Pino Rodolfo, Manzella Faro, Puccio Danilo, Sciortino Giuseppa, Polizzi Giovanni
U.O. Cardiologia-UTIC, Ospedale Civico di Partinico, ASP Palermo, Partinico (PA).
G Ital Cardiol (Rome). 2016 Oct;17(10):827-830. doi: 10.1714/2464.25802.
The pathogenesis of tako-tsubo syndrome remains, nowadays, unclear: it is likely that the relevance of the different proposed mechanisms differs among specific clinical contexts. In this paper, we describe the case of a 61-year-old woman admitted to the intensive cardiac care unit for pre-syncope and persistent hypotension. Clinical and echocardiographic data were suggestive of tako-tsubo syndrome with severe dynamic left ventricular outflow tract (LVOT) obstruction and severe mitral regurgitation. Coronary angiography was normal. Inotropic agents were not administered, because absolutely contraindicated in the presence of LVOT obstruction: indeed, they may worsen the dynamic gradient with further hemodynamic compromise. The patient was, therefore, initially treated with intravenous fluid infusion and, later on, with beta-blockers; the patient had a regular clinical recovery, with progressive disappearance of ECG and echocardiographic abnormalities. This case confirms that an early echocardiographic diagnosis of LVOT obstruction is essential for therapeutic decision-making, especially in the setting of tako-tsubo syndrome presenting with compromised hemodynamic status.
目前，应激性心肌病的发病机制仍不明确：在特定临床背景下，不同提出机制的相关性可能有所不同。在本文中，我们描述了一名61岁女性因先兆晕厥和持续性低血压入住心脏重症监护病房的病例。临床和超声心动图数据提示为应激性心肌病，伴有严重的动态左心室流出道（LVOT）梗阻和严重二尖瓣反流。冠状动脉造影正常。未使用正性肌力药物，因为在存在LVOT梗阻时绝对禁忌使用：事实上，它们可能会使动态压差恶化，进一步导致血流动力学受损。因此，该患者最初接受静脉输液治疗，随后使用β受体阻滞剂；患者临床恢复正常，心电图和超声心动图异常逐渐消失。该病例证实，LVOT梗阻的早期超声心动图诊断对于治疗决策至关重要，尤其是在血流动力学状态受损的应激性心肌病患者中。
