病例报告：老年患者Takotsubo心肌病的逐步无创诊断——从心电图线索到超声心动图和CT血管造影确认

Case Report: Stepwise noninvasive diagnosis of Takotsubo cardiomyopathy in an elderly patient-From ECG clues to echocardiographic and CTA confirmation.

作者信息

Teng Yanling, Sun Xingxing, Wang Minglang, Wang Ziyang, Wang Yilian

机构信息

Department of Cardiology, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China.

Department of Cardiology, The Second People's Hospital of Lianyungang, Affiliated to Kangda College of Nanjing Medical University, Lianyungang, China.

出版信息

Front Cardiovasc Med. 2025 Jun 4;12:1608992. doi: 10.3389/fcvm.2025.1608992. eCollection 2025.

DOI:10.3389/fcvm.2025.1608992

PMID:40535152

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12174099/

Abstract

BACKGROUND

Takotsubo cardiomyopathy (TTC) is frequently misdiagnosed as acute coronary syndrome in elderly patients. This case demonstrates how ECG findings facilitate a noninvasive diagnostic algorithm for TTC, validated by echocardiography and coronary computed tomography angiography (CCTA).

CASE SUMMARY

An 88-year-old woman presented with chest tightness and dyspnea after emotional stress (bereavement). Initial ECGs showed the concurrent appearance of ST-segment elevations in anterior (V3-V5) and inferior leads (II, III, aVF), suggesting apical injury and the diagnosis of TTC. Bedside echocardiography revealed apical akinesis with preserved basal contraction (LVEF 35%), while CCTA ruled out obstructive disease. Supportive therapy led to symptom resolution. At 1-year follow-up, LVEF recovered to 61% with normalized ECG.

CONCLUSION

This case highlights ECG's pivotal role in suspecting TTC, enabling a Noninvasive diagnostic approach (echocardiography + CCTA) for elderly patients.

摘要

背景

在老年患者中，应激性心肌病（TTC）常被误诊为急性冠状动脉综合征。本病例展示了心电图表现如何助力TTC的无创诊断算法，并通过超声心动图和冠状动脉计算机断层扫描血管造影（CCTA）得到验证。

病例摘要

一名88岁女性在经历情绪应激（丧亲之痛）后出现胸闷和呼吸困难。最初的心电图显示前壁导联（V3-V5）和下壁导联（II、III、aVF）同时出现ST段抬高，提示心尖部损伤，诊断为TTC。床旁超声心动图显示心尖部运动减弱，基底段收缩功能保留（左心室射血分数35%），而CCTA排除了阻塞性疾病。支持性治疗使症状得到缓解。在1年随访时，左心室射血分数恢复至61%，心电图正常。