Johnson Shelsey W, Hedgire Sandeep S, Scott Nandita S, Natarajan Pradeep
Department of Medicine, Massachusetts General Hospital, 55 Fruit Street Gray 730, Boston, MA, USA.
Harvard Medical School, 25 Shattuck Street, Boston, MA, USA.
Eur Heart J Case Rep. 2018 Oct 11;2(4):yty102. doi: 10.1093/ehjcr/yty102. eCollection 2018 Dec.
Although obstructive coronary artery disease (CAD) is the most likely cause of acute coronary syndromes (ACS), nearly one in 20 individuals with clinical myocardial infarction (MI) do not have obstructive CAD. For many such individuals, presentation of Takotsubo cardiomyopathy frequently mimics presentation of MI, though spontaneous coronary artery dissection (SCAD) is an increasingly recognized aetiology of MI in women.
This case report describes a woman with chest pain, found to have non-obstructive CAD on angiogram and left ventricular apical dysfunction on echocardiogram raising suspicion for Takotsubo cardiomyopathy. Additional suspicion for SCAD led to coronary CT angiogram (CCTA) which ultimately confirmed this diagnosis.
Familiarity with a differential diagnosis for non-obstructive CAD is less common than that for obstructive coronary disease. This case emphasizes the clinical features that should raise suspicion for SCAD when Takotsubo is presumed and outlines the clinical utility of CCTA in making this diagnosis when angiography is unrevealing.
尽管阻塞性冠状动脉疾病（CAD）是急性冠状动脉综合征（ACS）最可能的病因，但近二十分之一临床诊断为心肌梗死（MI）的患者并无阻塞性CAD。对于许多此类患者，Takotsubo心肌病的表现常与MI相似，不过自发性冠状动脉夹层（SCAD）在女性MI病因中越来越受到认可。
本病例报告描述了一名胸痛女性，血管造影显示为非阻塞性CAD，超声心动图显示左心室心尖功能障碍，引发了对Takotsubo心肌病的怀疑。对SCAD的进一步怀疑促使进行冠状动脉CT血管造影（CCTA），最终确诊为此病。
熟悉非阻塞性CAD的鉴别诊断不如熟悉阻塞性冠状动脉疾病常见。本病例强调了在假定为Takotsubo心肌病时应引起对SCAD怀疑的临床特征，并概述了在血管造影未发现问题时CCTA在做出此诊断方面的临床效用。
