White Charles, Jeanmonod Rebecca
Emergency Medicine, St. Luke's University Health Network, Bethlehem, USA.
Cureus. 2022 Apr 19;14(4):e24282. doi: 10.7759/cureus.24282. eCollection 2022 Apr.
Stress-induced (Takotsubo) cardiomyopathy is a clinical syndrome and its incidence has been on the rise. Patients with this syndrome often present with chest pain, dyspnea, or syncope. The findings from a typical cardiac evaluation can make this entity difficult to distinguish from acute myocardial infarction (AMI). A 50-year-old woman presented to the emergency department (ED) with anxiety and palpitations after the accidental ingestion of a sympathomimetic. The patient had consumed coffee that she had brewed in a hotel coffee pot, unaware that a previous guest had placed drug paraphernalia including methamphetamine in the water reservoir of the coffee pot. Her symptoms had started shortly thereafter. In the ED, the patient's workup was remarkable for positive troponin and an echocardiogram demonstrating basilar hypokinesis. The patient's ejection fraction was reduced at 40%. She was admitted to the hospital, where she underwent catheterization, demonstrating normal coronary arteries. She had full clinical recovery at the six-month follow-up. Reverse Takotsubo cardiomyopathy is a rare variant of Takotsubo cardiomyopathy, which presents with basal left ventricular hypokinesis. It is associated with younger age and female gender and has an overall good prognosis. This diagnosis should be considered in patients who are otherwise at low risk for atherosclerotic cardiac disease with known emotional or physical triggers and changes in left ventricular function. Treatment is generally supportive, but a Takotsubo cardiomyopathy diagnosis alters the management of shock and dysrhythmia when known.
应激性（ tako 壶腹样）心肌病是一种临床综合征，其发病率一直在上升。患有这种综合征的患者常表现为胸痛、呼吸困难或晕厥。典型心脏评估的结果可能使该病症难以与急性心肌梗死（ AMI ）区分开来。一名 50 岁女性在意外摄入拟交感神经药后因焦虑和心悸就诊于急诊科（ ED ）。患者喝了她在酒店咖啡壶中煮的咖啡，却不知道前一位客人在咖啡壶的储水箱里放置了包括甲基苯丙胺在内的吸毒用具。此后不久她就开始出现症状。在急诊科，患者的检查结果显示肌钙蛋白阳性，超声心动图显示基底运动减弱。患者的射血分数降至 40% 。她被收治入院，在医院接受了心导管检查，结果显示冠状动脉正常。在六个月的随访中她实现了完全临床康复。反向 tako 壶腹样心肌病是 tako 壶腹样心肌病的一种罕见变体，表现为左心室基底运动减弱。它与较年轻的年龄和女性性别有关，总体预后良好。对于已知有情绪或身体诱因且左心室功能发生变化但患动脉粥样硬化性心脏病风险较低的患者，应考虑这一诊断。治疗通常是支持性的，但已知 tako 壶腹样心肌病的诊断会改变休克和心律失常的治疗管理。
