Khan Zahid, Eldabe Fady, Tyrovolas Konstantinos, Rathod Krishna, Rees Paul
Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR.
Cardiology, Barts Heart Centre, London, GBR.
Cureus. 2025 May 22;17(5):e84593. doi: 10.7759/cureus.84593. eCollection 2025 May.
Takotsubo cardiomyopathy (TCM) is an acute and reversible cardiac condition triggered by an adrenaline rush in response to stress that is characterised by apical ballooning of the left ventricle in the absence of coronary artery obstruction. Although the exact pathophysiology remains unclear, it is believed to be secondary to the release of adrenaline or catecholamine in response to stress. We present the case of a 71-year-old female who presented to a district general hospital (DGH) at approximately 1700 pm in the evening with signs and symptoms of anaphylaxis following the consumption of pistachios the night before. She woke up with mild shortness of breath (sob) in the morning at 0900 am. The symptoms progressively got worse after midday, and she developed throat tightness and mild tongue swelling at 1600, prompting her to attend the local hospital's accident and emergency department. Following evaluation in the accident and emergency department, she was given 0.5 mg of adrenaline one in 1000 (1 mg/mL) solution intramuscularly for a delayed allergic reaction to pistachios. She developed central chest pain and tightness within minutes of receiving the intramuscular adrenaline, and an electrocardiogram showed ST elevation in the lateral leads and ST depression inferiorly. She was transferred to our cardiac centre for emergency coronary angiography, and bedside echocardiography revealed mild to moderate left ventricular systolic dysfunction (LVSD). Coronary angiography via the right radial access showed unobstructed coronaries. Left ventriculogram (LVG) post-angiogram demonstrated apical ballooning suggestive of TCM secondary to adrenaline administration for anaphylaxis to pistachio. Departmental echocardiography revealed a mild LVSD with an ejection fraction of 45%. She was started on bisoprolol in addition to her regular medications. Echocardiography demonstrated normal left ventricular function three months later, and the patient was discharged from the outpatient clinic.
应激性心肌病（TCM）是一种急性且可逆的心脏疾病，由应激状态下肾上腺素激增引发，其特征为左心室心尖部气球样扩张，且无冠状动脉阻塞。尽管确切的病理生理机制尚不清楚，但据信是由于应激状态下肾上腺素或儿茶酚胺释放所致。我们报告一例71岁女性病例，该患者于晚上约17:00因前一晚食用开心果后出现过敏反应的症状和体征，就诊于一家区综合医院（DGH）。她早上09:00醒来时伴有轻度呼吸急促（气短）。中午过后症状逐渐加重，16:00时出现喉咙发紧和轻度舌头肿胀，促使她前往当地医院的急诊科。在急诊科接受评估后，因对开心果的迟发性过敏反应，她接受了0.5毫克1:1000（1毫克/毫升）溶液的肾上腺素肌肉注射。在接受肌肉注射肾上腺素后几分钟内，她出现了中央胸痛和胸闷，心电图显示侧壁导联ST段抬高，下壁导联ST段压低。她被转至我们的心脏中心进行急诊冠状动脉造影，床旁超声心动图显示轻度至中度左心室收缩功能障碍（LVSD）。经右桡动脉途径的冠状动脉造影显示冠状动脉通畅。血管造影后的左心室造影显示心尖部气球样扩张，提示因对开心果过敏而注射肾上腺素继发的应激性心肌病。科室超声心动图显示轻度LVSD，射血分数为45%。除了她的常规药物治疗外，还开始给她使用比索洛尔。三个月后超声心动图显示左心室功能正常，患者从门诊出院。
