Menchaca Kristina, Ostos Perez Catherine A, Draguljevic Nemanja, Isaac Shaun
Internal Medicine, University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, USA.
Internal Medicine, University of Belgrade, Belgrade, SRB.
Cureus. 2022 Jul 14;14(7):e26836. doi: 10.7759/cureus.26836. eCollection 2022 Jul.
An 84-year-old woman with depression, who witnessed the suicide of a close friend, presented with symptoms of chest pain, palpitations, and cold and clammy extremities. An electrocardiogram showed alternating tachycardia and bradycardia. Urgent transthoracic echocardiogram demonstrated left greater than right ventricular dysfunction, moderate mitral regurgitation, global hypokinesis, and an estimated ejection fraction of 20%. Cardiac catheterization demonstrated non-obstructive coronary artery disease and decreased cardiac output. Findings were consistent with Takotsubo cardiomyopathy complicated with cardiogenic shock, acute mitral regurgitation, and sinus node dysfunction. Management of this patient required the use of a mechanical device intra-aortic balloon pump, and pacemaker insertion for persistent symptomatic arrhythmia. This case highlights the challenging management of potentially fatal acute complications of Takotsubo cardiomyopathy and inadequate data on how to approach them.
一名84岁患有抑郁症的女性，目睹了一位密友的自杀，出现胸痛、心悸以及四肢冰冷潮湿的症状。心电图显示心动过速和心动过缓交替出现。紧急经胸超声心动图显示左心室功能障碍大于右心室，中度二尖瓣反流，整体运动减弱，估计射血分数为20%。心导管检查显示非阻塞性冠状动脉疾病和心输出量减少。检查结果符合应激性心肌病并发心源性休克、急性二尖瓣反流和窦房结功能障碍。该患者的治疗需要使用主动脉内球囊反搏机械装置，并因持续性症状性心律失常而植入起搏器。本病例突出了应激性心肌病潜在致命急性并发症的挑战性管理以及关于如何处理这些并发症的资料不足。
