Nepal Subash, Aiello Dana, Ojha Kamala
Internal Medicine, Upstate Medical University, Syracuse, USA.
Cardiovascular Disease, Upstate University Hospital, Syracuse, USA.
Cureus. 2023 Jul 20;15(7):e42181. doi: 10.7759/cureus.42181. eCollection 2023 Jul.
Myocardial stress can lead to a myriad of cardiovascular complications, and stress-induced cardiomyopathy is the predominant manifestation. Exogenous or endogenous hormonal excess, sepsis, tachycardia, and physical or emotional trauma can lead to neurohormonal and catecholaminergic surges. Stress-induced cardiomyopathy often presents with chest pain, ischemic-like ECG changes, troponin elevation, and wall motion abnormalities in echocardiography. It is a diagnosis of exclusion, and coronary artery disease needs to be ruled out by a normal angiogram as per guidelines. It presents predominantly in postmenopausal women and presentation is similar to acute coronary syndrome (ACS) due to plaque rupture. We report a case of a 72-year-old female who presented to the emergency room with severe anginal chest pain without any preceding stress. ECG showed lateral leads ST-elevation and serial serum troponins were elevated. Emergent cardiac catheterization showed insignificant coronary artery disease. Left ventriculogram and echocardiogram showed a moderately reduced left ventricular systolic function with akinetic-hypokinetic mid to distal myocardial segments and normal basal contraction suggestive of stress-induced cardiomyopathy.
心肌应激可导致多种心血管并发症，应激性心肌病是其主要表现形式。外源性或内源性激素过量、脓毒症、心动过速以及身体或情绪创伤均可导致神经激素和儿茶酚胺激增。应激性心肌病常表现为胸痛、类似缺血的心电图改变、肌钙蛋白升高以及超声心动图显示的室壁运动异常。这是一种排除性诊断，需根据指南通过正常的血管造影排除冠状动脉疾病。该病主要发生在绝经后女性，其表现与因斑块破裂所致的急性冠状动脉综合征（ACS）相似。我们报告一例72岁女性患者，该患者无任何前驱应激因素，因严重心绞痛性胸痛就诊于急诊室。心电图显示侧壁导联ST段抬高，系列血清肌钙蛋白升高。急诊心脏导管检查显示冠状动脉疾病不明显。左心室造影和超声心动图显示左心室收缩功能中度降低，心肌中至远端节段运动减弱或无运动，基底节段收缩正常，提示为应激性心肌病。
