Horiguchi Yuudai, Hoshi Takuo, Yoshimatsu Aya, Yoshida Mika
Department of Anesthesiology and Critical Care Medicine, Ibaraki Prefectural Central Hospital, 6528 Kasama, Ibaraki, 309-1793, Japan.
Department of Anesthesiology and Critical Care Medicine, Clinical and Educational Training Center, Tsukuba University Hospital, Tsukuba, Japan.
JA Clin Rep. 2018 Jul 6;4(1):53. doi: 10.1186/s40981-018-0190-1.
Thromboembolism is a rare complication of Takotsubo cardiomyopathy. Importantly, an acute arterial occlusion needs rapid diagnosis and urgent treatment to help save the patient's life. Here, we report a case of arterial occlusion due to ventricular thrombus of Takotsubo cardiomyopathy.
A woman in her 30s, without previous medical history, felt sudden strong pain on her right leg and was diagnosed with right femoral arterial occlusion. An emergency operation was subsequently performed to take out thrombus. The patient's oxygenation deteriorated to 93% of hemoglobin saturation just after extubation and exacerbated in the intensive care unit. Transthoracic echocardiography revealed Takotsubo cardiomyopathy-like left ventricular wall motion abnormalities and left ventricular thrombus. Heparin treatment was immediately started. After 10 days, the thrombus disappeared and the left ventricular wall motion improved and she was discharged from the hospital.
The patient's acute arterial occlusion in this case report was mainly caused by thrombus of cardiac origin. We suggest to routinely check echocardiography reports before surgery and perform anesthetic management carefully to better control the patient's blood pressure and heart rhythm.
血栓栓塞是应激性心肌病的一种罕见并发症。重要的是，急性动脉闭塞需要快速诊断和紧急治疗以挽救患者生命。在此，我们报告一例因应激性心肌病心室血栓导致动脉闭塞的病例。
一名30多岁无既往病史的女性，感到右腿突然剧痛，被诊断为右股动脉闭塞。随后进行了急诊手术取出血栓。患者在拔管后氧合恶化至血红蛋白饱和度的93%，并在重症监护病房加重。经胸超声心动图显示类似应激性心肌病的左心室壁运动异常和左心室血栓。立即开始肝素治疗。10天后，血栓消失，左心室壁运动改善，患者出院。
本病例报告中患者的急性动脉闭塞主要由心脏来源的血栓引起。我们建议术前常规检查超声心动图报告，并谨慎进行麻醉管理以更好地控制患者的血压和心律。
