Udroiu Cristian A, Zorman Darko, Vinereanu Dragos
University and Emergency Hospital of Bucharest, Department of Cardiology, Romania.
University Medical Centre Ljubliana, Head of Invasive and Interventional Cardiology Unit Department of Cardiology, Slovenia.
Maedica (Bucur). 2013 Sep;8(3):265-8.
We reported a patient with Takotsubo syndrome, with severe symptoms, prolonged angina with hemodynamic compromise, in the context of severe coronary artery spasm, without response to full medical treatment, which was successfully managed with coronary balloon angioplasty. A 49-year old woman was admitted with chest pain, ECG changes and elevated myocardial necrosis markers suggestive for acute coronary syndrome. First coronary angiography revealed normal epicardial arteries and typical left ventricular apical ballooning, strongly suggestive for Takotsubo syndrome. Forty-eight hours later, with standard medical treatment, patient developed again severe angina with hemodynamic consequences. Second angiography showed total occlusive spasm of one coronary artery, without response to full medical treatment. Coronary balloon angioplasty was performed with final good result. Two month later, angiography revealed normal coronary arteries and normal ventricular shape. The patient is currently asymptomatic.As far as we know, no other examples of similar cases were published in medical literature. Therefore, interventional treatment can be taken into consideration for some particular types of patients with Takotsubo syndrome, non-responsive to medical treatment; despite of balloon angioplasty or stenting of coronary vasospasm is not a standard of care.
我们报告了一例患有应激性心肌病的患者，症状严重，在严重冠状动脉痉挛的情况下出现长时间心绞痛并伴有血流动力学障碍，经充分药物治疗无效，最终通过冠状动脉球囊血管成形术成功治疗。一名49岁女性因胸痛、心电图改变及心肌坏死标志物升高入院，提示急性冠状动脉综合征。首次冠状动脉造影显示心外膜动脉正常，典型的左心室心尖部气球样变，强烈提示应激性心肌病。48小时后，经标准药物治疗，患者再次出现严重心绞痛并伴有血流动力学改变。第二次血管造影显示一条冠状动脉完全闭塞性痉挛，充分药物治疗无效。遂行冠状动脉球囊血管成形术，最终效果良好。两个月后，血管造影显示冠状动脉正常，心室形态正常。患者目前无症状。据我们所知，医学文献中尚未发表过类似病例。因此，对于某些特定类型的药物治疗无效的应激性心肌病患者，可考虑采取介入治疗；尽管冠状动脉痉挛的球囊血管成形术或支架置入术并非标准治疗方法。
