Cardiology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy.
Cardiovasc Pathol. 2011 Jul-Aug;20(4):254-7. doi: 10.1016/j.carpath.2010.06.006. Epub 2010 Aug 11.
Takotsubo cardiomyopathy is a left ventricle cardiomyopathy characterized by a reversible dyskinesia responsible for the typical apical ballooning aspect. The disease is considered benignant with a full recovery within a few weeks. We present the case of a 52-year-old woman who presented with angina diagnosed with Takotsubo cardiomyopathy on the basis of both noninvasive (electrocardiography, echocardiography) and invasive (angiography) exams. At discharge, a Holter monitor was fitted to the patient. During the recording the patient faced sudden cardiac death. The analysis of the Holter traces allowed some speculations on the mechanism of this unexpected arrhythmic death. The cause of the fatal ventricular fibrillation appears to be the fast reperfusion following a short occlusion of an epicardial coronary artery. This case highlights the epicardial vasospasm as an important pathogenic mechanism of the syndrome and the possible usefulness of diagnostic tests able to elicit the spasm susceptibility and guide a more targeted pharmacological therapy. Some considerations are also possible on the cellular processes linking the rapid reperfusion and the arrhythmias onset.
心尖球囊样综合征是一种左心室心肌病，其特征为可逆性运动障碍，导致典型的心尖球囊样外观。该疾病被认为是良性的，在数周内可完全恢复。我们报告了一例 52 岁女性病例，该患者因心绞痛就诊，根据非侵入性（心电图、超声心动图）和侵入性（血管造影）检查诊断为心尖球囊样综合征。出院时，为患者佩戴了动态心电图监测仪。在记录过程中，患者发生了心源性猝死。动态心电图监测仪的分析结果对这种意外心律失常性死亡的机制进行了一些推测。致命性心室颤动的原因似乎是心外膜冠状动脉短暂闭塞后快速再灌注。该病例强调了心外膜血管痉挛作为该综合征的重要发病机制，以及可能有用的诊断测试来诱发痉挛易感性并指导更有针对性的药物治疗。还可以对连接快速再灌注和心律失常发作的细胞过程进行一些考虑。
