热射病致Brugada拟表型1例

doi:10.3969/j.issn.1674-8115.2025.04.016

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (4): 523-528.doi: 10.3969/j.issn.1674-8115.2025.04.016

• 病例报告 • 上一篇

热射病致Brugada拟表型1例

李遥敏(), 徐建国, 于霞

浙江大学医学院附属第二医院心电图室，杭州 310009

收稿日期:2024-11-20 接受日期:2025-01-07 出版日期:2025-04-28 发布日期:2025-04-21
通讯作者: 李遥敏 E-mail:liyaomin@zju.edu.cn

Brugada phenocopy induced by heatstroke: a case report

LI Yaomin(), XU Jianguo, YU Xia

Electrocardiogram Room, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310009, China

Received:2024-11-20 Accepted:2025-01-07 Online:2025-04-28 Published:2025-04-21
Contact: LI Yaomin E-mail:liyaomin@zju.edu.cn

摘要/Abstract

摘要：

患者男性，56岁，因“被发现神志不清伴体温升高1 d”于急诊就诊。同时有凝血功能障碍、呼吸衰竭、肝肾功能异常、胃肠功能紊乱等多器官功能障碍的临床表现，排除其他疾病后诊断为热射病；并且该患者有相对突出的心肌损伤表现，心电图显示ST段抬高、Brugada波，考虑热射病相关心肌损伤并且致Brugada拟表型。这种表现可能与心肌热损伤、热应激后的全身炎症反应、温度敏感的离子通道功能异常等多种机制有关。临床需加强对热射病相关心肌损伤和Brugada拟表型的认识，以改善热射病的治疗与预后。

关键词: 热射病, 心肌损伤, ST段抬高, Brugada拟表型

Abstract:

The patient, a 56-year-old male, was admitted to the emergency department due to confusion and elevated body temperature persisting for 1 d. He presented with multiple organ dysfunction, including coagulation dysfunction, respiratory failure, abnormal liver and kidney function, and gastrointestinal disorders. After excluding other potential causes, a diagnosis of heatstroke was made. Additionally, the patient exhibited myocardial injury and Brugada phenocopy, as evidenced by ST-segment elevation and Brugada wave on electrocardiogram. These findings may be related to several mechanisms such as myocardial thermal injury, systemic inflammatory response after heat stress, and abnormal function of temperator-sensitive ion channels. It is necessary to strengthen the understanding of heatstroke-related myocardial injury and Brugada phenotypy to help improve the treatment and prognosis of heatstroke.

Key words: heatstroke, myocardial injury, ST-segment elevation, Brugada phenocopy

中图分类号:

R594.1

李遥敏, 徐建国, 于霞. 热射病致Brugada拟表型1例[J]. 上海交通大学学报（医学版）, 2025, 45(4): 523-528.

LI Yaomin, XU Jianguo, YU Xia. Brugada phenocopy induced by heatstroke: a case report[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(4): 523-528.

图/表 4

图1 患者入院前某次体检时的心电图Note： No Bruagda wave.

Fig 1 Electrocardiogram from physical examination before admission

图2 入院时心电图Note： Type Ⅱ Bruagda wave and ST-segment elevation.

Fig 2 Electrocardiogram at admission

图3 入院14 h心电图Note： J wave and ST-segment elevation decreased.

Fig 3 Electrocardiogram 14 h after admission

图4 入院28 h心电图Note：The J point and ST-segment returned to baseline.

Fig 4 Electrocardiogram 28 h after admission

参考文献 16

1	ROMANELLO M, DI NAPOLI C, GREEN C, et al. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms[J]. Lancet, 2023, 402(10419): 2346-2394.
2	全军热射病防治专家组, 热射病急诊诊断与治疗专家共识组. 热射病急诊诊断与治疗专家共识(2021版)[J]. 中华急诊医学杂志, 2021, 30(11): 1290-1299.
	Military Heat Stroke Prevention and Control Expert Group, Heat Stroke Emergency Diagnosis and Treatment Expert Consensus Group. Expert consensus on emergency diagnosis and treatment of heat stroke (2021 edition)[J]. Chinese Journal of Emergency Medicine, 2021, 30(11): 1290-1299.
3	BOCK F J, TAIT S W G. Mitochondria as multifaceted regulators of cell death[J]. Nat Rev Mol Cell Biol, 2020, 21(2): 85-100.
4	XIA R, SUN M, LI Y L, et al. The pathogenesis and therapeutic strategies of heat stroke-induced myocardial injury[J]. Front Pharmacol, 2024, 14: 1286556.
5	BAO C H, FENG Q, ZHANG C, et al. Heat stroke with significantly elevated troponin and dynamic ECG changes: myocardial infarction or myocardial injury?[J]. Am J Med Sci, 2024, 368(3): 258-264.
6	张伯翼, 罗雪, 罗珍, 等. 经典型及劳力型热射病大鼠心肌损伤对比研究[J]. 陆军军医大学学报, 2023, 45(17): 1779-1789.
	ZHANG B Y, LUO X, LUO Z, et al. Comparison on myocardial injury in rats with classic versus exertional heat stroke[J]. Journal of Army Medical University,2023, 45(17): 1779-1789.
7	翟羽佳, 徐超, 薛霞, 等. 劳力型热射病患者心电图ST-T异常的临床意义[J]. 中国卫生标准管理, 2021, 12(12): 99-101.
	ZHAI Y J, XU C, XUE X, et al. Clinical significance of electrocardiographic ST-T abnormalities in patients with exertional heat stroke[J]. China Health Standard Management, 2021, 12(12): 99-101.
8	刘娜娜, 王晨霞. 中暑热痉挛并横纹肌溶解误诊为急性心肌梗死剖析[J]. 临床误诊误治, 2017, 30(3): 19-21.
	LIU N N, WANG C X. Analysis of moderate heat spasm meanwhile rhabdomyolysis misdiagnosed as acute myocardial infarction[J]. Clinical Misdiagnosis and Mistreatment, 2017, 30(3): 19-21.
9	AMUSINA O, MEHTA S, NELSON M E. Brugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency[J]. J Am Coll Emerg Physicians Open, 2022, 3(4): e12800.
10	ELIKOWSKI W, ŁAZOWSKI S, FERTAŁA N, et al. Brugada phenocopy in pulmonary embolism: clinicopathological case study and literature review[J]. Pol Merkur Lekarski, 2022, 50(300): 378-383.
11	LANCINI D, SHETTY R. Tension pneumothorax: a Brugada phenocopy and ST-elevation myocardial infarction mimic[J]. Eur Heart J, 2020, 41(23): 2163.
12	DE OLIVEIRA NETO N R, DE OLIVEIRA W S, MASTROCOLA F, et al. Brugada phenocopy: mechanisms, diagnosis, and implications[J]. J Electrocardiol, 2019, 55: 45-50.
13	BRANCO T, BARBOSA A, CUNHA N, et al. Brugada phenocopy caused by intracranial hemorrhage[J]. Cureus, 2023, 15(3): e35687.
14	DHARANIPRADAB M, VISWANATHAN S, KUMAR G R, et al. Yellow phosphorus-induced brugada phenocopy[J]. J Electrocardiol, 2018, 51(1): 129-131.
15	岳铭慧, 郑佳纯, 朱金秀, 等. 发热引起Brugada综合征的研究进展[J]. 实用心电学杂志, 2019, 28(5): 356-359, 364.
	YUE M H, ZHENG J C, ZHU J X, et al. Research progress in fever-induced Brugada syndrome[J]. Journal of Practical Electrocardiology, 2019, 28(5): 356-359, 364.
16	CANPOLAT U, BAYAZIT Y, AYTEMIR K. Brugada syndrome unmasked by heat exhaustion[J]. Ann Noninvasive Electrocardiol, 2017, 22(1): e12356.

[1]	李昕欣, 边懿泽, 赵航, 姜萌. 人工智能辅助测量心肌应变的研究进展[J]. 上海交通大学学报（医学版）, 2024, 44(6): 773-778.
[2]	胡晓, 张鑫, 谷阳. 体质量与C1q肿瘤坏死因子相关蛋白1在心肌梗死患者中的交互作用[J]. 上海交通大学学报（医学版）, 2022, 42(6): 786-791.
[3]	胡培堃, 何杰, 吴连明, 葛恒, 许建荣, 卜军. ST段抬高型心肌梗死患者微血管阻塞对左室功能及预后的影响[J]. 上海交通大学学报(医学版), 2021, 41(2): 173-179.
[4]	李欢, 易培强, 苏筠, 陈培战, 许赬, 曹璐, 陈佳艺, 李敏. 垂体腺苷酸环化酶激活肽38对急性放射性心肌损伤的防护作用[J]. 上海交通大学学报(医学版), 2021, 41(2): 129-133.
[5]	高亚洁, 马文坤, 高程洁, 周翌, 潘静薇. 心肌应变对急性ST段抬高型心肌梗死后心室重构的预测价值探讨[J]. 上海交通大学学报(医学版), 2021, 41(11): 1478-1484.
[6]	冯泽豪1，张清1，柴烨子1，苏璇1，孙宝航行1，刘启明1，严福华2，姜萌1#，卜军1#. 吸烟对急性ST段抬高型心肌梗死急性期心肌损伤及预后的影响[J]. 上海交通大学学报(医学版), 2020, 40(5): 573-582.
[7]	张明亮，张俊峰. 血栓抽吸术在急性ST段抬高型心肌梗死治疗中的研究进展[J]. 上海交通大学学报（医学版）, 2016, 36(11): 1664-.
[8]	孙瑛, 朱明, 张剑蔚, 等. 七氟醚预处理和后处理对婴幼儿体外循环心肌再灌注损伤的影响[J]. , 2011, 31(9): 1316-.
[9]	胡萌, 蒋慧, 夏敏. RAC2基因遗传多态性与柔红霉素引起心肌损伤的相关性研究[J]. , 2011, 31(1): 47-.
[10]	刁雪红, 申锷, 胡兵, 等. 糖尿病小鼠心肌组织microRNA表达谱分析[J]. , 2010, 30(10): 1194-.

热射病致Brugada拟表型1例

Brugada phenocopy induced by heatstroke: a case report

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 16

相关文章 10

编辑推荐

Metrics