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[NEJM临床医学影像]:Takotsubo心肌病
2017年11月16日 临床影像, 临床话题 暂无评论

Images in Clinical Medicine

Takotsubo Cardiomyopathy

Abhishek Maiti, Abhijeet Dhoble

N Engl J Med 2017; 377: e24

DOI:10.1056/NEJMicm1615835

A  61-year-old woman with hypertension and hypothyroidism presented to the emergency department with acute onset of severe chest pain. She reported multiple recent stressors, including the death of her dog. An electrocardiogram showed ST-segment elevation in the anterolateral leads. Emergency coronary angiography revealed normal coronary arteries. Left ventriculography (Video 1 and Panel A [showing diastole] and Panel B [showing systole]) and contrast echocardiography (Video 2) revealed severe hypokinesis in the apical segments and hyperdynamic basal segments, with an ejection fraction of 40 to 45%. A diagnosis of takotsubo cardiomyopathy was made. Takotsubo cardiomyopathy, also called apical ballooning syndrome or stress cardiomyopathy, typically occurs in postmenopausal women and may be preceded by a stressful or emotional event. The clinical presentation may be identical to that seen in patients with acute coronary syndrome, but the condition is characterized by transient left ventricular systolic and diastolic dysfunction of the apex and midventricle in the absence of attributable coronary artery disease. Medical management, including the administration of an angiotensin-converting–enzyme (ACE) inhibitor and a beta-blocker, was initiated, and the patient’s chest pain resolved. An echocardiogram obtained 1 month after presentation showed normalization of cardiac wall motion and an ejection fraction of 65 to 70%. At follow-up 1 year after presentation, the patient remained asymptomatic.

一名62岁女性高血压及甲减患者因急性严重胸痛就诊于急诊科。患者主诉近期有多重压力,包括爱犬的去世。心电图显示前侧壁导联ST段抬高。急诊冠脉造影显示冠状动脉正常。左心室造影(视频1 及 图A [舒张期] 及图B [收缩期])及心脏超声造影显示心尖部节段运动严重减退,基底部运动增强,射血分数40-45%。据此,临床诊断为Takotsubo心肌病。Takotsubo心肌病也称为心尖球囊综合征或应激性心肌病,通常见于绝经后女性,发病前有应激或情绪事件。临床表现与急性冠脉综合征相同,但常为一过性左心室心尖部及心室中部收缩和舒张功能障碍,且不能用冠脉疾病解释。开始应用药物治疗包括ACE抑制剂和beta受体阻滞剂,患者胸痛缓解。发病后一个月复查心脏超声显示心室壁运动恢复正常,射血分数65-70%。一年后随访时患者仍没有临床症状的复发。

 

 

 

 

 

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