Morita Seiji, Inokuchi Sadaki, Yamagiwa Takeshi, Aoki Hiromichi, Nakagawa Yoshihide, Yamamoto Isotoshi
Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara-City, Kanagawa, Japan.
J Emerg Med. 2010 Sep;39(3):301-4. doi: 10.1016/j.jemermed.2007.10.086. Epub 2008 Jul 2.
The etiology of a novel cardiac syndrome called "tako-tsubo" cardiomyopathy, otherwise known as "acute onset and reversible left ventricular apical wall motion abnormality (ballooning)," is very similar to that of acute myocardial infarction; however, it may also be associated with emotional or physical stress. We report a case of tako-tsubo-like left ventricular dysfunction with ST-segment elevation after trauma. A 69-year-old man was transferred to our hospital after a fall in which he injured his back. He was diagnosed with a central spinal cord injury and was admitted to our Intensive Care Unit. He complained of a sudden chest pain 12 h after the injury. ST-segment elevation was observed on the electrocardiographic monitor, and subsequent 12-lead electrocardiogram demonstrated ST-segment elevation in leads V(2) through V(5). We considered acute myocardial infarction or cardiac contusion to be the cause of this event; therefore, an emergency coronary angiography was performed. However, the angiography revealed no significant coronary artery stenosis. Furthermore, left ventriculography demonstrated severe hypokinesis of the left ventricular apical region, consistent with tako-tsubo-like left ventricular dysfunction. The patient's cardiac function improved gradually, and he was discharged from our hospital on the 18(th) day after admission. Physicians should recognize the syndrome of tako-tsubo-like left ventricular dysfunction, which may result from traumatic stress or chest injury.
一种名为“应激性心肌病”的新型心脏综合征，又称“急性发作且可逆的左心室心尖部室壁运动异常（球囊样改变）”，其病因与急性心肌梗死非常相似；然而，它也可能与情绪或身体应激有关。我们报告一例创伤后出现ST段抬高的应激性心肌病样左心室功能障碍病例。一名69岁男性在摔倒致背部受伤后被转送至我院。他被诊断为中央脊髓损伤，并入住我院重症监护病房。受伤12小时后，他突然胸痛。心电图监护显示ST段抬高，随后的12导联心电图显示V(2)至V(5)导联ST段抬高。我们认为急性心肌梗死或心脏挫伤是该事件的原因；因此，进行了急诊冠状动脉造影。然而，造影显示冠状动脉无明显狭窄。此外，左心室造影显示左心室心尖区域严重运动减弱，符合应激性心肌病样左心室功能障碍。患者的心功能逐渐改善，入院第18天出院。医生应认识到应激性心肌病样左心室功能障碍综合征，其可能由创伤应激或胸部损伤引起。
