Sawamoto Keigo, Hase Mamoru, Uemura Shuji, Kasai Takehiko, Narimatsu Eichi
Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan.
J Emerg Med. 2015 Feb;48(2):e35-8. doi: 10.1016/j.jemermed.2014.10.003. Epub 2014 Nov 20.
Takotsubo cardiomyopathy (TC) is an uncommon immune-endocrinologic cause of acute reversible heart failure, generally caused by some form of stress.
We report a case of TC after hanging for attempted suicide. Upon admission, the patient demonstrated an almost entirely normal electrocardiogram (ECG) and mild hypotension. However, on the third day after hanging, she developed chest and back pain with inverted T waves and QTc prolongation on ECG. Her coronary arteries were normal on angiogram, but the left ventricle showed apical ballooning, consistent with TC. She was treated with an intra-aortic balloon pump and fully recovered. We observed that the QTc interval seemed to be a good guide for clinical course in this case. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TC should be considered in any acute stressful presentation, and to assist in the diagnosis as TC, we suggest following the QTc on ECG. TC should be taken into consideration in patients after suicide attempt with low blood pressure or an abnormal ECG, including ST segment elevation, T wave inversion, and QTc prolongation.
应激性心肌病（TC）是急性可逆性心力衰竭一种不常见的免疫 - 内分泌病因，通常由某种形式的应激引起。
我们报告一例自杀未遂上吊后发生的应激性心肌病病例。入院时，患者心电图（ECG）几乎完全正常，仅有轻度低血压。然而，上吊后第三天，她出现胸痛和背痛，心电图显示T波倒置和QTc延长。血管造影显示其冠状动脉正常，但左心室呈心尖部气球样改变，符合应激性心肌病表现。她接受了主动脉内球囊泵治疗并完全康复。我们观察到在该病例中QTc间期似乎是临床病程的良好指导指标。
急诊医生为何应了解此情况？：任何急性应激表现均应考虑应激性心肌病，为协助诊断应激性心肌病，我们建议观察心电图上的QTc。自杀未遂且伴有低血压或心电图异常（包括ST段抬高、T波倒置和QTc延长）的患者应考虑应激性心肌病。
