De Gennaro Luisa, Ruggiero Massimo, Musci Sergio, Tota Francesco, De Laura Domenica, Resta Manuela, Locuratolo Nicola, Santoro Francesco, Brunetti Natale Daniele, Caldarola Pasquale
Cardiology Departement, Ospedale San Paolo, Bari, Italy.
Department of Medical and&Surgical Sciences, University of Foggia, Foggia, Italy.
J Thromb Thrombolysis. 2017 Aug;44(2):234-237. doi: 10.1007/s11239-017-1510-4.
Endo-ventricular thrombosis represents a possible clinical complication of stress(takotsubo)-cardiomyopathy (SC). Depressed ventricular systolic ventricular function, localized left ventricular (LV) dyskinesis, but also an increased pro-thrombotic state induced by catecholamine surge may facilitate the occurrence of endovascular thrombosis in SC. SC, however, may also present as right ventricular (RV) dysfunction or even as biventricular ballooning. Ventricular thrombosis may therefore theoretically occur in either ventricles or both. We report the case of an 88-year old woman, with vascular dementia and depression, admitted for abdominal pain, diarrhea, and rectal bleeding. Unexpectedly, electrocardiogram showed induced QT-prolongation with diffuse negative T-waves, while echocardiogram severe LV dysfunction (ejection fraction 35%), but also RV dysfunction and biventricular thrombosis. The diagnosis was therefore biventricular SC complicated by biventricular thrombosis; LV recovered after 10 days. When SC presents with a biventricular involvement, a careful assessment of either ventricular cavities should be therefore recommended to exclude the presence of (bi)ventricular thrombosis. It remains unresolved whether biventricular SC may represent a condition at higher risk of ventricular thrombosis.
心室内血栓形成是应激性（Takotsubo）心肌病（SC）可能出现的一种临床并发症。心室收缩功能降低、局部左心室（LV）运动障碍，以及儿茶酚胺激增所导致的促血栓形成状态增加，都可能促使SC患者发生心室内血栓形成。然而，SC也可能表现为右心室（RV）功能障碍，甚至是双心室气球样变。因此，理论上心室血栓可能发生在任一心室或双侧心室。我们报告了一例88岁女性患者，患有血管性痴呆和抑郁症，因腹痛、腹泻及直肠出血入院。意外的是，心电图显示QT间期延长伴弥漫性负向T波，而超声心动图显示严重的左心室功能障碍（射血分数35%），同时伴有右心室功能障碍和双心室血栓形成。因此诊断为双心室SC合并双心室血栓形成；左心室在10天后恢复。所以，当SC表现为双心室受累时，建议仔细评估任一心室腔，以排除（双）心室血栓的存在。双心室SC是否可能代表心室血栓形成风险更高的一种情况，目前仍未明确。
