Depertment of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
Diagn Pathol. 2020 Jul 21;15(1):90. doi: 10.1186/s13000-020-01006-x.
Takotsubo cardiomyopathy is characterized by transient dysfunction of the medial to apical segment of the left ventricle. Recurrence within a few months or years has been reported and serious complications, including arrhythmia, acute cardiac shock and cardiac rupture, can arise; however, recurrence is rare and takotsubo cardiomyopathy is typically a reversible functional disorder.
A 91-year-old Japanese woman with a past medical history of angina pectoris, hypertension and uterine carcinoma noted bilateral axillary pain and presented herself to an emergency room. Although the pain improved and she went home, there were several subsequent episodes of recurrent chest pain. At approximately 1 week after the onset, she was hospitalized as her symptom worsened. Electrocardiography showed low voltage in limb and chest leads, and ST-segment elevation in leads II, III, aVF and V3 to V6. Echocardiography revealed medial to apical dyskinesia and basal hypercontractility of the left ventricle, and cardiac tamponade. Pericardiocentesis improved the symptom, but not her cardiac dysfunction. At 3 days after her admission, cardiopulmonary resuscitation was performed due to ventricular fibrillation. She died on the 5th day of admission (2 weeks after the onset). At autopsy, the left ventricle was dilatated and the apical ventricular wall was thin. On microscopy, remarkable wavy change and thinning of myocardium were diffusely observed, especially at the apex and the anterior to lateral wall of the left ventricle, interventricular septum and right ventricle, intermingled with interstitial fibrosis, hemorrhage and neutrophil infiltration. Contraction band necrosis was mainly observed on the posterior to inferior wall of the left ventricle.
Our case showed severe morphological myocardial change after several chest pain episodes that were considered to be takotsubo cardiomyopathy. This notable case suggests that the frequent recurrence of serious takotsubo cardiomyopathy is life threatening and can lead to irreversible serious myocardial degeneration.
应激性心肌病的特征为左心室中段至心尖段短暂性功能障碍。据报道，该病在数月至数年内可复发，可出现心律失常、急性心源性休克和心脏破裂等严重并发症；然而，该病的复发较为罕见，且应激性心肌病通常为一种可逆性功能障碍。
一位 91 岁日本女性，既往有心绞痛、高血压和子宫癌病史，诉双侧腋窝痛，并至急诊就诊。尽管疼痛有所改善并回家，但随后又出现数次胸痛复发。大约在发病后 1 周，她因症状加重而住院。心电图显示肢体导联和胸前导联低电压，II、III、aVF 和 V3 至 V6 导联 ST 段抬高。超声心动图显示左心室中段至心尖段运动障碍和基底段收缩亢进，并伴有心脏压塞。心包穿刺术改善了症状，但未改善心功能。入院后 3 天，因室颤行心肺复苏。入院后第 5 天死亡（发病后 2 周）。尸检显示左心室扩张，心尖部心室壁变薄。镜下，弥漫性观察到明显的波浪状改变和心肌变薄，尤其是左心室心尖部和前侧壁、室间隔和右心室，伴有间质纤维化、出血和中性粒细胞浸润。左心室后下壁主要观察到收缩带坏死。
我们的病例在数次胸痛发作后表现出严重的形态学心肌改变，考虑为应激性心肌病。这一显著病例提示，严重应激性心肌病频繁复发可危及生命，并导致不可逆转的严重心肌变性。
