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对脆弱的恐惧:一例骨质疏松引发的应激性心肌病病例

Fear of Fragility: A Case of Osteoporosis-Triggered Takotsubo Cardiomyopathy.

作者信息

Hlupeni Admire, Khan Wagmah J, Adejola Adebisi, LaRue Shane J

机构信息

Internal Medicine, St. Luke's Hospital, Chesterfield, USA.

Immunology, Midlands State University, Gweru, ZWE.

出版信息

Cureus. 2024 Dec 7;16(12):e75289. doi: 10.7759/cureus.75289. eCollection 2024 Dec.

Abstract

We present a case of a 73-year-old woman with a medical history significant for hyperlipidemia, on pravastatin, who developed Takotsubo cardiomyopathy following a diagnosis of osteoporosis. She presented to the Emergency Department with acute transient left arm pain that resolved spontaneously. Investigations revealed elevated troponin levels, non-specific electrocardiographic changes, no significant coronary artery disease on angiography, and left ventricular systolic dysfunction, findings consistent with Takotsubo cardiomyopathy. Further evaluation revealed that the patient's intense anxiety about her recent osteoporosis diagnosis served as the primary emotional stressor, ultimately triggering Takotsubo cardiomyopathy. Osteoporosis, though not immediately life-threatening, can evoke significant psychological distress due to fears about future fractures, physical limitations, and loss of independence. This highlights the broader impact of chronic disease diagnoses on emotional well-being, particularly in older adults. Management in this case included losartan, carvedilol, and supportive care. Beyond pharmacologic treatment, addressing the patient's emotional health was a priority. Specific psychosocial interventions included in-depth discussion with the patient to alleviate misconceptions about osteoporosis, referrals to counseling services to manage anxiety, and strategies to build coping mechanisms such as mindfulness and relaxation techniques. Providing education on the manageable nature of osteoporosis and available treatments helped reduce the patient's sense of helplessness. These interventions aimed to not only support the patient's immediate recovery but also to minimize the risk of recurrence of stress-induced adverse events such as Takotsubo cardiomyopathy. The case underscores the importance of integrating emotional well-being into routine clinical practice by offering tailored psychosocial support, including clear communication, access to mental health resources, and fostering a collaborative care environment. Holistic care that addresses both physical and psychological health can improve patient outcomes, reduce hospitalizations, and empower patients to manage their conditions more effectively.

摘要

我们报告一例73岁女性病例,该患者有高脂血症病史,正在服用普伐他汀,在诊断为骨质疏松症后发生了应激性心肌病。她因急性短暂性左臂疼痛自行缓解而就诊于急诊科。检查发现肌钙蛋白水平升高、非特异性心电图改变、血管造影显示无明显冠状动脉疾病以及左心室收缩功能障碍,这些发现符合应激性心肌病。进一步评估发现,患者对近期骨质疏松症诊断的强烈焦虑是主要的情绪应激源,最终引发了应激性心肌病。骨质疏松症虽然不会立即危及生命,但由于对未来骨折、身体限制和失去独立性的恐惧,可能会引起严重的心理困扰。这凸显了慢性病诊断对情绪健康的更广泛影响,尤其是在老年人中。该病例的治疗包括使用氯沙坦、卡维地洛和支持性护理。除了药物治疗外,关注患者的情绪健康是首要任务。具体的社会心理干预措施包括与患者进行深入讨论以消除对骨质疏松症的误解、转介至咨询服务以管理焦虑,以及建立应对机制的策略,如正念和放松技巧。提供关于骨质疏松症可管理性和可用治疗方法的教育有助于减轻患者的无助感。这些干预措施不仅旨在支持患者的即刻康复,还旨在将应激诱发的不良事件(如应激性心肌病)复发的风险降至最低。该病例强调了通过提供量身定制的社会心理支持,将情绪健康纳入日常临床实践的重要性,包括清晰的沟通、获取心理健康资源以及营造协作性的护理环境。兼顾身体和心理健康的整体护理可以改善患者的治疗效果、减少住院次数,并使患者更有效地管理自己的病情。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86c6/11703781/b97bc0931500/cureus-0016-00000075289-i01.jpg

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