Kleinfeldt T, Drawert S, Schneider H, Ince H, Körber T, Nienaber C A
Universität Rostock, Klinik und Poliklinik für Innere Medizin, Abteilung Kardiologie.
Dtsch Med Wochenschr. 2007 Jan 19;132(3):87-90. doi: 10.1055/s-2007-959293.
A clinical entity that mimics acute coronary syndrome with reversible left ventricular systolic dysfunction and is triggered by emotional stress was identified in 6 patients by screening a database of > 1000 patients with the ICD-10 coding of acute coronary syndrome. The search criteria were acute coronary syndrome, normal coronary anatomy, absence of coronary lesions and transient left ventricular dysfunction, triggered by emotional stress.
We analyzed 6 patients, who fulfilled the criteria of (1) acute substernal chest pain with ST-segment elevation and/or T-wave inversion; (2) absence of significant coronary arterial narrowing on angiography, (3) systolic dysfunction with abnormal regional wall motion ("apical ballooning") in the context of (4) severe psychological stress immediately before and triggering the cardiac events.
The primary diagnosis for all 6 acutely ill patients accorded with the ICD-code of acute coronary syndrome. All patients had survived and eventually recovered with an LV ejection fraction of 60 +/- 5 %; P = 0.03 and had had recovered normal levels of physical activity at hospital discharge. Of note is the number of women of postmenopausal age.
A transient cardiomyopathy triggered by major emotional stress may mimic an acute coronary syndrome but without significant coronary artery disease. This condition is characterized by reversible cardiac dysfunction and may be more frequent in women. It has a favorable clinical outcome.
通过筛查1000多名患有急性冠状动脉综合征ICD - 10编码的患者数据库，在6例患者中发现了一种模仿急性冠状动脉综合征且伴有可逆性左心室收缩功能障碍并由情绪应激引发的临床实体。搜索标准为急性冠状动脉综合征、冠状动脉解剖结构正常、无冠状动脉病变以及由情绪应激引发的短暂性左心室功能障碍。
我们分析了6例符合以下标准的患者：（1）急性胸骨后胸痛伴ST段抬高和/或T波倒置；（2）血管造影显示无明显冠状动脉狭窄；（3）在（4）心脏事件发生前即刻及引发时存在严重心理应激的情况下出现收缩功能障碍伴异常节段性室壁运动（“心尖部气球样变”）。
所有6例急性病患者的初步诊断均符合急性冠状动脉综合征的ICD编码。所有患者均存活，最终康复，左心室射血分数为60±5%；P = 0.03，出院时体力活动恢复到正常水平。值得注意的是绝经后年龄女性的数量。
由重大情绪应激引发的短暂性心肌病可能模仿急性冠状动脉综合征，但无明显冠状动脉疾病。这种情况的特征是可逆性心脏功能障碍，在女性中可能更常见。其临床结局良好。
