Núñez-Gil Iván Javier, García-Rubira Juan Carlos, Fernández-Ortiz Antonio, Vivas David, Gonzalez Juan José, Luaces María, Macaya Carlos
Int J Cardiol. 2008 Nov 12;130(2):e60-2. doi: 10.1016/j.ijcard.2007.11.056. Epub 2008 Jan 16.
Apical transient left ventricular diskynesia is a recently described entity able to imitate acute coronary syndrome. The presence of previous coronary artery disease (CAD) is an exclusion criterion for this diagnosis in several studies. We report the case of a sixty-three year-old-caucasian man with previously known CAD, left anterior descending artery (LAD) stented-disease, presenting in the emergency room with angina and ST-segment elevation. A coronariography was urgently performed. No new coronary lesions could be demonstrated. LAD-placed stents were patent and showed no change in their angiographic appearance. Left ventriculogram demonstrated apical diskynesia (Takotsubo-like). Complete and rapid resolution of left ventricular dysfunction was echocardiographycally displayed seven days later. Months after, coronary lesions increased associated with new acute coronary syndromes and new revascularization procedures were required. The present case supports the idea that CAD and apical transient diskynesia could coexist in the same patient, arising further questions about the pathophysiology, prognosis and management of the latter.
心尖部短暂性左心室运动障碍是一种最近被描述的、能够模仿急性冠状动脉综合征的病症。在多项研究中，既往存在冠状动脉疾病（CAD）是该诊断的一项排除标准。我们报告了一例63岁的白种男性病例，其既往已知患有CAD，左前降支（LAD）置入支架，因心绞痛和ST段抬高就诊于急诊室。紧急进行了冠状动脉造影。未发现新的冠状动脉病变。LAD置入的支架通畅，血管造影表现无变化。左心室造影显示心尖部运动障碍（类似Takotsubo综合征）。七天后超声心动图显示左心室功能障碍完全且迅速恢复。数月后，冠状动脉病变增加并伴有新的急性冠状动脉综合征，需要进行新的血运重建手术。本病例支持CAD和心尖部短暂性运动障碍可在同一患者中共存的观点，这引发了关于后者的病理生理学、预后和管理的进一步问题。
