Moady Gassan, Vons Shelly, Atar Shaul
Department of Cardiology, Galilee Medical Center, Nahariya, Israel.
Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
Isr Med Assoc J. 2021 Feb;23(2):107-110.
Takotsubo syndrome (TTS) is a non-ischemic cardiomyopathy characterized by an acute reversible left ventricular dysfunction with typical apical ballooning, usually with subsequent complete spontaneous recovery. TTS shares several features with acute coronary syndrome (ACS), including clinical presentation, ECG changes, and elevated troponin.
To identify different features that may help differentiate between TTS and ACS with presentation based on presenting symptoms and physical examination.
We compared 35 patients who TTS had been diagnosed with 60 age- and sex- matched patients with ACS (both ST and non-ST segment elevation myocardial infarction) who were hospitalized in Galilee Medical Center through 2011-2015.Basic characteristics and clinical features of the two groups were compared using appropriate statistical tests.
Of the patients with TTS, 21 (60%) reported an emotional trigger (60%) before admission, although they did not have increased prevalence of psychiatric disease compared to ACS patients (5.7% vs. 5%, P = 0.611). There was no difference in the type of chest pain or accompanied symptoms between the groups. Of notice, ECG changes in the TTS group were prominent in the anterior leads, and the patients presented with higher heart rate (86 ± 17 vs. 79 ± 15, P = 0.029) and lower systolic blood pressure (129 ± 26 vs. 142 ± 30, P = 0.034) on admission compared to the ACS group.
There was no reliable feature that could distinguish TTS from ACS based on clinical presentation. TTS should always be in the differential diagnosis in patients with acute chest pain, especially in elderly women.
应激性心肌病（TTS）是一种非缺血性心肌病，其特征为急性可逆性左心室功能障碍，并伴有典型的心尖部气球样改变，通常随后可完全自发恢复。TTS与急性冠状动脉综合征（ACS）有若干共同特征，包括临床表现、心电图改变及肌钙蛋白升高。
基于症状和体格检查，确定有助于鉴别TTS和ACS的不同特征。
我们比较了2011年至2015年在加利利医疗中心住院的35例已确诊TTS的患者与60例年龄和性别匹配的ACS患者（包括ST段抬高型和非ST段抬高型心肌梗死）。使用适当的统计检验比较两组的基本特征和临床特征。
在TTS患者中，21例（60%）报告入院前有情绪触发因素（60%），尽管与ACS患者相比，他们的精神疾病患病率并未增加（5.7%对5%，P = 0.611）。两组间胸痛类型或伴随症状无差异。值得注意的是，TTS组的心电图改变在前壁导联更为突出，与ACS组相比，患者入院时心率较高（86±17对79±15，P = 0.029），收缩压较低（129±26对142±30，P = 0.034）。
基于临床表现，没有可靠的特征可区分TTS和ACS。对于急性胸痛患者，尤其是老年女性，TTS应始终列入鉴别诊断。
