Hiruma Takashi, Higuchi Ryosuke, Iguchi Nobuo
Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan.
Eur Heart J Case Rep. 2021 Jan 16;5(1):ytaa574. doi: 10.1093/ehjcr/ytaa574. eCollection 2021 Jan.
Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction, often preceded by emotional or physical trigger. The recurrence of TTS has been investigated, however, cases of multiple recurrences are scarcely reported.
A 79-year-old woman was admitted to the hospital with the complaint of dyspnoea following emotional stress. Electrocardiogram showed terminal T-wave inversion with QT interval prolongation in anterior leads. Transthoracic echocardiogram revealed severe hypokinesis of mid- and apical-anterior segments. She was diagnosed with focal TTS. After 3 months, she complained of orthopnoea subsequent to upper-respiratory infection. Coronary angiography (CAG) depicted normal coronary arteries. She had recurrence of TTS with bi-ventricular dysfunction, and complicated cardiac collapse requiring intra-aortic balloon pumping. One month after the second episode, she had dyspnoea after herpes zoster infection. She was diagnosed with recurrence of focal TTS. After 4 months, she complained of central chest pain without evident trigger factors. CAG showed no coronary artery stenosis, and left ventriculography revealed mid-inferior and apical segment akinesis. She was diagnosed with the 4th occurrence of TTS.
We describe the case of an elderly female experiencing quadruple episodes of TTS with various triggers, LV dysfunctions and severities in a short period of 10 months. Although multiple recurrences of TTS is rare, it can occur with variable trigger factors and patterns of myocardial dysfunction. An analysis of multiple recurrences could aid in clarifying the pathophysiology of TTS.
应激性心肌病（TTS）的特征为短暂性左心室（LV）功能障碍，常由情绪或身体应激诱发。已有研究探讨了TTS的复发情况，然而，多次复发的病例鲜有报道。
一名79岁女性因情绪应激后出现呼吸困难入院。心电图显示前壁导联终末T波倒置伴QT间期延长。经胸超声心动图显示左心室中前壁和心尖前壁节段严重运动减弱。她被诊断为局灶性TTS。3个月后，她因上呼吸道感染后出现端坐呼吸。冠状动脉造影（CAG）显示冠状动脉正常。她复发了TTS并伴有双心室功能障碍，并发心源性休克，需要主动脉内球囊反搏。第二次发作后1个月，她在带状疱疹感染后出现呼吸困难。她被诊断为局灶性TTS复发。4个月后，她无明显诱因出现胸痛。CAG显示无冠状动脉狭窄，左心室造影显示中下部和心尖节段运动不能。她被诊断为第4次发生TTS。
我们描述了一名老年女性在10个月的短时间内经历4次TTS发作的病例，发作诱因、左心室功能障碍及严重程度各不相同。虽然TTS多次复发很少见，但可由多种触发因素及心肌功能障碍模式引起。对多次复发进行分析有助于阐明TTS的病理生理学机制。
