Castiglione Vincenzo, Arzilli Chiara, Ciardetti Marco, Emdin Michele, Coceani Michele
Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy.
Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy.
Eur Heart J Case Rep. 2024 Dec 26;9(1):ytae694. doi: 10.1093/ehjcr/ytae694. eCollection 2025 Jan.
Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction, often triggered by emotional or physical stress. It usually presents with clinical features similar to acute coronary syndrome, making its occurrence following elective percutaneous coronary intervention (PCI) challenging to diagnose and treat.
A 67-year-old man with ischaemic heart disease and recurrent angina underwent elective PCI of the right coronary artery. The procedure, although technically challenging, was completed without immediate complications. However, shortly after the intervention, the patient experienced acute chest pain, initially thought to be due to subocclusion of a postero-lateral branch, which was treated with balloon angioplasty. Despite this intervention, the patient developed severe ventricular arrhythmias and exhibited dynamic electrocardiographic changes and echocardiographic features consistent with TTS. Cardiac magnetic resonance (CMR) imaging confirmed the diagnosis, revealing classic apical ballooning and left ventricular dysfunction. With comprehensive medical management and haemodynamic support, the patient gradually recovered. He was discharged after stabilization, with follow-up showing complete resolution of the left ventricular dysfunction.
This case highlights the importance of recognizing TTS as a potential complication following PCI, particularly in patients with a heightened stress response. It emphasizes the need for increased awareness and the use of advanced diagnostic tools, such as CMR imaging, to accurately identify TTS. Early diagnosis and appropriate management are crucial for improving outcomes, especially in complex PCI cases where TTS can mimic more common coronary complications.
应激性心肌病（TTS）的特征是短暂性左心室功能障碍，常由情绪或身体应激诱发。它通常表现出与急性冠状动脉综合征相似的临床特征，这使得其在择期经皮冠状动脉介入治疗（PCI）后发生时的诊断和治疗具有挑战性。
一名67岁患有缺血性心脏病和复发性心绞痛的男性接受了右冠状动脉的择期PCI。该手术虽然在技术上具有挑战性，但顺利完成且无即刻并发症。然而，介入治疗后不久，患者出现急性胸痛，最初认为是由于后侧支亚闭塞所致，遂行球囊血管成形术治疗。尽管进行了此干预，患者仍出现严重室性心律失常，并表现出与TTS一致的动态心电图变化和超声心动图特征。心脏磁共振（CMR）成像确诊，显示典型的心尖气球样变和左心室功能障碍。经过综合药物治疗和血流动力学支持，患者逐渐康复。病情稳定后出院，随访显示左心室功能障碍完全消退。
该病例强调了认识到TTS作为PCI后潜在并发症的重要性，尤其是在应激反应增强的患者中。它强调需要提高认识并使用先进的诊断工具，如CMR成像，以准确识别TTS。早期诊断和适当管理对于改善预后至关重要，特别是在TTS可模仿更常见冠状动脉并发症的复杂PCI病例中。
