Collen Jacob, Bimson William, Devine Patrick
Department of Internal Medicine, Walter Reed Army Medical Center, Washington, DC, USA.
J Invasive Cardiol. 2008 Nov;20(11):E310-3.
Catecholamine-induced cardiomyopathy has been recognized for decades. We present the case of a 21-year-old female referred for an electrophysiologic (EP) study who underwent an infusion of isoproterenol and epinephrine in an attempt to unmask an ectopic atrial tachycardia. Prior to leaving the study suite, the patient started complaining of chest pain and shortness of breath. Bedside echocardiography revealed a severely depressed left ventricular ejection fraction (EF) of 25-30% with basal-mid left ventricular cavity hypokinesis, but normal apical wall motion. Her coronary angiography was normal. Repeat echocardiography 48 hours post EP study revealed a normally contracting LV with an ejection fraction of 55-60%. Our case illustrates an interesting clinical setting of acute catecholamine-induced cardiomyopathy. Takotsubo syndrome has been classically attributed to an intense emotional or physical stress resulting in excessive serum catecholamine levels causing apical hypokinesis and sparing of basal left ventricular function. This case is felt to represent an uncommon presentation of takotsubo cardiomyopathy occurring during an EP study triggered by iatrogenic catecholamine excess and manifesting with mid-ventricular wall hypokinesis.
儿茶酚胺诱导的心肌病已被认识数十年。我们报告一例21岁女性，因进行电生理（EP）检查而被转诊，在检查过程中输注了异丙肾上腺素和肾上腺素，试图诱发出异位房性心动过速。在离开检查室之前，患者开始抱怨胸痛和呼吸急促。床旁超声心动图显示左心室射血分数（EF）严重降低，为25% - 30%，左心室基底 - 中部腔室运动减弱，但心尖壁运动正常。她的冠状动脉造影正常。EP检查后48小时重复超声心动图显示左心室收缩正常，射血分数为55% - 60%。我们的病例说明了急性儿茶酚胺诱导的心肌病这一有趣的临床情况。应激性心肌病传统上归因于强烈的情绪或身体应激，导致血清儿茶酚胺水平过高，引起心尖运动减弱，而左心室基底功能保留。该病例被认为代表了应激性心肌病的一种罕见表现，发生在EP检查期间，由医源性儿茶酚胺过量引发，并表现为心室中部壁运动减弱。
