Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Interv Cardiol. 2009 Oct;22(5):444-52. doi: 10.1111/j.1540-8183.2009.00488.x. Epub 2009 Jul 13.
Takotsubo cardiomyopathy often presents to the cardiac catheterization laboratory masquerading as acute ST-elevation myocardial infarction (STEMI). Some of these patients present in shock secondary to dynamic left ventricular outflow tract (LVOT) obstruction. The typical patient is an elderly, hypertensive female with sigmoid deformity of the intraventricular septum. The management of hemodynamic instability in these patients is different from patients with STEMI. While hemodynamic instability in the setting of STEMI is usually treated with inotropic agents and intraaortic balloon counterpulsation, these therapies can increase LVOT pressure gradients in patients with takotsubo cardiomyopathy and lead to deepening of shock and worse outcomes. Thus accurate diagnosis and correct management are essential to prevent mortality in these patients, who will usually go on to have good long-term outcomes. This case report and literature review addresses the clinical characteristics, outcome, and management of these patients.
心尖球囊样综合征常以急性 ST 段抬高型心肌梗死（STEMI）的形式出现在心脏导管实验室。这些患者中的一些因左心室流出道（LVOT）梗阻的动态变化而出现休克。典型的患者是有高血压的老年女性，伴有室间隔的“S”形弯曲。这些患者的血流动力学不稳定的管理不同于 STEMI 患者。尽管 STEMI 中的血流动力学不稳定通常使用正性肌力药物和主动脉内球囊反搏治疗，但这些治疗可能会增加 Takotsubo 心肌病患者的 LVOT 压力梯度，导致休克加深和预后更差。因此，准确的诊断和正确的管理对于预防这些患者的死亡率至关重要，他们通常会有良好的长期预后。本病例报告和文献复习介绍了这些患者的临床特征、结局和管理。
