Srdanović Ilija, Dabović Dragana, Ivanović Vladimir, Čanković Milenko, Pantić Teodora, Stefanović Maja, Dimić Sonja, Crnomarković Branislav, Bjelobrk Marija, Govedarica Miljana, Zdravković Marija
Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia.
Clinic of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia.
Life (Basel). 2023 Aug 18;13(8):1770. doi: 10.3390/life13081770.
Takotsubo cardiomyopathy (TCM) is a reversible form of cardiomyopathy characterized by transient regional systolic dysfunction of the left ventricle.
A 78-year-old woman was admitted to the general hospital due to acute inferior STEMI late presentation. Two days after admission, the patient reported intense chest pain and an ECG registered diffuse ST-segment elevation in all leads with ST-segment denivelation in aVR. The patient also showed clinical signs of cardiogenic shock and was referred to a reference institution for further evaluation. Echocardiography revealed akinesia of all medioapical segments, dynamic obstruction of the left ventricular outflow tract (LVOT), moderate mitral regurgitation, and pericardial effusion. Coronary angiography showed the suboccluded right coronary artery, and a primary percutaneous coronary intervention was performed, which involved implanting a drug-eluting stent. The patient's condition worsened as pericardial effusion increased and led to tamponade. Pericardiocentesis was performed, resulting in the patient's stabilization. At this point, significant gradients at the LVOT and pericardial effusion were not registered. After eight days without symptoms and stable status, the patient was discharged.
The simultaneous presence of AMI and TCM increases the risk of developing cardiogenic shock. The cardio-circulatory profile of these patients is different from those with AMI.
应激性心肌病（TCM）是一种可逆性心肌病，其特征为左心室短暂性局部收缩功能障碍。
一名78岁女性因急性下壁ST段抬高型心肌梗死延迟就诊入住综合医院。入院两天后，患者报告剧烈胸痛，心电图显示所有导联弥漫性ST段抬高，aVR导联ST段压低。患者还出现心源性休克的临床体征，被转诊至一家参考机构进行进一步评估。超声心动图显示所有心尖中段运动减弱、左心室流出道（LVOT）动态梗阻、中度二尖瓣反流和心包积液。冠状动脉造影显示右冠状动脉次全闭塞，遂进行了一次主要的经皮冠状动脉介入治疗，包括植入一枚药物洗脱支架。随着心包积液增加，患者病情恶化并导致心包填塞。进行了心包穿刺术，使患者病情稳定。此时，LVOT处未记录到明显压差，心包积液也已消失。在无症状且病情稳定八天后，患者出院。
急性心肌梗死（AMI）与TCM同时存在会增加发生心源性休克的风险。这些患者的心脏循环特征与AMI患者不同。
