Sacha Jerzy, Maselko Jacek, Wester Andrzej, Szudrowicz Zbigniew, Pluta Wladyslaw
Department of Cardiology, Regional Medical Center in Opole, Al. Witosa 26, 45-418 Opole, Poland.
Circ J. 2007 Jun;71(6):982-5. doi: 10.1253/circj.71.982.
An 81-year-old woman with emotionally-induced takotsubo cardiomyopathy developed a fatal left ventricular (LV) apical rupture. During the hospitalization persistent ST-segment elevation with no electrocardiographic time evolution was observed on the ECG, characteristic for takotsubo cardiomyopathy. Histopathologically, transmural myocardial necrosis with hemorrhage was found at the rupture site, but there were foci of coagulation and contraction band necrosis with mononuclear lymphocyte infiltrations in other heart regions, and the intensity and distribution of these pathological changes corresponded to the distribution of the LV contraction abnormalities seen on ventriculography. The article concludes that: the LV functional disorder in takotsubo cardiomyopathy may be caused by distracted foci of coagulation and contraction band necrosis in the myocardium; contraction band necrosis (a sign of catecholamine cardiotoxicity) may reflect the sympathetic hyperactivity in this disease; persistent myocardial damage expressed by persistent ST-segment elevation without an electrocardiographic time evolution should be carefully observed with sequential echocardiographic examinations because of the possibility of cardiac rupture.
一名81岁患有情绪诱发型应激性心肌病的女性发生了致命的左心室心尖部破裂。住院期间，心电图上观察到持续性ST段抬高且无心电图时间演变，这是应激性心肌病的特征。组织病理学检查发现，破裂部位有透壁性心肌坏死伴出血，但在其他心脏区域存在凝固性和收缩带坏死灶，并伴有单核淋巴细胞浸润，这些病理变化的强度和分布与心室造影显示的左心室收缩异常分布相对应。文章得出结论：应激性心肌病中的左心室功能障碍可能由心肌中分散的凝固性和收缩带坏死灶引起；收缩带坏死（儿茶酚胺心脏毒性的标志）可能反映了该疾病中的交感神经过度活跃；由于存在心脏破裂的可能性，对于无心电图时间演变的持续性ST段抬高所表示的持续性心肌损伤，应通过连续超声心动图检查仔细观察。
