Madias John E
Icahn School of Medicine at Mount Sinai of the New York University, Division of Cardiology, Elmhurst Hospital Center, New York, NY, USA.
Int J Cardiol. 2013 Oct 12;168(5):4593-5. doi: 10.1016/j.ijcard.2013.08.031. Epub 2013 Aug 15.
Takotsubo syndrome (TTS) is characterized by electrocardiogram (ECG) diffuse ST-segment elevations (+ST), and T-wave inversions with prolongation of the QTc interval. Thus ECG-wise, TTS is not different from acute coronary syndromes (ACSs). However unlike acute ST-elevation myocardial infarction, one type of ACS, a rapid conversion of+ST to T-wave inversion with prolongation of the QTc interval is seen in TTS. The author hypothesizes that this conversion is paralleled by a change of segmental myocardial dyskinesis to akinesis, development of myocardial edema, and reversion of the cardioinhibitory ß-2 adrenergic receptor function, to its cardiostimulatory normal status. This hypothesis does not negate the plausibility that the ECG changes in TTS are due to myocardial ischemia/injury as traditionally perceived in ACSs. The reasons of the counterintuitive concurrence of the cardiac contractility to normal, or previous baseline status, while myocardial edema and T-wave inversions persist for several weeks in patients with TTS, are still elusive.
应激性心肌病（TTS）的特征是心电图（ECG）出现弥漫性ST段抬高（+ST）、T波倒置以及QTc间期延长。因此，从心电图角度来看，TTS与急性冠状动脉综合征（ACS）并无差异。然而，与急性ST段抬高型心肌梗死（一种ACS类型）不同的是，在TTS中可观察到+ST迅速转变为T波倒置并伴有QTc间期延长。作者推测，这种转变与节段性心肌运动障碍转变为心肌运动消失、心肌水肿的发展以及心脏抑制性β-2肾上腺素能受体功能恢复到其心脏刺激正常状态同时发生。这一假设并不否定TTS中ECG变化是由于传统上认为的ACS中的心肌缺血/损伤这一合理性。TTS患者心肌水肿和T波倒置持续数周，而心脏收缩力却恢复到正常或先前的基线状态，这种违反直觉的同时出现的原因仍然难以捉摸。
