Grawe H, Katoh M, Kühl H P
Medizinische Klinik I, Universitätsklinikum der RWTH Aachen, Germany.
Clin Res Cardiol. 2006 Mar;95(3):179-85. doi: 10.1007/s00392-006-0346-2. Epub 2006 Jan 12.
Stress cardiomyopathy is a novel clinical syndrome affecting predominantly elderly female patients. It is characterized by severe reversible left ventricular dysfunction demonstrating a peculiar pattern of extensive apical wall motion abnormality known as "apical ballooning". The syndrome is typically precipitated by acute severe emotional, psychological or physical stress. It mimics acute coronary syndrome exhibiting typical clinical and electrocardiographic features of acute myocardial infarction. At angiography, however, significant coronary artery disease is invariably excluded. In the acute phase, the syndrome may be complicated by cardiogenic shock or ventricular fibrillation. Clinical data indicate that the disease is associated with an extensive increase of endogenous cathecholamine levels which may exhibit a direct toxic effect on the myocytes causing non-ischemic myocardial "stunning". This mechanism may have important implications for the management of patients in the acute phase of the disease. The prognosis of stress cardiomyopathy, however, seems favorable with recovery of global and regional myocardial function within a few weeks in the vast majority of patients. Yet, long-term outcome data in larger patient populations are lacking. We report the case of a female patient presenting with stress cardiomyopathy and review the current knowledge of the disease.
应激性心肌病是一种主要影响老年女性患者的新型临床综合征。其特征为严重的可逆性左心室功能障碍，表现出一种特殊的广泛心尖壁运动异常模式，称为“心尖气球样变”。该综合征通常由急性严重的情绪、心理或身体应激诱发。它模仿急性冠状动脉综合征，表现出急性心肌梗死的典型临床和心电图特征。然而，在血管造影时，总是排除严重冠状动脉疾病。在急性期，该综合征可能并发心源性休克或心室颤动。临床数据表明，该疾病与内源性儿茶酚胺水平的广泛升高有关，这可能对心肌细胞产生直接毒性作用，导致非缺血性心肌“顿抑”。这种机制可能对疾病急性期患者的管理具有重要意义。然而，应激性心肌病的预后似乎良好，绝大多数患者在几周内整体和局部心肌功能恢复。然而，缺乏更大患者群体的长期结局数据。我们报告一例患有应激性心肌病的女性患者病例，并综述该疾病的当前知识。
