Ahmed Adnan, Javaid Ayesha, Lai Chin Kon David
Cardiology, Stockport NHS Foundation Trust, Manchester, GBR.
Cardiology, Countess of Chester Hospital, Chester, GBR.
Cureus. 2025 Jul 26;17(7):e88820. doi: 10.7759/cureus.88820. eCollection 2025 Jul.
We report the case of a 79-year-old woman with background of chronic hyponatremia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) who presented with chest pain and marked troponin elevation in the absence of an identifiable emotional stressor. Initial investigations revealed severe hyponatremia (serum sodium 122 mmol/L) and elevated cardiac enzymes. Her electrocardiogram showed normal sinus rhythm with deep, symmetrical T wave inversions in the inferior and precordial leads. Other investigations revealed apical akinesia on echocardiography and apical ballooning on the left ventriculogram. Coronary angiography showed unobstructed coronary arteries. Further investigations supported the diagnosis of SIADH, for which she was treated with fluid restriction and demeclocycline. The patient responded well with gradual normalisation of her sodium levels and improvement in symptoms. Follow-up imaging showed normal biventricular systolic function and resolution of apical ballooning. Given the temporal association and lack of alternative triggers, we hypothesize that profound hyponatremia contributed to the development of Takotsubo cardiomyopathy (TCM). This case highlights the potential for severe hyponatraemia to act as a precipitating factor in TCM.
我们报告了一例79岁女性病例，该患者有慢性低钠血症病史，继发于抗利尿激素分泌不当综合征（SIADH），她在没有明显情绪应激源的情况下出现胸痛和肌钙蛋白显著升高。初步检查发现严重低钠血症（血清钠122 mmol/L）和心肌酶升高。她的心电图显示窦性心律正常，下壁和胸前导联出现深而对称的T波倒置。其他检查显示超声心动图提示心尖运动减弱，左心室造影提示心尖气球样改变。冠状动脉造影显示冠状动脉无阻塞。进一步检查支持SIADH的诊断，为此她接受了限液和地美环素治疗。患者反应良好，钠水平逐渐恢复正常，症状改善。随访影像学检查显示双心室收缩功能正常，心尖气球样改变消失。鉴于时间上的关联以及缺乏其他触发因素，我们推测严重低钠血症促成了Takotsubo心肌病（TCM）的发生。该病例突出了严重低钠血症作为TCM诱发因素的可能性。
