剖検により全身性炎症の合併が判明した心臓突然死の一例  [in Japanese] An Autopsy Case of Out-of-Hospital Cardiopulmonary Arrest Caused by unexpected systemic inflammation and cardiac attack  [in Japanese]

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Author(s)

    • 林田 昌子 Hayashida Akiko
    • 山形大学医学部救急医学講座 Department of Emergency and Critical Care Medicine, Yamagata University, School of Medicine
    • 伊関 憲 Iseki Ken
    • 山形大学医学部救急医学講座 Department of Emergency and Critical Care Medicine, Yamagata University, School of Medicine

Abstract

53 歳、男性。夜間就寝中に、数時間のうなり声を最後に、翌朝心肺停止状態で見つかった。心電図上は心静止であり、心肺蘇生法を施行しながら、当院救急部へ搬送された。すでに死後硬直および紫斑が出現しており、死亡が確認された。Autopsy imaging を施行したが、明らかな死因の特定に至らず、剖検を行った。左室優位の全周性求心性肥大を認め、心室壁の一部に心筋細胞の錯綜配列を認めた。また、左室壁、中隔、心尖部に広範囲な線維化を認めた。特に刺激伝導系の洞房結節に脂肪細胞の置換を認め、左脚起始部には広範囲に及ぶ線維化を認めた。また、気管支に多量な痰の貯留があり、食道壁のびらん、膵臓に微小膿瘍形成、膀胱に膿尿など多臓器に炎症所見を認めた。本症例は男性で、喫煙歴、高血圧の既往があり、一年前の健診などよりHBs 抗原陽性、心電図上左室肥大に伴うST-T 変化、潜在的な陳旧性心筋梗塞と、突然死の危険因子を多数満たしていた。心臓突然死が考えられる一方、数時間上げていたうなり声に着目し、致死的不整脈に至る以前に体調不良を来たす何らかの病態が存在したと推測した。聴取した状況や剖検結果から、全身性炎症反応症候群(SIRS)に準じる病態が併存していたと考えられ、死因として複数の病態が相互に影響を与えたことが示された。

An Autopsy Case of Out-of-Hospital Cardiopulmonary Arrest Caused by unexpected systemic inflammation and cardiac attack. A 53-year-old man spent a few hours of the night in pain in bed and developed cardiopulmonary arrest the next morning. The electrocardiogram obtained when the emergency team arrived showed asystole. When the patient was transferred to our emergency department, we confirmed that he presented with postmortem rigidity. No fatal disorders were found even on performing medical examination that included autopsy imaging. An autopsy was performed to determine the cause of his death. The autopsy findings showed left-dominant concentric ventricular hypertrophy with localized cardiomyocytes disarray and also showed widespread fibrosis over the left ventricular wall, septum, and apex. In the conducting system, the sinoatrial node had been infiltrated with many adipocytes, and extensive fibrosis was found at the origin of the bundle branch. Furthermore, widespread inflammation was observed in the lungs, esophageal wall, pancreas, and in the urinary bladder mucosa. Data from his previous health examination showed the presence of many risk factors for sudden death, especially those associated with cardiac events. It is presumed that the patient developed systemic inflammatory response syndrome before cardiac arrest. The combination of these clinical conditions was considered as the cause of his sudden death. Autopsy played a key role in establishing the factors responsible for death in this case.

Journal

  • Bulletin of the Yamagata University. Medical science

    Bulletin of the Yamagata University. Medical science 30(1), 23-31, 2012-02-15

    Yamagata University

Codes

  • NII Article ID (NAID)
    110008906961
  • NII NACSIS-CAT ID (NCID)
    AN00067279
  • Text Lang
    JPN
  • Article Type
    departmental bulletin paper
  • ISSN
    0288030X
  • Data Source
    NII-ELS  IR 
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