Khan Maria, Watti Husam, Dahal Khagendra, Dominic Paari
Department of Internal Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71130, United States.
Department of Cardiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71130, United States.
World J Cardiol. 2019 Mar 26;11(3):120-125. doi: 10.4330/wjc.v11.i3.120.
Takotsubo cardiomyopathy (TCM) is a transient reversible systolic dysfunction, estimated to be the culprit in 1%-2% of patients presenting with clinical symptoms of acute coronary syndrome (ACS). TCM was previously thought to be indistinguishable from ACS on the basis of electrocardiogram (EKG) findings; many authors now describe specific EKG changes that distinguish TCM from ACS as well as aid in early recognition of TCM.
This unique case presentation illustrates an uncommon subtype of TCM, and very clearly exemplifies the specific EKG changes meant to aid in distinguishing TCM from ACS. A bronchogenic subtype of TCM has been proposed, given its prevalence and distinguishing features from TCM without pulmonary pathology; this case exemplifies that notion. The specific EKG changes of low QRS voltage and attenuation of the amplitude of the QRS complex are now being noted in the EKGs of TCM patients. This patient presented for worsening shortness of breath and increased productive cough; her EKG revealed ST elevations in leads V3-V6, and low voltage QRS complexes when compared to previous EKG from 12 wk ago; troponin peaked at 5.16 ng/mL. Left heart catheterization did not reveal significant lesions and left ventriculogram findings were consistent with TCM. Patient was treated for COPD exacerbation, her symptoms improved significantly; she was sent home on the appropriate medications.
This case exemplifies EKG changes noted in TCM patients who may aid in early detection and appropriate treatment of TCM.
应激性心肌病（TCM）是一种短暂可逆的收缩功能障碍，据估计在出现急性冠状动脉综合征（ACS）临床症状的患者中占1%-2%。此前认为，根据心电图（EKG）表现，应激性心肌病与急性冠状动脉综合征无法区分；现在许多作者描述了一些特定的心电图变化，这些变化可将应激性心肌病与急性冠状动脉综合征区分开来，并有助于早期识别应激性心肌病。
本独特病例展示了应激性心肌病的一种罕见亚型，非常清楚地例证了有助于将应激性心肌病与急性冠状动脉综合征区分开来的特定心电图变化。鉴于其患病率以及与无肺部病变的应激性心肌病的区别特征，有人提出了应激性心肌病的支气管源性亚型；本病例例证了这一概念。目前在应激性心肌病患者的心电图中注意到了低QRS电压和QRS波群振幅衰减等特定心电图变化。该患者因呼吸急促加重和咳痰增多前来就诊；她的心电图显示V3-V6导联ST段抬高，与12周前的心电图相比，QRS波群电压较低；肌钙蛋白峰值为5.16 ng/mL。左心导管检查未发现明显病变，左心室造影结果与应激性心肌病一致。患者因慢性阻塞性肺疾病（COPD）急性加重接受治疗，症状明显改善；她在服用适当药物后出院。
本病例例证了应激性心肌病患者的心电图变化，这些变化可能有助于早期发现和适当治疗应激性心肌病。
