Y-Hassan Shams, Shahgaldi Kambiz
Department of Cardiology, Karolinska University Hospital-Huddinge, Sweden.
Intern Med. 2011;50(19):2175-8. doi: 10.2169/internalmedicine.50.5893. Epub 2011 Oct 1.
Thrombo-embolism is one of the serious complications of takotsubo syndrome (TS). It typically occurs in the classical mid-apical left ventricular ballooning form of TS. This complication has not been reported in cases of left mid-ventricular ballooning type of TS. We describe a 67-year-old woman who presented with 2-3 days of increasing signs and symptoms of heart failure. Echocardiography showed marked hypokinesia/akinesia in the mid-anterior, mid-anterolateral, and mid-inferior wall of the left ventricle and mild hypokinesia in the apical region. There was also hypokinesia of the mid and apical parts of the right ventricle. One day after admission, she developed acute left-sided renal infarction. Left ventriculography and coronary angiography 3 days after admission showed typical left mid-ventricular ballooning with no identifiable coronary lesion. Follow-up echocardiography showed complete resolution of left and right ventricular dysfunction. Takotsubo syndrome with right ventricular involvement complicated with heart failure and left renal embolic infarction was diagnosed. The mechanism of left renal embolic infarction is discussed.
血栓栓塞是应激性心肌病（TS）的严重并发症之一。它通常发生在TS典型的心尖中部左心室气球样变形式中。左心室中部气球样变类型的TS病例尚未报道过这种并发症。我们描述了一名67岁女性，她出现心力衰竭症状和体征加重2 - 3天。超声心动图显示左心室前中部、前外侧中部和下中部壁明显运动减弱/运动消失，心尖区域轻度运动减弱。右心室中部和心尖部也有运动减弱。入院一天后，她发生了急性左侧肾梗死。入院3天后的左心室造影和冠状动脉造影显示典型的左心室中部气球样变，未发现明显冠状动脉病变。随访超声心动图显示左、右心室功能障碍完全恢复。诊断为累及右心室的应激性心肌病并发心力衰竭和左肾栓塞性梗死。并讨论了左肾栓塞性梗死的机制。
