Gale Michael, Loarte Pablo, Mirrer Brooks, Mallet Thierry, Salciccioli Louis, Petrie Alison, Cohen Ronny
Division of Cardiology, Department of Medicine, Woodhull Medical Center, 760 Broadway, Suite 3B320, Brooklyn, NY 11206, USA.
Department of Medicine, Yale-New Haven Hospital, 20 York Street, CB2041, New Haven, CT 06510, USA.
Case Rep Crit Care. 2015;2015:536931. doi: 10.1155/2015/536931. Epub 2015 Aug 23.
Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usually accompanied by electrocardiographic changes. The literature documents only two other cases of Takotsubo cardiomyopathy in the latter setting. Methods. A 78-year-old female presented to the ED with severe shortness of breath, hypertension, and tachycardia. On physical exam, heart sounds (S1 and S2) were regular and wheezing was noticed bilaterally. We found laboratory results with a WBC of 20.0 (103/μL), troponin of 16.52 ng/mL, CK-mb of 70.6%, and BNP of 177 pg/mL. The patient was intubated for acute hypoxemic respiratory failure. A chest X-ray revealed a large left-sided tension pneumothorax. Initial echocardiogram showed apical ballooning with a LVEF of 10-15%. A cardiac angiography revealed normal coronary arteries with no coronary disease. After supportive treatment, the patient's condition improved with a subsequent echocardiogram showing a LVEF of 60%. Conclusion. The patient was found to have Takotsubo cardiomyopathy in the setting of a tension pneumothorax. The exact mechanisms of ventricular dysfunction have not been clarified. However, multivessel coronary spasm or catecholamine cardiotoxicity has been suggested to have a causative role. We suggest that, in our patient, left ventricular dysfunction was induced by the latter mechanism related to the stress associated with acute pneumothorax.
背景。应激性心肌病被定义为一种短暂的左心室功能障碍，通常伴有心电图改变。文献仅记载了另外两例在后者情况下发生的应激性心肌病病例。方法。一名78岁女性因严重气短、高血压和心动过速被送至急诊科。体格检查时，心音（S1和S2）规律，双侧可闻及哮鸣音。我们发现实验室检查结果显示白细胞计数为20.0（10³/μL），肌钙蛋白为16.52 ng/mL，肌酸激酶同工酶为70.6%，B型利钠肽为177 pg/mL。该患者因急性低氧性呼吸衰竭行气管插管。胸部X线显示左侧大量张力性气胸。初始超声心动图显示心尖部气球样变，左心室射血分数为10% - 15%。心脏血管造影显示冠状动脉正常，无冠心病。经过支持治疗，患者病情好转，随后的超声心动图显示左心室射血分数为60%。结论。该患者在张力性气胸情况下被发现患有应激性心肌病。心室功能障碍的确切机制尚未阐明。然而，多支冠状动脉痉挛或儿茶酚胺心脏毒性被认为具有致病作用。我们认为，在我们的患者中，左心室功能障碍是由与急性气胸相关应激有关的后一种机制诱发的。
