Doue Tomoki, Ito Kazuki, Yuba Tatsuya, Tanabe Takuji, Adachi Yoshihiko, Katoh Shuji, Azuma Akihiro, Sugihara Hiroki, Nakagawa Masao
Department of Cardiology, Murakami Memorial Hospital, Asahi University.
Kaku Igaku. 2002 Nov;39(4):511-8.
A 57-year-old woman was emergently admitted to our hospital because of chest oppression. On examination, blood pressure was 174/96 mmHg, pulse rate was 90/min and coarse crackle and third heart sound were audible. On laboratory data, the levels of LDH and CPK-MB were mildly elevated. Electrocardiogram (ECG) demonstrated elevation of the ST segment in leads I, aVL and V2-V5. 99mTc-tetrofosmin myocardial SPECT (TF) showed severely reduced uptake in the apex and anterior wall. Emergent coronary angiography (CAG) did not show any stenotic lesion. Left ventriculography (LVG), however, demonstrated akinesis of the apex, anterior, and inferior walls, and basal hyperkinesis. On the second hospital day, ECG demonstrated inverted T wave in leads I, aVL and V2-V5. 123I-BMIPP myocardial SPECT (BMIPP) and 123I-MIBG myocardial SPECT (MIBG) were performed on the second and fourth hospital days, respectively. These cardiac images showed severely reduced uptake equally. TF, BMIPP, and MIBG were re-examined on the eighth, tenth, and twelfth hospital days, respectively. MIBG, BMIPP, and TF showed reduced uptake in order of severity. On the fourteenth hospital day, CAG and LVG were re-examined. Coronary vasospasm provocation test was negative using ergonovine and acetylcholine, and LVG did not demonstrated any sign of asynergy. We considered that this case was "Takotsubo" cardiomyopathy and might be caused by microvascular spasm.
一名57岁女性因胸部压迫感紧急入院。检查发现，血压为174/96 mmHg，脉搏率为90次/分钟，可闻及粗湿啰音和第三心音。实验室检查数据显示，乳酸脱氢酶（LDH）和肌酸磷酸激酶同工酶（CPK-MB）水平轻度升高。心电图（ECG）显示I、aVL及V2-V5导联ST段抬高。99m锝-替曲膦心肌单光子发射计算机断层扫描（TF）显示心尖和前壁摄取严重减少。紧急冠状动脉造影（CAG）未显示任何狭窄病变。然而，左心室造影（LVG）显示心尖、前壁和下壁运动减弱，基底段运动增强。入院第二天，心电图显示I、aVL及V2-V5导联T波倒置。分别在入院第二天和第四天进行了123碘-苄基异丙基胍心肌单光子发射计算机断层扫描（BMIPP）和123碘-间碘苄胍心肌单光子发射计算机断层扫描（MIBG）。这些心脏影像均显示摄取严重减少。分别在入院第八天、第十天和第十二天对TF、BMIPP和MIBG进行了复查。MIBG、BMIPP和TF摄取减少的程度依次加重。入院第十四天，再次进行了CAG和LVG检查。使用麦角新碱和乙酰胆碱进行冠状动脉痉挛激发试验为阴性，LVG未显示任何协同失调迹象。我们认为该病例为“Takotsubo”心肌病，可能由微血管痉挛引起。
