Coaguila-Cusicanqui Luis, Castillo-Atoche Vanessa, Montalvo-Suyon Roberto, Cavero-Reyes Yuriko, Failoc-Rojas Virgilio E
Hospital Regional Lambayeque, Lambayeque, 14013, Peru.
Universidad Privada Norbert Wiener, Lima, 15079, Peru.
F1000Res. 2022 Nov 14;11:616. doi: 10.12688/f1000research.122298.2. eCollection 2022.
Takotsubo cardiomyopathy (TC) is characterized by a clinical presentation that mimics acute coronary syndrome but is reversible. Alterations of Takotsubo in patients without previous heart disease remain a challenge for diagnosis. We present a case of an 80-year-old patient from Peru. The patient underwent surgery, with the diagnosis of Chilaiditi's syndrome. One day after surgery, she presented with dyspnea, tachycardia, and electrocardiographic changes. The diagnosis of Takotsubo syndrome with cardiogenic shock and renal failure on hemodialysis was made. She was hospitalized in the Intensive Care Unit and was managed with vasopressors and nitroglycerin. There was no cardiac lesion in the cineangiogram or occlusion of arteries. The patient was extubated and received daily dialysis until discharge. : Takotsubo is an emotional, non-cardiac, or post-traumatic stressful event that triggers myocardial injury with segmental anomalous, the possible etiology of which is the release of an endothelial neurotransmitter caused by stress. Emergency physicians should be aware of this as even patients without previous cardiac pathologies when exposed to stressors (such as surgeries) develop emergency symptomatology similar to myocardial infarction. Thus, emergency physicians should identify any cardiac abnormalities after a stressor, as well as be prepared for the diagnosis of TC.
应激性心肌病(TC)的临床表现类似于急性冠状动脉综合征,但具有可逆性。对于既往无心脏病史的患者,应激性心肌病的诊断仍具有挑战性。我们报告一例来自秘鲁的80岁患者。该患者接受了手术,诊断为奇莱迪蒂综合征。术后一天,她出现呼吸困难、心动过速和心电图改变。诊断为应激性心肌病伴心源性休克和正在进行血液透析的肾衰竭。她被收入重症监护病房,接受血管升压药和硝酸甘油治疗。心血管造影未发现心脏病变或动脉闭塞。患者拔管并接受每日透析直至出院。应激性心肌病是一种由情绪、非心脏或创伤后应激事件引发的心肌损伤,伴有节段性异常,其可能病因是应激导致内皮神经递质释放。急诊医生应意识到这一点,因为即使是既往无心脏疾病的患者,在接触应激源(如手术)时也会出现类似于心肌梗死的紧急症状。因此,急诊医生应在应激源出现后识别任何心脏异常情况,并为应激性心肌病的诊断做好准备。