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围手术期发生的应激性心肌病

Takotsubo Cardiomyopathy Occurring in the Postoperative Period.

作者信息

Deniz Süleyman, Bakal Ömer, İnangil Gökhan, Şen Hüseyin, Özkan Sezai

机构信息

Department of Anaesthesiology and Reanimation, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey.

出版信息

Turk J Anaesthesiol Reanim. 2015 Feb;43(1):47-9. doi: 10.5152/TJAR.2014.90582. Epub 2014 Sep 9.

Abstract

Takotsubo cardiomyopathy simulates acute myocardial infarction, and it is characterised by reversible left ventricular failure. A case of Takotsubo cardiomyopathy diagnosed after emergency angiography performed in a patient with evidence of acute myocardial infarction in the postoperative period will be described in this report. Transurethral resection of a bladder tumour (TUR-BT) was performed in a 92-year-old male patient by the urology clinic. The patient was transferred to the post-anaesthesia care unit after the operation. An echocardiography was performed because of the sudden onset of dyspnoea, tachycardia (140-150 beats per minute, rhythm-atrial fibrillation) and ST-segment elevation on electrocardiography (ECG) at the first postoperative hour, and midapical dyskinesia was detected at the patient. An immediate angiography was performed due to suspicion of acute coronary syndrome. Patent coronary arteries and temporary aneurysmatic dilatation of the apex of the heart were revealed by angiography. As a result of these findings, the patient was diagnosed with Takotsubo cardiomyopathy by the cardiology service. The patient was discharged uneventfully following 10 days in the intensive care unit. Aneurysm of the apex of the left ventricle and normal anatomy of the coronary arteries in the angiography have diagnostic value for Takotsubo cardiomyopathy. Diuretics (furosemide) and beta-blockers (metoprolol) are commonly used for the treatment of Takotsubo cardiomyopathy. Even though Takotsubo cardiomyopathy is a rare and benign disease, it should be kept in mind in patients suspected for acute myocardial infarction in the postoperative period.

摘要

应激性心肌病可模拟急性心肌梗死,其特征为可逆性左心室衰竭。本报告将描述一例在术后出现急性心肌梗死迹象的患者经急诊血管造影后诊断为应激性心肌病的病例。一名92岁男性患者由泌尿外科诊所进行了经尿道膀胱肿瘤切除术(TUR-BT)。术后患者被转入麻醉后护理单元。术后第一小时,因患者突然出现呼吸困难、心动过速(每分钟140 - 150次,心律为房颤)以及心电图(ECG)上ST段抬高,遂进行了超声心动图检查,发现患者存在心尖部运动障碍。因怀疑急性冠状动脉综合征,立即进行了血管造影。血管造影显示冠状动脉通畅,心尖部有暂时性动脉瘤样扩张。根据这些检查结果,患者被心血管科诊断为应激性心肌病。在重症监护病房住院10天后,患者顺利出院。血管造影中左心室心尖部动脉瘤及冠状动脉正常解剖结构对应激性心肌病具有诊断价值。利尿剂(呋塞米)和β受体阻滞剂(美托洛尔)常用于应激性心肌病的治疗。尽管应激性心肌病是一种罕见的良性疾病,但对于术后疑似急性心肌梗死的患者应予以考虑。

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本文引用的文献

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Takotsubo cardiomyopathy secondary in part to cancer-related pain crisis: a case report.
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Urinary sepsis associated with Takotsubo cardiomyopathy.与Takotsubo心肌病相关的尿源性脓毒症。
Int J Urol. 2014 Apr;21(4):432-3. doi: 10.1111/iju.12303. Epub 2013 Oct 22.
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Abnormal noradrenergic function in posttraumatic stress disorder.创伤后应激障碍中去甲肾上腺素能功能异常。
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