Sendil Selin, Shrimanker Isha, Yarlagadda Keerthi, Bhandari Binita, Nookala Vinod K
Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, USA.
Cureus. 2020 Jun 22;12(6):e8763. doi: 10.7759/cureus.8763.
Takotsubo cardiomyopathy (TCM) is a rare but reversible myocardial left ventricular (LV) dysfunction, which mimics acute coronary syndrome (ACS) without the presence of significant coronary artery disease (CAD). Emotional stressors may include the death of kin or a life-threatening medical diagnosis whereas physical stressors include infections, endoscopic procedures, exacerbation of asthma, or systemic disorders. A 90-year-old female presented to the ED with nausea, intermittent chest heaviness, and generalized weakness for a duration of three days. Her troponin-I was elevated and an electrocardiogram (EKG) showed T-wave inversions in leads V2-V6 and no ST-segment changes. An echocardiogram (ECHO) revealed an ejection fraction (EF) of 35%-40% with anteroapical hypokinesis. She underwent cardiac catheterization showing nonobstructive CAD. She was diagnosed with pan-sensitive Escherichia coli urosepsis and started on ceftriaxone. She improved clinically and was discharged. A repeat ECHO done a month later showed normal EF. Urosepsis-induced TCM has rarely been reported in the literature. Physicians should have a high index of suspicion of TCM in patients with symptoms mimicking ACS in the presence of a physical stressor like an infection. We report the case of TCM, which resulted from a urinary tract infection (UTI) in an elderly female.
应激性心肌病（TCM）是一种罕见但可逆的左心室心肌功能障碍，在无显著冠状动脉疾病（CAD）的情况下酷似急性冠状动脉综合征（ACS）。情绪应激源可能包括亲属死亡或危及生命的医学诊断，而身体应激源包括感染、内镜检查、哮喘加重或全身性疾病。一名90岁女性因恶心、间歇性胸部沉重和全身无力3天就诊于急诊科。她的肌钙蛋白I升高，心电图（EKG）显示V2-V6导联T波倒置，无ST段改变。超声心动图（ECHO）显示射血分数（EF）为35%-40%，前壁心尖运动减弱。她接受了心脏导管检查，显示为非阻塞性CAD。她被诊断为对多种药物敏感的大肠埃希菌尿脓毒症，并开始使用头孢曲松治疗。她临床症状改善后出院。一个月后复查ECHO显示EF正常。文献中很少报道尿脓毒症诱发的TCM。对于存在感染等身体应激源且症状酷似ACS的患者，医生应高度怀疑TCM。我们报告了一例老年女性因尿路感染（UTI）导致的TCM病例。
