Zinnamosca Laura, Petramala Luigi, Cotesta Dario, Lefons Maria Luisa, Marinelli Cristiano, Chirletti Piero, Greco Cesare, Letizia Claudio
Dipartimento di Medicina Interna e Spacialità Medicine.
Recenti Prog Med. 2011 May;102(5):202-6. doi: 10.1701/659.7669.
"Tako-tsubo" cardiomyopathy is a condition characterized by a transitory left ventricular asinergia, induced by physical and emotional stress. In literature there are few cases of association between cardiomyopathy and pheochromocytoma. We described a case of a 72 year-old woman admitted in Emergency Room for chest pain associated with high blood pressure: the ECG showed non-ST elevation in leads III, AVF and V1. An echocardiogram showed global reduction in contractility (EF 40%) with apical akinesia. The coronary angiography showed coronary without stenosis while left ventriculography showed an average apical akinesia of the anterior wall with enhanced contractility of basal segments. Subsequently, the patient continued to present episodes of tremors associated with high blood pressure and therefore was made the determination of urinary metanephrines and urinary vanilmandelic acid that were both high. A subsequent abdomen MRI showed a 32 mm left adrenal lesion with arterial phase impregnation. The diagnosis of left adrenal pheochromocytoma was made and the tumor, after appropriate preoperative pharmacological preparation with α-blockers, was removed surgically. In conclusion, the unexplained transitory left ventricular asinergia alert the clinician of an underlying disorder, such as pheochromocytoma, the early detection of which is crucial to the prognosis.
“应激性心肌病”是一种由身体和情绪应激诱发的、以短暂性左心室运动不能为特征的病症。文献中关于心肌病与嗜铬细胞瘤关联的病例较少。我们描述了一例72岁女性因胸痛伴高血压入住急诊室的病例：心电图显示Ⅲ、AVF及V1导联ST段无抬高。超声心动图显示心肌收缩力整体下降（射血分数40%），心尖运动减弱。冠状动脉造影显示冠状动脉无狭窄，而左心室造影显示前壁心尖平均运动减弱，基底节段收缩力增强。随后，患者持续出现与高血压相关的震颤发作，因此检测了尿间甲肾上腺素和尿香草扁桃酸，结果均升高。随后的腹部MRI显示左肾上腺有一个32毫米的病灶，动脉期有强化。诊断为左肾上腺嗜铬细胞瘤，在使用α受体阻滞剂进行适当的术前药物准备后，肿瘤被手术切除。总之，不明原因的短暂性左心室运动不能应提醒临床医生存在潜在疾病，如嗜铬细胞瘤，早期发现对预后至关重要。
