Y-Hassan Shams, Settergren Magnus, Henareh Loghman
Karolinska Institute at Karolinska University Hospital, Department of Cardiology , Stockholm , Sweden.
Acute Card Care. 2014 Sep;16(3):102-9. doi: 10.3109/17482941.2014.920089. Epub 2014 Jun 23.
Abstract Background and objectives: Myocardial depression in the setting of sepsis and septic shock is common and has been recognized for a long time. The aim of this study is to find out an association and causal link between sepsis and takotsubo syndrome (TS).
Fifteen cases of TS were studied. Critical review of the literature dealing with sepsis and myocardial depression was done Results: Fifteen cases of sepsis-induced TS are described. Fifty-three per cent of the patients were men. The ages ranged from 39 to 76 years (mean age 60 years). Two-thirds of the patients had ST-elevation myocardial infarction ECG changes. Complications occurred in 80% of the patients. No specific types of sepsis or micro-organisms were associated with the development of TS. Critical review of the sepsis-induced myocardial depression shows that the left ventricular dysfunction, which is reversible within one-to-two weeks, is characterized by segmental ventricular dysfunction, and involvement of the right ventricle in one fourth of cases. These features are also consistent with TS.
Sepsis triggers TS, which may be the cause of the majority of cases of sepsis-induced myocardial depression. Acute cardiac sympathetic disruption with noradrenaline spill-over may be the cause of sepsis-induced TS.
摘要 背景与目的：脓毒症和脓毒性休克时的心肌抑制很常见，且早已被认识到。本研究的目的是找出脓毒症与应激性心肌病（TS）之间的关联及因果关系。
对15例应激性心肌病患者进行了研究。对有关脓毒症和心肌抑制的文献进行了严格审查。结果：描述了15例脓毒症诱发的应激性心肌病病例。53%的患者为男性。年龄范围为39至76岁（平均年龄60岁）。三分之二的患者有ST段抬高型心肌梗死心电图改变。80%的患者出现了并发症。没有特定类型的脓毒症或微生物与应激性心肌病的发生相关。对脓毒症诱发的心肌抑制的严格审查表明，左心室功能障碍在1至2周内可逆转，其特征为节段性心室功能障碍，四分之一的病例右心室受累。这些特征也与应激性心肌病一致。
脓毒症引发应激性心肌病，这可能是大多数脓毒症诱发心肌抑制病例的病因。急性心脏交感神经紊乱伴去甲肾上腺素溢出可能是脓毒症诱发应激性心肌病的病因。
