Taha Mohamed E, Al-Khafaji Jaafar, Abdalla Abubaker O, Wilson Christopher R
Department of Internal Medicine, University of Nevada, Reno, NV, USA.
Department of Cardiology, Renown Institute for Heart and Vascular Health, Reno, NV, USA.
Am J Case Rep. 2018 May 29;19:614-618. doi: 10.12659/AJCR.908836.
BACKGROUND A coronary artery-left ventricular fistula is an anomalous communication between the coronary arteries and the cardiac chambers and is a rare congenital coronary anomaly that is often small and asymptomatic. Takotsubo cardiomyopathy, on the other hand, is a syndrome characterized by transient regional systolic dysfunction of the left ventricle, mimicking myocardial infarction, but in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. We present the case of an elderly woman who presented with Takotsubo cardiomyopathy and who was incidentally discovered to have an associated coronary artery-left ventricular fistula. CASE REPORT We report the case of a 68-years-old woman with a family history of premature cardiac diseases who presented with ischemic chest pain and elevated troponin levels. Her EKG and troponins were suggestive of non-ST-elevation myocardial infarction (NSTEMI), for which she was initially treated medically and later underwent coronary angiography. Unexpectedly, the angiography revealed patent coronary arteries, and we discovered evidence of coronary artery to left ventricular fistula in the addition to angiographic evidence of Takotsubo cardiomyopathy. A working diagnosis of Takotsubo was made, for which she was treated medically with resulting improvement of her symptoms and later in the imaging findings. CONCLUSIONS This described case illustrates a rare association between coronary artery fistulas and Takotsubo cardiomyopathy. It is unclear if this association has played a role in the pathogenesis or perhaps is just an incidental finding. More similar cases are needed to expand the clinical presentation of both conditions and add to the literature.
背景 冠状动脉-左心室瘘是冠状动脉与心腔之间的异常连通，是一种罕见的先天性冠状动脉异常，通常较小且无症状。另一方面，应激性心肌病是一种以左心室短暂性局部收缩功能障碍为特征的综合征，类似于心肌梗死，但无阻塞性冠状动脉疾病或急性斑块破裂的血管造影证据。我们报告一例老年女性患者，她表现为应激性心肌病，偶然发现合并冠状动脉-左心室瘘。病例报告 我们报告一例68岁女性，有早发性心脏病家族史，出现缺血性胸痛和肌钙蛋白水平升高。她的心电图和肌钙蛋白提示非ST段抬高型心肌梗死（NSTEMI），最初接受药物治疗，后来接受冠状动脉造影。出乎意料的是，血管造影显示冠状动脉通畅，除了应激性心肌病的血管造影证据外，我们还发现了冠状动脉-左心室瘘的证据。做出了应激性心肌病的初步诊断，她接受了药物治疗，症状得到改善，影像学检查结果也有所好转。结论 本病例描述了冠状动脉瘘与应激性心肌病之间罕见的关联。尚不清楚这种关联是否在发病机制中起作用，或者只是一个偶然发现。需要更多类似病例来扩展这两种疾病的临床表现并丰富文献资料。
