Keskin Abdulgazi, Winkler Ralph, Mark Bernd, Kilkowski Andreas, Bauer Timm, Koeth Oliver, Camci Selcan, Cornelius Bernd, Layer Günther, Zeymer Uwe, Zahn Ralf
Department of Cardiology (Herzzentrum Ludwigshafen), Hospital Ludwigshafen, Academic Teaching Hospital of Johannes-Gutenberg-University of Mainz, Ludwigshafen am Rhein, Germany.
J Med Case Rep. 2010 Aug 20;4:280. doi: 10.1186/1752-1947-4-280.
Tako-tsubo cardiomyopathy (stress-induced cardiomyopathy or transient left ventricular ballooning) is characterized by clinical suspicion of an acute myocardial infarction with transient apical or midventricular dyskinesia of the left ventricle without significant coronary stenosis on angiography. The etiology of this disease remains obscure. One of the possible causes is myocardial ischemia induced by coronary vasospasm due to sympathetic activation. It has been hypothesized that the application of ergometrine could induce tako-tsubo cardiomyopathy.
We report the case of a 28-year-old Turkish woman who developed tako-tsubo cardiomyopathy after administration of ergometrine for release of placenta and prevention of bleeding during the post-partum phase in the course of an elective caesarean delivery. Tako-tsubo cardiomyopathy was diagnosed by echocardiography and urgent cardiac magnetic resonance imaging. A coronary angiography was not performed because of the absence of myocardial necrosis or ischemia and signs of myocarditis on cardiac magnetic resonance imaging.
This life-threatening disease should be excluded in the differential diagnosis by comparing the symptoms with those of typical heart failure, particularly after use of ergometrine.
应激性心肌病（应激性心肌病或短暂性左心室气球样变）的特点是临床上怀疑为急性心肌梗死，伴有左心室短暂的心尖或心室中部运动障碍，而血管造影显示冠状动脉无明显狭窄。该病的病因仍不清楚。一种可能的原因是交感神经激活导致冠状动脉痉挛引起的心肌缺血。有人推测，应用麦角新碱可能诱发应激性心肌病。
我们报告一例28岁的土耳其女性病例，该患者在择期剖宫产术后的产后阶段，因使用麦角新碱促进胎盘娩出和预防出血而发生了应激性心肌病。通过超声心动图和紧急心脏磁共振成像诊断为应激性心肌病。由于心脏磁共振成像未显示心肌坏死或缺血以及心肌炎迹象，因此未进行冠状动脉造影。
在鉴别诊断中，应通过将症状与典型心力衰竭的症状进行比较来排除这种危及生命的疾病，尤其是在使用麦角新碱之后。
