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应激性心肌病导致的心源性休克中的动态左心室流出道梗阻。

Dynamic left ventricular outflow tract obstruction in Takotsubo cardiomyopathy resulting in cardiogenic shock.

作者信息

Conradi Paulina M, van Loon Ramon B, Handoko M Louis

机构信息

Cardiology, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands.

Cardiology, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands

出版信息

BMJ Case Rep. 2021 Mar 24;14(3):e240010. doi: 10.1136/bcr-2020-240010.

DOI:10.1136/bcr-2020-240010
PMID:33762278
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7993169/
Abstract

We report a case of a 73-year-old female patient, who was admitted to the coronary care unit due to chest pain, malaise and near syncope. During physical examination, the patient was hypotensive and there were signs of left-sided heart failure and a loud systolic murmur. Echocardiogram showed apical ballooning with dynamic left ventricular outflow tract obstruction, based on systolic anterior motion of the mitral valve with important mitral valve regurgitation. In the acute setting, the cardiogenic shock was treated cautiously with fluid resuscitation and intravenous metoprolol, resulting in direct stabilisation of her haemodynamic condition. As a codiagnosis, there was a significant stenosis of left anterior descending artery, which was treated successfully by percutaneous coronary intervention with drug eluting stents. During follow-up, left ventricular function normalised, and the left ventricular outflow tract obstruction, systolic anterior motion of mitral valve and related mitral regurgitation all resolved.

摘要

我们报告一例73岁女性患者，因胸痛、不适和接近晕厥入住冠心病监护病房。体格检查时，患者血压低，有左侧心力衰竭体征及响亮的收缩期杂音。超声心动图显示心尖部气球样变并伴有动态左心室流出道梗阻，这是基于二尖瓣收缩期前向运动伴严重二尖瓣反流。在急性期，谨慎地通过液体复苏和静脉注射美托洛尔治疗心源性休克，使她的血流动力学状况直接稳定。作为合并诊断，左前降支存在严重狭窄，通过药物洗脱支架经皮冠状动脉介入治疗成功。随访期间，左心室功能恢复正常，左心室流出道梗阻、二尖瓣收缩期前向运动及相关二尖瓣反流均消失。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b25/7993169/c8daa5e33eb7/bcr-2020-240010f04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b25/7993169/d9eb32544d5e/bcr-2020-240010f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b25/7993169/2c4414368f2f/bcr-2020-240010f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b25/7993169/372803e8e084/bcr-2020-240010f03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b25/7993169/c8daa5e33eb7/bcr-2020-240010f04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b25/7993169/d9eb32544d5e/bcr-2020-240010f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b25/7993169/2c4414368f2f/bcr-2020-240010f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b25/7993169/372803e8e084/bcr-2020-240010f03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b25/7993169/c8daa5e33eb7/bcr-2020-240010f04.jpg

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JACC Case Rep. 2019 Aug 21;1(2):161-165. doi: 10.1016/j.jaccas.2019.06.022. eCollection 2019 Aug.
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Cardiogenic Shock in Takotsubo Cardiomyopathy Versus Acute Myocardial Infarction: An 8-Year National Perspective on Clinical Characteristics, Management, and Outcomes.心尖球形综合征与急性心肌梗死所致心原性休克的临床特征、处理和预后的 8 年全国性观察研究
JACC Heart Fail. 2019 Jun;7(6):469-476. doi: 10.1016/j.jchf.2018.12.007. Epub 2019 May 8.
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Norepinephrine and Dobutamine-Induced Dynamic Left Ventricular Outflow Tract Obstruction Caused by Systolic Anterior Motion.去甲肾上腺素和多巴酚丁胺诱发的收缩期前向运动导致的动态左心室流出道梗阻
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