Pires Carla Marques, Rocha Sérgia, Salomé Nuno, Azevedo Pedro
Department of Cardiology, Braga Hospital, Sete Fontes-São Vitor, 4710-243 Braga, Portugal.
Eur Heart J Case Rep. 2021 Sep 9;5(11):ytab359. doi: 10.1093/ehjcr/ytab359. eCollection 2021 Nov.
Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction and is usually triggered by emotional, physical, or combined stress. This syndrome has been increasingly recognized, although it remains a challenging and often misdiagnosed disorder.
A 36-year-old breastfeeding woman was admitted with sudden dyspnoea and oppressive chest pain. On admission, she was lethargic, hypotensive, and tachycardic. The electrocardiogram showed rapid atrial fibrillation and diffuse ST-segment depression. The transthoracic echocardiogram (TTE) revealed severe LV systolic dysfunction, with midventricular and basal akinesis, compensatory apical hyperkinesia, and without intraventricular gradient. Emergent coronary angiogram showed normal coronary arteries. A presumptive diagnosis of reverse TTS with cardiogenic shock (CS) was made. The patient was transferred to the intensive care unit after intubation and inotropic and vasopressor support was initiated. During hospitalization, rapid clinical improvement was observed. In 3 days, the patient was weaned from haemodynamic support and extubated. Furthermore, β-blocker and angiotensin receptor blocker were initiated and tolerated. Cabergoline was also administered to inhibit lactation. The presumptive diagnosis was further strengthened by cardiac magnetic resonance and all triggering factors were excluded. At hospital discharge she was asymptomatic and the follow-up TTE was normal, which confirmed the diagnosis of reverse TTS.
We present a case of a young woman, 8 months after delivery, which developed a life-threatening reverse TTS without triggering factor identified. Reverse TTS is a rare variant of TTS with different clinical features and is more likely to be complicated by pulmonary oedema and CS.
应激性心肌病（TTS）的特征为短暂性左心室（LV）功能障碍，通常由情绪、身体或综合应激引发。尽管该综合征仍是一种具有挑战性且常被误诊的疾病，但已得到越来越多的认识。
一名36岁的哺乳期妇女因突发呼吸困难和压榨性胸痛入院。入院时，她嗜睡、低血压且心动过速。心电图显示快速房颤和弥漫性ST段压低。经胸超声心动图（TTE）显示严重的左心室收缩功能障碍，心室中部和基部运动减弱，心尖代偿性运动增强，且无室内梯度。急诊冠状动脉造影显示冠状动脉正常。初步诊断为伴有心源性休克（CS）的反向TTS。患者插管后被转入重症监护病房，并开始给予强心剂和血管加压药支持。住院期间，观察到临床症状迅速改善。3天内，患者停用血流动力学支持并拔除气管插管。此外，开始使用β受体阻滞剂和血管紧张素受体阻滞剂，患者耐受良好。还给予卡麦角林抑制泌乳。心脏磁共振进一步强化了初步诊断，并排除了所有触发因素。出院时她无症状，随访TTE正常，这证实了反向TTS的诊断。
我们报告一例产后8个月的年轻女性病例，该患者发生了危及生命的反向TTS，且未发现触发因素。反向TTS是TTS的一种罕见变体，具有不同的临床特征，更易并发肺水肿和CS。
