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应激性心肌病(心碎综合征):简要综述

Takotsubo Cardiomyopathy (Broken-Heart Syndrome): A Short Review.

作者信息

Potu Kalyan Chakravarthy, Raizada Amol, Gedela Maheedhar, Stys Adam

出版信息

S D Med. 2016 Apr;69(4):169-71.

Abstract

Takotsubo cardiomyopathy, also called "broken heart" syndrome or apical ballooning syndrome, is a reversible cardiomyopathy characterized by left ventricular dysfunction and ballooning of the left ventricular apex on imaging during systole. It predominantly occurs in post-menopausal women and is commonly associated with emotional or physical stress. Patients commonly present with chest pain and electrocardiographic evidence of ST segment elevation or T-wave-mimicking acute coronary syndrome, but with an absence of angiographic evidence of obstructive coronary disease. The exact cause is unknown, but potential contributors include catecholamine excess and sympathetic nervous system hyperactivity. There is no consensus on pharmacological treatment of takotsubo cardiomyopathy. Based on the suspected pathophysiology of the disease, adrenergic blockade using beta-blocker therapy is employed. Near complete resolution of left ventricular wall motion dyskinesis occurs in the majority of takotsubo cardiomyopathy patients within a month. Although the prognosis is generally favorable, there are reports of complications during the acute phase, including cardiogenic shock, pulmonary edema, ventricular tachycardia, apical thrombus formation, and death. This review article will briefly discuss the epidemiology, etiology, clinical features, diagnostic evaluation, and treatment of this condition.

摘要

应激性心肌病,也称为“心碎”综合征或心尖球囊样综合征,是一种可逆性心肌病,其特征为左心室功能障碍以及在收缩期成像时左心室心尖部呈球囊样改变。它主要发生在绝经后女性中,通常与情绪或身体应激有关。患者通常表现为胸痛以及心电图显示ST段抬高或T波改变,类似急性冠状动脉综合征,但冠状动脉造影无阻塞性冠状动脉疾病的证据。确切病因尚不清楚,但潜在因素包括儿茶酚胺过量和交感神经系统功能亢进。对于应激性心肌病的药物治疗尚无共识。基于该疾病可疑的病理生理学,采用β受体阻滞剂进行肾上腺素能阻断治疗。大多数应激性心肌病患者在一个月内左心室壁运动障碍几乎完全缓解。尽管总体预后良好,但有报道称急性期会出现并发症,包括心源性休克、肺水肿、室性心动过速、心尖血栓形成和死亡。这篇综述文章将简要讨论该疾病的流行病学、病因、临床特征、诊断评估和治疗。

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