Elsayed Mohamed, Connemann Bernhard J, Dahme Tillman, Tesfay Temsgen, Gahr Maximilian
Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany.
Department of Medicine II, Ulm University Medical Center, Ulm, Germany.
Front Psychiatry. 2019 May 16;10:308. doi: 10.3389/fpsyt.2019.00308. eCollection 2019.
Takotsubo cardiomyopathy (TCM) is frequently associated with emotional or physical stress. Thus, patients with TCM might present primarily at a psychiatric clinic. Appropriate diagnosis and therapy may thus be delayed. A 43-year-old female patient presented as an emergency to the psychiatric outpatient clinic after experiencing severe work-related bullying. On admission, she complained of acute left thoracic chest pain as well as depressed mood, low energy, anhedonia, generalized anxiety, and sleep difficulties, present for several weeks. The initial electrocardiogram (ECG) was unremarkable; serum troponin levels, however, were markedly elevated. The patient was transferred to the department of cardiology. cardiac catheterization and MRI, an acute coronary syndrome was excluded and apical ballooning and left ventricular dysfunction, compatible with TCM, was found. Patients with acute psychopathology, recent emotional or physical stress, and acute cardiothoracic symptoms should receive immediate cardiological investigations. As the ECG may be normal in patients with TCM, concurrent measurement of the troponin serum level is recommended. Psychiatrists should consider TCM in patients who report recent stressful events accompanied by cardiothoracic symptoms.
应激性心肌病（TCM）常与情绪或身体应激相关。因此，TCM患者可能首先就诊于精神科门诊。这样一来，可能会延误正确的诊断和治疗。一名43岁女性患者在经历严重的工作场所欺凌后，作为急诊被送往精神科门诊。入院时，她诉说有急性左胸胸痛，同时伴有情绪低落、精力不足、快感缺失、广泛性焦虑和睡眠困难，这些症状已持续数周。最初的心电图（ECG）无明显异常；然而，血清肌钙蛋白水平显著升高。患者被转至心内科。经心脏导管插入术和磁共振成像检查，排除了急性冠状动脉综合征，并发现了与TCM相符的心尖部气球样变和左心室功能障碍。有急性精神病理学表现、近期情绪或身体应激以及急性心胸症状的患者应立即接受心脏检查。由于TCM患者的心电图可能正常，建议同时检测血清肌钙蛋白水平。精神科医生在接诊报告近期有应激事件并伴有心胸症状的患者时，应考虑到TCM。
