Orphanou Nicoletta, Eftychiou Christos, Papasavvas Elias, Ioannides Marios, Avraamides Panayiotis
Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus.
Oxf Med Case Reports. 2020 Jun 25;2020(6):omaa036. doi: 10.1093/omcr/omaa036. eCollection 2020 Jun.
A 70-year-old woman with known history of hypertension presented because of a syncopal episode during dinner at a wedding party, followed by chest pain. On physical examination a systolic murmur was noted, and her electrocardiogram showed ST segment elevation in anterior leads. She had elevated troponin levels while echocardiography showed a hypertrophic interventricular septum with dyskinetic apex and left ventricular outflow (LVOT) obstruction. Emergency coronary angiography excluded obstructive coronary artery disease and confirmed the presence of LVOT obstruction with a gradient of 90 mm Hg. A left ventriculography showed hypercontractility of the basal and mid segments with apical wall dyskinesia indicating Takotsubo cardiomyopathy. Patient was discharged after 6 days of hospitalization with normalization of left ventricular function and regression of the LVOT obstruction. This is an interesting case of Takotsubo cardiomyopathy complicated with severe LVOT obstruction in a patient with hypertensive heart disease and a sigmoid septum hypertrophy.
一名70岁有高血压病史的女性，因在婚礼晚宴上出现晕厥发作，随后出现胸痛前来就诊。体格检查发现有收缩期杂音，其心电图显示前壁导联ST段抬高。她的肌钙蛋白水平升高，而超声心动图显示室间隔肥厚，心尖运动障碍，左心室流出道（LVOT）梗阻。急诊冠状动脉造影排除了阻塞性冠状动脉疾病，并证实存在LVOT梗阻，压差为90 mmHg。左心室造影显示基底段和中间段心肌收缩力增强，心尖壁运动障碍，提示应激性心肌病。患者住院6天后出院，左心室功能恢复正常，LVOT梗阻消退。这是一例有趣的应激性心肌病合并严重LVOT梗阻的病例，患者患有高血压性心脏病且有乙状结肠样室间隔肥厚。
