Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna Stråket 16, 413 45 Gothenburg, Sweden ; Department of Cardiology, Sahlgrenska University Hospital, Bruna Stråket 16, 413 45 Gothenburg, Sweden.
J Geriatr Cardiol. 2014 Jun;11(2):171-3. doi: 10.3969/j.issn.1671-5411.2014.02.001.
Takotsubo cardiomyopathy (TCM) is an acute cardiac syndrome characterized by extensive, but potentially reversible, left ventricular dysfunction in the absence of an explanatory coronary obstruction. Thus, TCM is distinct from coronary artery disease (CAD) and acute myocardial infarction (AMI). However, substantial evidence for co-existing CAD in some TCM patients exist. Herein, we take this association one step further and present a case in which the patient simultaneously suffered from AMI and TCM, and in which we believe that a primary coronary event triggered TCM. An 88-year-old female presented with chest pain. Echocardiography revealed apical akinesia with hypercontractile bases. An occluded diagonal branch with suspected acute plaque rupture was identified on the angiogram, but could not explain the extent of akinesia. Cardiac function recovered completely. Thus, this patient adhered to current diagnostic criteria for TCM. TCM is a well-known complication for other conditions associated with somatic stress. It is therefore intuitive to assume that AMI, which also associates with somatic stress and elevated catecholamine, can cause TCM. Our case illustrates that TCM and AMI may occur simultaneously. Although causality cannot be conclusively inferred from this association, the somatic stress associated with AMI may have caused TCM in this patient.
心尖球囊样综合征（TCM）是一种急性心脏综合征，其特征为在不存在可解释性冠状动脉阻塞的情况下出现广泛但可能是可逆性的左心室功能障碍。因此，TCM 有别于冠状动脉疾病（CAD）和急性心肌梗死（AMI）。然而，在一些 TCM 患者中存在共存 CAD 的大量证据。在此，我们更进一步，提出了一个同时患有 AMI 和 TCM 的病例，我们认为原发性冠状动脉事件引发了 TCM。一位 88 岁女性因胸痛就诊。超声心动图显示心尖无运动，基底部高收缩。血管造影显示对角支闭塞，疑似急性斑块破裂，但无法解释无运动的程度。心功能完全恢复。因此，该患者符合当前 TCM 的诊断标准。TCM 是与躯体应激相关的其他疾病的常见并发症。因此，直观地认为 AMI 也与躯体应激和儿茶酚胺升高有关，可能导致 TCM。我们的病例表明 TCM 和 AMI 可能同时发生。尽管不能从这种关联中得出因果关系的结论，但 AMI 相关的躯体应激可能导致了该患者的 TCM。
