Saprungruang Ankavipar, Vithessonthi Kanyalak, Vorasettakarnkij Yongkasem, Lertsapcharoen Pornthep, Khongphatthanayothin Apichai
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
J Cardiol Cases. 2019 May 1;20(1):14-19. doi: 10.1016/j.jccase.2019.02.010. eCollection 2019 Jul.
Takotsubo syndrome is a rare cause of reversible ventricular dysfunction that imitate an acute coronary syndrome. The entity is unusual among pediatric populations and a recurrent episode is extremely rare. We report a case of recurrent takotsubo syndrome in an eight-year-old boy with Duchenne muscular dystrophy (DMD). His chest pain episodes were aggravated by a strong emotional stimuli. During episodes of chest pain, electrocardiograms (ECG) showed ST elevation while echocardiograms showed left ventricle apical ballooning; however, a coronary angiography was normal. Serial ECG and echocardiogram revealed a spontaneous resolution of ST elevation and normalized apical contraction which were compatible with the diagnosis of takotsubo syndrome. Interestingly, serial cardiac magnetic resonance imaging demonstrated increasing subepicardial enhancement which was compatible with progression of cardiac involvement in DMD. < Takotsubo syndrome should be considered in pediatric patients with acute chest pain. A recurrent episode of takotsubo syndrome is rare but is possible in pediatric populations. Patients with inherited muscular dystrophy could also develop takotsubo cardiomyopathy. A growing awareness of this syndrome may help physicians to diagnose and provide an early appropriate management of children with chest pain.>.
应激性心肌病是可逆性心室功能障碍的一种罕见病因，可模仿急性冠脉综合征。该病症在儿科人群中并不常见，复发情况极为罕见。我们报告一例患有杜氏肌营养不良症（DMD）的8岁男孩复发性应激性心肌病的病例。他的胸痛发作因强烈的情绪刺激而加重。在胸痛发作期间，心电图（ECG）显示ST段抬高，而超声心动图显示左心室心尖部气球样变；然而，冠状动脉造影正常。系列心电图和超声心动图显示ST段抬高自发缓解，心尖部收缩恢复正常，这与应激性心肌病的诊断相符。有趣的是，系列心脏磁共振成像显示心外膜下强化增加，这与DMD心脏受累的进展相符。<对于患有急性胸痛的儿科患者应考虑应激性心肌病。应激性心肌病的复发情况罕见，但在儿科人群中是可能的。患有遗传性肌营养不良症的患者也可能发生应激性心肌病。对该综合征的认识不断提高可能有助于医生诊断并为胸痛儿童提供早期适当的治疗。>
