Department of Pediatrics,
Division of Pediatric Critical Care, and.
Pediatrics. 2014 Oct;134(4):e1211-7. doi: 10.1542/peds.2013-1881. Epub 2014 Sep 8.
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is an acquired form of left ventricular systolic dysfunction seen in the setting of physiologic stress and the absence of coronary artery disease. It is thought to be caused by excessive sympathetic stimulation. It is well described in the adult literature associated with subarachnoid hemorrhage where it is known as neurogenic stress cardiomyopathy (NSC), but few such pediatric cases have been reported. We describe our experience with 2 children (13- and 10-year-old girls) who presented with spontaneous intracranial hemorrhage followed by pulmonary edema and shock. Echocardiography revealed similar patterns of left ventricular wall motion abnormalities consistent with NSC, inverted Takotsubo variant. One child progressed to death, whereas the other made a remarkable recovery, including significant improvement in cardiac function over the course of 1 week. We argue that at least 1 of these cases represents true stress-induced cardiomyopathy. This report will alert pediatricians to this transient cardiomyopathy that is likely underdiagnosed in pediatric intensive care. We also highlight the challenges of managing both shock and elevated intracranial pressure in the setting of NSC.
心尖球囊样综合征，亦称应激性心肌病，是一种在生理性应激和无冠状动脉疾病的情况下出现的左心室收缩功能障碍的获得性疾病。其被认为是由过度的交感神经刺激引起的。在蛛网膜下腔出血相关文献中已有详尽描述，这种情况被称为神经源性应激性心肌病（NSC），但相关儿科病例报告较少。我们描述了 2 例儿童（分别为 13 岁和 10 岁的女孩）的发病经过，她们均因自发性颅内出血继而出现肺水肿和休克。超声心动图显示了类似的左心室壁运动异常模式，符合 NSC 的特点，即反向心尖球囊样综合征。其中 1 例患儿进展为死亡，而另 1 例患儿则恢复良好，包括心脏功能在 1 周内显著改善。我们认为，这些病例中至少有 1 例为真正的应激性心肌病。本报告将提醒儿科医生注意这种在儿科重症监护中可能被漏诊的短暂性心肌病。我们还强调了在 NSC 情况下，同时处理休克和颅内压升高的挑战。
