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因癫痫持续状态继发 Takotsubo 心肌病导致的心源性休克的经皮左心室辅助。

Percutaneous left ventricular assistance in cardiogenic shock due to Takotsubo cardiomyopathy secondary to status epilepticus.

机构信息

Intensive Care Unit, Garcia de Orta Hospital, Almada, Portugal

Intensive Care Unit, Garcia de Orta Hospital, Almada, Portugal.

出版信息

BMJ Case Rep. 2023 Aug 9;16(8):e254125. doi: 10.1136/bcr-2022-254125.

Abstract

Takotsubo syndrome is an acute reversible cardiomyopathy with left ventricular dysfunction and a clinical presentation similar to an acute coronary syndrome. Emotional or physical triggers can cause it, including neurological conditions such as seizures. We describe a case of a woman in her 50s with Takotsubo syndrome secondary to status epilepticus, presenting with cardiac arrest and cardiogenic shock. We excluded acute coronary syndrome with coronary angiography. Despite inotropic support, she remained haemodynamically unstable and a percutaneous left ventricular assistance with an Impella CP catheter was initiated. This resulted in a quick weaning of haemodynamic support and recovery of left ventricle systolic function in 2 weeks. This case illustrates the importance of a high index of suspicion to make this diagnosis and link it to neurological triggers, as well as to consider mechanical circulatory support in managing cardiogenic shock due to this cardiomyopathy.

摘要

心尖球囊综合征是一种左心室功能障碍的急性可逆性心肌病,其临床表现类似于急性冠状动脉综合征。情绪或身体的触发因素都可能导致该病,包括癫痫等神经系统疾病。我们描述了一位 50 多岁的女性因癫痫持续状态继发心尖球囊综合征的病例,表现为心脏骤停和心源性休克。我们通过冠状动脉造影排除了急性冠状动脉综合征。尽管给予了正性肌力支持,但她的血流动力学仍不稳定,因此开始使用 Impella CP 导管进行经皮左心室辅助。这使得在 2 周内快速减少了血流动力学支持,并恢复了左心室收缩功能。该病例说明了高度怀疑该诊断并将其与神经触发因素联系起来的重要性,以及在管理这种心肌病引起的心源性休克时考虑机械循环支持的重要性。

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