Izgi Cemil, Ray Sanjoy, Nyktari Evangelia, Alpendurada Francisco, Lyon Alexander R, Rathore Sudhir, Baksi Arun John
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, SW3 6NP London, UK.
Department of Cardiology, Frimley Park Hospital NHS Foundation Trust, Frimley GU16 7UJ, Surrey, UK.
Heart Lung. 2015 Nov-Dec;44(6):481-5. doi: 10.1016/j.hrtlng.2015.07.008. Epub 2015 Aug 25.
Myocardial edema is one of the characteristic features in the pathogenesis of Takotsubo syndrome. We report a middle aged man who presented with typical clinical and echocardiographic features of apical variant of Takotsubo syndrome. However, a cardiovascular magnetic resonance study performed 10 days after presentation did not show any apical 'ballooning' but revealed features of an apical hypertrophic cardiomyopathy on cine images. Tissue characterization with T2 weighted images proved severe edema as the cause of significantly increased apical wall thickness. A follow-up cardiovascular magnetic resonance study was performed 5 months later which showed that edema, wall thickening and the appearance of apical hypertrophic cardiomyopathy all resolved, confirming Takotsubo syndrome as the cause of the initial appearance. As the affected myocardium most commonly involves the apical segments, an edema induced increase in apical wall thickness may lead to appearances of an apical hypertrophic cardiomyopathy rather than apical ballooning in the acute to subacute phase of Takotsubo syndrome.
心肌水肿是应激性心肌病发病机制的特征性表现之一。我们报告了一名中年男性，其表现出应激性心肌病心尖部变异型典型的临床和超声心动图特征。然而，发病10天后进行的心血管磁共振研究未显示任何心尖部“膨出”，但在电影图像上显示出心尖肥厚型心肌病的特征。T2加权图像的组织特征证实严重水肿是心尖壁厚度显著增加的原因。5个月后进行了随访心血管磁共振研究，结果显示水肿、心肌增厚和心尖肥厚型心肌病的表现均已消失，证实应激性心肌病是最初表现的病因。由于受影响的心肌最常累及心尖段，在应激性心肌病的急性至亚急性期，水肿导致的心尖壁厚度增加可能导致心尖肥厚型心肌病的表现，而非心尖膨出。
