Prasad Abhiram, Lerman Amir, Rihal Charanjit S
The Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Am Heart J. 2008 Mar;155(3):408-17. doi: 10.1016/j.ahj.2007.11.008. Epub 2008 Jan 31.
Apical ballooning syndrome (ABS) is a unique reversible cardiomyopathy that is frequently precipitated by a stressful event and has a clinical presentation that is indistinguishable from a myocardial infarction. We review the best evidence regarding the pathophysiology, clinical features, investigation, and management of ABS. The incidence of ABS is estimated to be 1% to 2% of patients presenting with an acute myocardial infarction. The pathophysiology remains unknown, but catecholamine mediated myocardial stunning is the most favored explanation. Chest pain and dyspnea are the typical presenting symptoms. Transient ST elevation may be present on the electrocardiogram, and a small rise in cardiac troponin T is invariable. Typically, there is hypokinesis or akinesis of the mid and apical segments of the left ventricle with sparing of the basal systolic function without obstructive coronary lesions. Supportive treatment leads to spontaneous rapid recovery in nearly all patients. The prognosis is excellent, and a recurrence occurs in <10% of patients. Apical ballooning syndrome should be included in the differential diagnosis of patients with an apparent acute coronary syndrome with left ventricular regional wall motion abnormality and absence of obstructive coronary artery disease, especially in the setting of a stressful trigger.
心尖气球样变综合征（ABS）是一种独特的可逆性心肌病，常由应激事件诱发，临床表现与心肌梗死难以区分。我们回顾了关于ABS的病理生理学、临床特征、检查及管理的最佳证据。ABS的发病率估计占急性心肌梗死患者的1%至2%。其病理生理学尚不清楚，但儿茶酚胺介导的心肌顿抑是最受青睐的解释。胸痛和呼吸困难是典型的首发症状。心电图可能出现短暂ST段抬高，心肌肌钙蛋白T会有小幅升高。典型表现为左心室中部和心尖段运动减弱或消失，基底收缩功能保留，且无阻塞性冠状动脉病变。支持性治疗几乎可使所有患者自发快速恢复。预后良好，复发率<10%。对于出现明显急性冠状动脉综合征、左心室局部壁运动异常且无阻塞性冠状动脉疾病的患者，尤其是在有应激诱因的情况下，应将心尖气球样变综合征纳入鉴别诊断。
