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病例报告:经皮冠状动脉介入治疗后心尖球形综合征。

Case report: Takotsubo syndrome following percutaneous coronary intervention.

机构信息

Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China.

Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China.

出版信息

J Cardiothorac Surg. 2023 Nov 16;18(1):335. doi: 10.1186/s13019-023-02412-0.

Abstract

BACKGROUND

Takotsubo syndrome (TTS), which is frequently secondary to severe emotional (fear, anxiety, etc.) or physical stress, is an acute reversible heart failure syndrome characterized by temporary left ventricular regional systolic dysfunction. Nevertheless, TTS after percutaneous coronary intervention (PCI) is rare, and its clinical characteristics are easily confused with complications after PCI.

CASE PRESENTATION

This article reports a case of TTS induced by psychological and physical pressure after successful PCI in our institution. The patient had symptoms comparable to complications after PCI, including V1-V5 ST segment elevation and T wave changes of electrocardiogram (ECG) and troponin elevation. Coronary angiogram, left ventricle opacification (LVO), and cardiac magnetic resonance (CMR) were performed to exclude postoperative complications. Diagnosis of TTS was eventually achieved.

CONCLUSION

We cannot dismiss the risk of TTS in patients who have unexplained V1-V5 ST segment elevation and T wave changes of ECG and troponin elevation following successful PCI. Meanwhile, medical personnel should provide mental, cultural, and emotional services to patients in addition to essential diagnostic and treatment technical services during the perioperative period.

摘要

背景

Takotsubo 综合征(TTS)常继发于严重的情绪(恐惧、焦虑等)或身体应激,是一种以短暂性左心室区域性收缩功能障碍为特征的急性可逆性心力衰竭综合征。然而,经皮冠状动脉介入治疗(PCI)后 TTS 很少见,其临床特征容易与 PCI 后并发症混淆。

病例介绍

本文报道了我院成功 PCI 后心理和身体压力引发 TTS 的病例。患者出现类似于 PCI 后并发症的症状,包括 V1-V5 段心电图(ECG)ST 段抬高和 T 波改变,以及肌钙蛋白升高。进行了冠状动脉造影、左心室显影(LVO)和心脏磁共振(CMR)检查,以排除术后并发症。最终诊断为 TTS。

结论

对于成功 PCI 后出现不明原因的 V1-V5 段 ECG ST 段抬高和 T 波改变以及肌钙蛋白升高的患者,不能排除 TTS 的风险。同时,医务人员在围手术期除了提供必要的诊断和治疗技术服务外,还应提供心理、文化和情感服务。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a473/10655480/bdbc2e3a2f44/13019_2023_2412_Fig1_HTML.jpg

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