Department of Medicine, University of Padova, Padova, Italy.
Aging Clin Exp Res. 2012 Feb;24(1):97-103. doi: 10.1007/BF03325357.
Tako-tsubo cardiomyopathy (idiopathic or transient left ventricular apical ballooning syndrome [ABS]) is a reversible condition frequently precipitated by a stressful trigger that clinically mimics an acute ST-elevation myocardial infarction. Characteristically, hypokinesis or akinesis occurs in the mid- and apical segments of the left ventricle in the absence of epicardial coronary lesions. Preserved or hyperdynamic function of the basal myocardial segments results in apical ballooning, assuming the shape of a Japanese pot used to catch octopus (a takotsubo). We report on 2 well over 70 years old women (78 and 82 years) admitted to the emergency room with chest pain. Clinical signs, ECG alterations and high troponin I in both patients imposed urgent diagnostic testing and management. The electrocardiographic findings were consistent with acute myocardial infarction and transthoracic echocardiography showed in both simultaneous apical akinesia and a hyperkinetic basal area with a moderately reduced left ventricular ejection fraction. Coronary angiography, performed on an emergency basis, in both cases revealed minimal luminal irregularities, with no evidence of plaque rupture or thrombus. The wall motion abnormality extended beyond the distribution of any single coronary artery, making it less likely that an occlusive thrombus had spontaneously dissolved or that intermittent vasospasm had occurred. Taken together, these findings were consistent with ABS, and critical observations on coronary angiography indicated the diagnosis by exclusion. The patients were seen in the clinic 4 weeks after discharge. They had had no recurrent chest pain, and had returned to the normal life they had had before the cardiovascular event. A repeat echocardiography showed a normalized estimated ejection fraction in both patients. ABS is a diagnosis of exclusion and its incidence is probably underestimated in elderly patients in whom coronary angiography is not common.
心尖球囊样综合征（特发性或一过性左心室心尖球囊样综合征[ABS]）是一种可逆性疾病，常由应激诱因引发，临床上类似于急性 ST 段抬高型心肌梗死。其特征为左心室中段和心尖段出现运动减弱或无运动，而心外膜冠状动脉无病变。基底段心肌节段的收缩功能正常或亢进导致心尖球囊样膨出，呈现出日本章鱼罐的形状（tako-tsubo）。我们报告了 2 位年龄均超过 70 岁的女性（78 岁和 82 岁），因胸痛就诊于急诊科。在这 2 位患者中，临床体征、心电图改变和高肌钙蛋白 I 均提示需紧急进行诊断性检查和治疗。心电图表现与急性心肌梗死一致，经胸超声心动图显示，2 位患者同时存在心尖段运动减弱和基底段运动亢进，左心室射血分数中度降低。在紧急情况下进行的冠状动脉造影显示，2 位患者的管腔均存在轻微不规则，无斑块破裂或血栓形成的证据。壁运动异常的范围超出了任何单一冠状动脉的分布，因此不太可能是闭塞性血栓自发溶解或间歇性血管痉挛所致。综合这些发现，符合 ABS 的诊断，且冠状动脉造影的关键观察结果提示通过排除诊断。患者在出院后 4 周就诊。她们没有再次出现胸痛，且恢复了心血管事件前的正常生活。2 位患者的重复超声心动图均显示左心室射血分数正常。ABS 是一种排除性诊断，在不常见进行冠状动脉造影的老年患者中，其发病率可能被低估。
