review of the literature. Injury 2019; 50: 2167-2175 DOI: 10.1016/j.injury.2019.09.034. (PMID: 31627899)