Amaro Tânia, Sgarbi Taynara, Vieira Raísa, Santos Rafael Reis, Matos Priscila, Oliveira Adilson
Cardiology Department Clínica Girassol Luanda Angola.
Universidade de Franca-UNIFRAN Franca Brazil.
Clin Case Rep. 2023 Oct 3;11(10):e7998. doi: 10.1002/ccr3.7998. eCollection 2023 Oct.
Takotsubo syndrome (TS) is an acute heart disease that mimics the typical features of acute coronary syndrome (ACS). TS is generally reported after subarachnoid hemorrhage (SAH) due to a ruptured aneurysm, and has an incidence rate of 0.8 (17%). Here, we report a rare case of TS with unruptured intracranial aneurism. A 54-year-old woman had a history of systemic arterial hypertension and migraine. She went to a secondary hospital 2 h after sudden-onset chest pain, which irradiated to the left upper limb and back. The initial electrocardiogram (ECG) was normal but showed a troponin curve, which led us to suspect acute non-ST elevation myocardial infarction. Serial ECG showed dynamic changes in ST-segment elevation in DIII, AvF, V5, and V6. Emergency cardiac catheterisation was performed and did not show any obstructive lesions. However, ventriculography revealed hypokinesia of the inferoapical wall. During hospitalization, the patient had a severe refractory headache. Computed tomography (CT) and CT angiography were performed, which identified "mirror" saccular aneurysms. A supraclinoid internal carotid artery aneurysm was embolized with two stents. The patient's condition progressed satisfactorily. The association between takotsubo syndrome and aneurysmal SAH with some populations has already been reported. Due to this prior knowledge, and severe headache, it was necessary to perform screening for SAH and the discovery of an unruptured aneurysm in this case report. The present case report differs from most reported cases of takotsubo syndrome described in the literature because it presents unruptured mirror aneurysms, while most cases are diagnosed after intracranial hemorrhage.
应激性心肌病（TS）是一种急性心脏病，其症状类似急性冠状动脉综合征（ACS）的典型特征。TS通常在因动脉瘤破裂导致蛛网膜下腔出血（SAH）后被报道，发病率为0.8（17%）。在此，我们报告一例罕见的伴有未破裂颅内动脉瘤的TS病例。一名54岁女性有系统性动脉高血压和偏头痛病史。突发胸痛2小时后她前往一家二级医院就诊，疼痛放射至左上肢和背部。初始心电图（ECG）正常，但肌钙蛋白曲线异常，这使我们怀疑为急性非ST段抬高型心肌梗死。系列心电图显示Ⅲ导联、aVF导联、V5导联和V6导联ST段抬高有动态变化。进行了急诊心脏导管插入术，未发现任何阻塞性病变。然而，心室造影显示下尖壁运动减弱。住院期间，患者出现严重难治性头痛。进行了计算机断层扫描（CT）和CT血管造影，发现了“镜像”囊状动脉瘤。用两个支架栓塞了床突上段颈内动脉瘤。患者病情进展顺利。应激性心肌病与某些人群的动脉瘤性SAH之间的关联已有报道。鉴于此既往认知以及患者严重头痛，在本病例报告中进行SAH筛查并发现未破裂动脉瘤很有必要。本病例报告与文献中报道的大多数应激性心肌病病例不同，因为它呈现的是未破裂的镜像动脉瘤，而大多数病例是在颅内出血后才被诊断出来。
