Cho YeJi, Inoue Kenji, Kunimoto Mitsuhiro, Minamino Tohru
Cardiovascular Biology and Medicine, School of Medicine, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
BMJ Case Rep. 2023 Oct 16;16(10):e255987. doi: 10.1136/bcr-2023-255987.
Takotsubo cardiomyopathy (TCM) leads to serious left ventricular outflow tract (LVOT) obstruction with cardiogenic shock in 6%-20% of cases. The onset of LVOT obstruction, coupled with mitral regurgitation resulting from systolic anterior motion of mitral valve leaflets, can lead to haemodynamic instability in addition to severely impaired systolic function. We describe three patients who experienced chest discomfort following emotional stress. These patients displayed pronounced abnormalities on ECGs, insignificant obstructive coronary disease and haemodynamic instability due to LVOT obstruction. The infusion of landiolol, a short-acting beta blocker, was effective in releasing the gradient. Dynamic outflow obstruction is the major predictor of haemodynamic collapse. We suggested that an early identification of this complication in hypotensive patients with suspected TCM could be of utmost importance to optimise the therapeutic approach in the acute setting.
应激性心肌病（TCM）在6%-20%的病例中会导致严重的左心室流出道（LVOT）梗阻并伴有心源性休克。LVOT梗阻的发生，再加上二尖瓣叶收缩期前向运动导致的二尖瓣反流，除了会严重损害收缩功能外，还会导致血流动力学不稳定。我们描述了三名在情绪应激后出现胸部不适的患者。这些患者心电图显示明显异常，阻塞性冠状动脉疾病不明显，且因LVOT梗阻导致血流动力学不稳定。静脉输注短效β受体阻滞剂兰地洛尔可有效降低压差。动态流出道梗阻是血流动力学崩溃的主要预测因素。我们认为，对于疑似TCM的低血压患者，早期识别这一并发症对于优化急性情况下的治疗方法至关重要。
