Henriquez C, Landau R, Sabharwal N, Rodriguez D, Virparia V, Sadiq A, Shani J
Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA.
Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA.
Case Rep Cardiol. 2018 Dec 13;2018:5498052. doi: 10.1155/2018/5498052. eCollection 2018.
A 73-year-old female with multiple comorbidities including coronary artery disease was admitted for an elective PCI of a lesion detected in the RCA. On the day of the planned PCI, shortly after right femoral artery cannulation, the patient developed a sudden complete heart block requiring the administration atropine and insertion of a temporary pacemaker. Concomitantly, the patient developed acute pulmonary edema, hypotension, and hypoxia requiring intubation for mechanical ventilation. Vasopressors were administered. A coronary angiogram showed patent left and right coronary arteries, unchanged when compared to the previous angiogram. An echocardiogram performed in the cardiac catheterization lab revealed global hypokinesis of the left and right ventricles, with severe LV systolic dysfunction (EF < 20%). Following an insertion of an intra-aortic balloon pump, the patient was transferred to the CICU. A repeat echocardiogram in the CICU two hours later revealed a classical echocardiographic presentation of Takotsubo syndrome, apical hypokinesis. By the next morning the patient's hemodynamic status significantly improved, the balloon pump was removed, and vasopressors were discontinued. Another echocardiogram was performed 24 hours after the event occurred and revealed a marked improvement in LV systolic function (EF 60%), with complete resolution of apical and septal wall motion abnormalities. Three days after the event, the patient was successfully discharged and asymptomatic at two-month follow-up. This case illustrates an atypical presentation of Takotsubo syndrome that was witnessed from onset to its complete resolution during the patient's hospital stay.
一名73岁女性，患有包括冠状动脉疾病在内的多种合并症，因计划对右冠状动脉（RCA）中检测到的病变进行择期经皮冠状动脉介入治疗（PCI）而入院。在计划进行PCI的当天，右股动脉插管后不久，患者突然出现完全性心脏传导阻滞，需要使用阿托品并插入临时起搏器。与此同时，患者出现急性肺水肿、低血压和低氧血症，需要插管进行机械通气。给予了血管升压药。冠状动脉造影显示左、右冠状动脉通畅，与之前的造影相比无变化。在心脏导管实验室进行的超声心动图显示左、右心室整体运动减弱，左心室收缩功能严重受损（射血分数<20%）。插入主动脉内球囊泵后，患者被转至心脏重症监护病房（CICU）。两小时后在CICU进行的重复超声心动图显示了应激性心肌病的典型超声心动图表现，心尖运动减弱。到第二天早上，患者的血流动力学状态明显改善，球囊泵被移除，血管升压药停用。事件发生24小时后进行的另一次超声心动图显示左心室收缩功能显著改善（射血分数60%），心尖和室间隔壁运动异常完全消失。事件发生三天后，患者成功出院，在两个月的随访中无症状。该病例说明了应激性心肌病的非典型表现，在患者住院期间从发病到完全缓解都有记录。
