Thapamagar S B, Pasha A G, Krishnamurthy M, Schiavone J A
Easton Hospital, Drexel University, Internal Medicine Residency Program, 250 South 25th Street, Easton, PA 18042, USA.
J Nepal Health Res Counc. 2012 Jan;10(1):69-72.
The "broken heart syndrome", or Takotsubo cardiomyopathy, is an acute cause of transient left ventricular systolic dysfunction characterized by abrupt onset of chest symptoms, ECG changes and a mild rise in myocardial enzymes mimicking acute myocardial infarction. This condition is more common in postmenopausal women and is typically preceded by an intense emotional or physical stress or an acute illness. A higher prevalence of anxiety disorders in patients with this syndrome have also been reported recently. Apical ballooning with left ventricular akinesis or dyskinesis of distal one-third to two-thirds of the left ventricle in cardiac catheterization and absence of significant coronary obstruction is this hallmark of this condition. However, various morphologic variants with different ventricular region involvement have been reported including "an atypical variant" where the left ventricular hypokinesia is restricted to the midventricular segment without involvement of the apex. Here we present a case of 56-year-old female with a history of chronic anxiety who presented with retrosternal chest pain after her partner threatened to leave her. Her EKG showed diffuse T-wave changes with prolonged QT intervals. She also had modest elevation of cardiac enzymes.
“心碎综合征”，即应激性心肌病，是导致短暂性左心室收缩功能障碍的急性病因，其特征为胸部症状突然发作、心电图改变以及心肌酶轻度升高，类似急性心肌梗死。这种情况在绝经后女性中更为常见，通常在强烈的情绪或身体应激、或急性疾病之前出现。最近也有报道称该综合征患者中焦虑症的患病率较高。心脏导管检查显示心尖部气球样扩张，左心室心尖部及远端三分之一至三分之二区域运动减弱或运动障碍，且无明显冠状动脉阻塞，这是该病症的标志。然而，已有报道称存在各种不同心室区域受累的形态学变异，包括“非典型变异型”，即左心室运动减弱局限于心室中段，未累及心尖部。在此，我们报告一例56岁女性病例，该患者有慢性焦虑病史，在其伴侣威胁要离开她后出现胸骨后胸痛。她的心电图显示广泛的T波改变及QT间期延长。她的心肌酶也有适度升高。
