Yao Tiezhu, Chen Lin, Ma Jingtao, Hu Zhenjie, Chen Yuhong
Department of Cardiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of radiology, Shijiazhuang People's Hospital, Shijiazhuang, China.
Gland Surg. 2020 Dec;9(6):2187-2192. doi: 10.21037/gs-20-855.
Stress cardiomyopathy (SC) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that SC may be associated with severe clinical complications including death and that its prevalence is probably underestimated. The disease is characterized by transient systolic and diastolic left ventricular (LV) dysfunction with a variety of wall-motion abnormalities. It predominantly affects postmenopausal women and is often preceded by an emotional or physical trigger, but the condition has also been reported with no evident trigger. The striking preponderance of postmenopausal females suggests a hormonal influence. Potentially, declining oestrogen levels after menopause increase the susceptibility to SC in women. Oestrogens can influence vasomotor tone via up-regulation of endothelial NO synthase. Also, there is evidence that oestrogens can attenuate catecholamine-mediated vasoconstriction and decrease the sympathetic response to mental stress in perimenopausal women. Rare cases of SC following thyroidectomy in premenopausal women have been described. Currently, the pathogenesis of SC remains obscure, several possible hypotheses include catecholamine induced myocardial spasm or catecholamine related myocardial stunning, metabolic disorders and coronary microvascular damage. So prompt diagnosis and optimal management are crucial to obtaining a good outcome for the patient. We report an extremely rare case of SC induced by thyroidectomy in a premenopausal woman with cancer, and share our personal experience by reviewing the literature.
应激性心肌病（SC）是一种认识不足的心脏病，最初被认为是一种良性疾病。最近研究表明，SC可能与包括死亡在内的严重临床并发症相关，且其患病率可能被低估。该病的特征是左心室（LV）出现短暂的收缩和舒张功能障碍，并伴有多种室壁运动异常。它主要影响绝经后女性，通常由情绪或身体触发因素诱发，但也有报道称无明显触发因素的情况。绝经后女性的显著优势表明存在激素影响。绝经后雌激素水平下降可能会增加女性患SC的易感性。雌激素可通过上调内皮型一氧化氮合酶来影响血管舒缩张力。此外，有证据表明雌激素可减弱儿茶酚胺介导的血管收缩，并降低围绝经期女性对精神应激的交感反应。已描述了绝经前女性甲状腺切除术后发生SC的罕见病例。目前，SC的发病机制仍不清楚，几种可能的假说是儿茶酚胺诱导的心肌痉挛或儿茶酚胺相关的心肌顿抑、代谢紊乱和冠状动脉微血管损伤。因此，及时诊断和优化管理对于患者获得良好预后至关重要。我们报告了一例绝经前癌症女性因甲状腺切除术诱发SC的极其罕见病例，并通过文献复习分享我们的个人经验。
