DEPARTMENT OF INTERNAL MEDICINE, JOZEF STRUS HOSPITAL, POZNAN, POLAND.
DEPARTMENT OF CARDIOLOGY, JOZEF STRUS HOSPITAL, POZNAN, POLAND.
Pol Merkur Lekarski. 2023;51(1):88-94. doi: 10.36740/Merkur202301112.
Takotsubo syndrome (TTS) has been reported in various clinical conditions. Coronary artery fistula (CAF) is diagnosed in 0.2- 0.4% of patients undergoing coronary angiography. Pathologic communication between coronary artery (e.g., left anterior de¬scending coronary artery - LAD) and cardiac chambers (e.g., left ventricle - LV) is cameral type of CAF which particularly predis¬pose to myocardial ischemia due to a steal syndrome. Eight cases of coexistent TTS and CAF have been reported so far; in 6 of them LAD cameral fistulas drained LV, in 2 others communications between coronary arteries and pulmonary artery were found. The authors describe a case of a 75-year-old female, admitted due to chest pain and dyspnea. Her clinical picture with ST-segment elevation in ECG, moderately increased troponin I and apical ballooning in echocardiography, was more typical for TTS than for myocardial infarction; besides that, color doppler imaging was suggestive of multiple CAF to LV. Coronary angiography showed communication between all (normal) coronary arteries and LV. Throughout the conservative therapy, first, an improve¬ment and then normalization of LV function were observed after 2 and 6 days, respectively. Chest x-ray and computed tomogra¬phy revealed mediastinal tumor (eventually diagnosed as lung cancer). Cardiac magnetic resonance performed after one month did not show late gadolinium enhancement. During the course of 24 months follow-up, she was taking bisoprolol and ramipril and her cardiologic state remained stable, even during chemotherapy and radiotherapy. The authors collected the clinical data of all 9 cases with concomitant TTS and CAF. Specific TTS triggering factors/predisposing conditions were present in all patients, which has indicated that coexistence of TTS and CAF is rather coincidental.
心尖球囊样综合征（TTS）在各种临床情况下均有报道。在行冠状动脉造影的患者中，冠状动脉瘘（CAF）的诊断率为 0.2-0.4%。冠状动脉（如左前降支冠状动脉-LAD）与心腔（如左心室-LV）之间存在病理性交通为心腔型 CAF，易发生盗血综合征引起心肌缺血。迄今为止，已有 8 例 TTS 合并 CAF 的病例报告；其中 6 例 LAD 心腔瘘引流至 LV，另外 2 例发现冠状动脉与肺动脉之间存在交通。作者描述了 1 例 75 岁女性，因胸痛和呼吸困难入院。其心电图出现 ST 段抬高，肌钙蛋白 I 中度升高，超声心动图示心尖球囊样改变，其临床表现更符合 TTS 而非心肌梗死；此外，彩色多普勒成像提示存在多个 CAF 至 LV。冠状动脉造影显示所有（正常）冠状动脉与 LV 之间存在交通。在保守治疗过程中，LV 功能在第 2 天和第 6 天分别先改善后恢复正常。胸部 X 线和计算机断层扫描显示纵隔肿瘤（最终诊断为肺癌）。一个月后进行的心脏磁共振未显示晚期钆增强。在 24 个月的随访过程中，她服用比索洛尔和雷米普利，其心脏状况保持稳定，甚至在化疗和放疗期间也是如此。作者收集了所有 9 例并发 TTS 和 CAF 的患者的临床资料。所有患者均存在特定的 TTS 触发因素/易患条件，这表明 TTS 和 CAF 的共存更多是偶然的。
