Chandy Shekinah, Dawson Dana K
Department of Cardiology, Aberdeen Royal Infirmary, Foresterhill Campus, Aberdeen AB25 2ZN, UK.
School of Medicine and Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, UK.
Eur Heart J Case Rep. 2019 Oct 24;3(4):1-5. doi: 10.1093/ehjcr/ytz191. eCollection 2019 Dec.
Takotsubo cardiomyopathy is a transient left ventricular dysfunction with an established recurrence rate in populations, however, recurrences in the same individual have not been well described.
We present a 76-year-old woman who had likely a total of six recurrent takotsubo cardiomyopathy episodes spanning over 33 years. Her diagnosis of takotsubo cardiomyopathy was first made in 2014 when she presented with chest pain, raised cardiac enzymes, and the presence of normal coronary arteries. Cardiac magnetic resonance was performed, ruling out any current or previous myocardial infarction. Subsequently, she had two further recurrences in 2015 and 2018. Stressors were identified on three occasions. She was diagnosed with 'myocardial infarction' in 1986, 1988, and 1998 when she presented with chest pain and electrocardiogram changes, despite demonstrating normal coronary arteries on each occasion.
This case demonstrates three confirmed recurrent episodes of takotsubo in the same individual, showing three different left ventricular phenotypic morphologies on the background of three previous episodes of 'myocardial infarction with normal coronary arteries', which most likely might have been takotsubo episodes as well. Any myocardial infarction-type injury was definitely ruled out in the 2014 admission instigating a potential change in this patient's past medical history and implicitly requirement for lifelong secondary prevention. It is notably difficult to make a confirmed diagnosis of takotsubo cardiomyopathy back in 1986, 1988, and 1998 due to the lack of awareness in this novel topic.
应激性心肌病是一种短暂性左心室功能障碍，在人群中有既定的复发率，然而，同一患者个体的复发情况尚未得到充分描述。
我们报告一名76岁女性，她在33年里可能总共经历了6次应激性心肌病复发。她的应激性心肌病诊断首次于2014年作出，当时她出现胸痛、心肌酶升高且冠状动脉正常。进行了心脏磁共振成像检查，排除了当前或既往的心肌梗死。随后，她在2015年和2018年又复发了两次。三次发病时均识别出了诱发因素。她在1986年、1988年和1998年出现胸痛和心电图改变时被诊断为“心肌梗死”，尽管每次冠状动脉均显示正常。
该病例显示同一患者个体确诊有3次应激性心肌病复发，在既往3次“冠状动脉正常的心肌梗死”发作背景下呈现出3种不同的左心室表型形态，而这3次发作很可能也是应激性心肌病发作。2014年入院时明确排除了任何心肌梗死型损伤，这可能改变该患者的既往病史，并隐含着终身二级预防的需求。由于当时对这个新课题认识不足，在1986年、1988年和1998年很难确诊应激性心肌病。
