Rodrigues Leticia Bôa-Hora, Batista Ana, Monteiro Fátima, Duarte João Silva
Serviço de Anestesiologia, Centro Hospitalar de Setúbal, Hospital de São Bernardo, Setúbal, Portugal.
Serviço de Anestesiologia, Centro Hospitalar de Setúbal, Hospital de São Bernardo, Setúbal, Portugal.
Braz J Anesthesiol. 2015 Sep-Oct;65(5):403-6. doi: 10.1016/j.bjane.2014.11.005. Epub 2015 Aug 17.
Takotsubo cardiomyopathy, also known as broken heart syndrome is a stress-induced cardiomyopathy, which can be interpreted as an acute coronary syndrome as it progresses with suggestive electrocardiographic changes. The purpose of this article is to show the importance of proper monitoring during surgery, as well as the presence of an interdisciplinary team to diagnose the syndrome.
Male patient, 66 years old, with diagnosis of gastric carcinoma, scheduled for diagnostic laparoscopy and possible gastrectomy. In the intraoperative period during laparoscopy, the patient always remained hemodynamically stable, but after conversion to open surgery he presented with ST segment elevation in DII. ECG during surgery was performed and confirmed ST-segment elevation in the inferior wall. The cardiology team was contacted and indicated the emergency catheterization. As the surgery had not yet begun irreversible steps, we opted for the laparotomy closure, and the patient was immediately taken to the hemodynamic room where catheterization was performed showing no coronary injury. The patient was taken to the hospital room where an echocardiogram was performed and showed slight to moderate systolic dysfunction, with akinesia of the mid-apical segments, suggestive of apical ballooning of the left ventricle. Faced with such echocardiographic finding and in the absence of coronary injury, the patient was diagnosed with intraoperative Takotsubo syndrome.
Because the patient was properly monitored, the early detection of ST-segment elevation was possible. The presence of an interdisciplinary team favored the syndrome early diagnosis, so the patient was again submitted to safely intervention, with the necessary security measures taken for an uneventful new surgical intervention.
应激性心肌病，又称心碎综合征，是一种应激诱导的心肌病，因其进展伴有提示性心电图改变，可被解释为急性冠状动脉综合征。本文旨在说明手术期间进行适当监测的重要性，以及跨学科团队对该综合征进行诊断的必要性。
一名66岁男性患者，诊断为胃癌，计划进行诊断性腹腔镜检查及可能的胃切除术。在腹腔镜手术期间，患者血流动力学一直保持稳定，但转为开放手术后，他在Ⅱ导联出现ST段抬高。术中进行了心电图检查，证实下壁ST段抬高。联系了心脏病学团队并建议进行紧急导管插入术。由于手术尚未开始不可逆步骤，我们选择关闭剖腹手术切口，患者立即被送往血流动力学室进行导管插入术，结果显示无冠状动脉损伤。患者被送往病房，在那里进行了超声心动图检查，结果显示有轻度至中度收缩功能障碍，心尖中段运动减弱，提示左心室心尖部气球样变。面对这样的超声心动图表现且无冠状动脉损伤，患者被诊断为术中应激性心肌病综合征。
由于对患者进行了适当监测，得以早期发现ST段抬高。跨学科团队的存在有利于该综合征的早期诊断，因此患者再次接受了安全干预，并采取了必要的安全措施以确保新的手术顺利进行。
