Wu Hao-Yu, Cheng Gong, Liang Lei, Cao Yi-Wei
Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China.
Department of Electrocardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China.
World J Clin Cases. 2021 Jan 26;9(3):677-684. doi: 10.12998/wjcc.v9.i3.677.
Takotsubo cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction triggered by emotional or physical stress. Only 1%-2% of patients with acute coronary syndrome are diagnosed with TCM. Although obstructive coronary artery disease is frequently considered to be the cause of chest pain, TCM should be considered in some clinical settings. In this case, clinicians did not make a timely and accurate diagnosis for TCM due to a lack of knowledge until the third hospitalization with a left ventriculogram.
A 55-year-old postmenopausal woman had intermittent chest pain following emotionally stressful events three times in the past 3 years. Cardiac troponin levels increased after each instance of symptom onset. A transthoracic echocardiogram showed reversible left ventricular dysfunction. The patient underwent three coronary angiograms without evidence of coronary artery disease. A left ventriculogram was first performed at the third hospitalization and revealed apical akinesia with ballooning of the apical region and consistent hypercontractile basal segments. The diagnosis of TCM was confirmed. The patient was treated with an angiotensin-converting-enzyme inhibitor (perindopril) and a β-blocker (metoprolol). No complications occurred during the patient's hospitalization. The patient was told to avoid stressful events. During the 9-mo follow-up visit, the patient was asymptomatic with an ejection fraction of 55%.
Clinicians should be conscious of the possibility of TCM, especially in postmenopausal women presenting with clinical manifestations similar to acute coronary syndrome without coronary occlusion.
应激性心肌病（TCM）的特征是由情绪或身体应激引发的可逆性左心室功能障碍。急性冠状动脉综合征患者中只有1%-2%被诊断为应激性心肌病。尽管阻塞性冠状动脉疾病常被认为是胸痛的病因，但在某些临床情况下应考虑应激性心肌病。在本病例中，由于缺乏相关知识，临床医生直到患者第三次住院进行左心室造影时才及时准确地诊断出应激性心肌病。
一名55岁的绝经后女性在过去3年中因情绪应激事件3次出现间歇性胸痛。每次症状发作后心肌肌钙蛋白水平均升高。经胸超声心动图显示可逆性左心室功能障碍。患者接受了3次冠状动脉造影，未发现冠状动脉疾病证据。在第三次住院时首次进行左心室造影，显示心尖运动减弱，心尖区域呈气球样改变，基底节段收缩增强。确诊为应激性心肌病。患者接受了血管紧张素转换酶抑制剂（培哚普利）和β受体阻滞剂（美托洛尔）治疗。患者住院期间未发生并发症。告知患者避免应激事件。在9个月的随访中，患者无症状，射血分数为55%。
临床医生应意识到应激性心肌病的可能性，尤其是在绝经后女性出现类似于急性冠状动脉综合征但无冠状动脉阻塞的临床表现时。
