Meng Li-Ping, Zhang Peng
Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China.
World J Clin Cases. 2022 Mar 16;10(8):2616-2621. doi: 10.12998/wjcc.v10.i8.2616.
With the spread and establishment of the Chest Pain Center in China, adhering to the idea that "time is myocardial cell and time is life", many hospitals have set up a standardized process that ensures that patients with acute myocardial infarction (AMI) who meet emergency percutaneous coronary intervention (PCI) guidelines are sent directly to the DSA room by the prehospital emergency doctor, saving the time spent on queuing, registration, payment, re-examination by the emergency doctor, and obtaining consent for surgery after arriving at the hospital. Takotsubo cardiomyopathy is an acute disease that is triggered by intense emotional or physical stress and must be promptly differentiated from AMI for its appropriate management.
A 52-year-old female patient was taken directly to the catheterization room to perform PCI due to 4 h of continuous thoracalgia and elevation of the ST segment in the V3-V5 lead, without being transferred to the emergency department according to the Chest Pain Center model. Loading doses of aspirin, clopidogrel and statins were administered and informed consent for PCI was signed in the ambulance. On first look, the patient looked nervous in the DSA room. Coronary angiography showed no obvious stenosis. Left ventricular angiography showed that the contraction of the left ventricular apex was weakened, and the systolic period was ballooning out, showing a typical "octopus trap" change. The patient was diagnosed with Takotsubo cardiomyopathy. Five days later, the patient had no symptoms of thoracalgia, and the serological indicators returned to normal. She was discharged with a prescription of medication.
Under the Chest Pain Center model for the treatment of patients with chest pain showing ST segment elevation, despite the urgency of time, Takotsubo cardiomyopathy must be promptly differentiated from AMI for its appropriate management.
随着胸痛中心在中国的推广与建立，秉持“时间就是心肌细胞，时间就是生命”的理念，许多医院制定了标准化流程，确保符合急诊经皮冠状动脉介入治疗（PCI）指南的急性心肌梗死（AMI）患者由院前急救医生直接送往数字减影血管造影（DSA）室，节省了排队、挂号、缴费、急救医生再次检查以及入院后获取手术同意书所花费的时间。应激性心肌病是一种由强烈情绪或身体应激引发的急性疾病，必须迅速与AMI鉴别以进行恰当治疗。
一名52岁女性患者因持续胸痛4小时且V3 - V5导联ST段抬高，未按照胸痛中心模式转至急诊科，而是直接被送往导管室进行PCI。在救护车上给予了阿司匹林、氯吡格雷和他汀类药物的负荷剂量，并签署了PCI知情同意书。初次在DSA室见到患者时，她看起来很紧张。冠状动脉造影显示无明显狭窄。左心室造影显示左心室心尖部收缩减弱，收缩期呈气球样膨出，呈现典型的“章鱼篓”样改变。该患者被诊断为应激性心肌病。五天后，患者胸痛症状消失，血清学指标恢复正常。她带着药物处方出院。
在胸痛中心模式下治疗ST段抬高的胸痛患者时，尽管时间紧迫，但必须迅速将应激性心肌病与AMI鉴别以进行恰当治疗。
