PDF(Pubmed)
Abstract：
Sympathetic nervous system hyperactivity and elevated catecholamine levels are known features of chronic kidney disease (CKD). On the other hand, CKD itself is a high risk for Cardiovascular disease (CVD) and in fact most patients with CKD die before reaching dialysis. Furthermore, Many CKD risk factors such as obesity, hypertension, diabetes are also associated with sympathetic hyperactivity. Sympathetic hyperactivity and elevated catecholamine levels also play a key role in the pathogenesis of takotsubo cardiomyopathy (TKCM). Owing to the high sympathetic tone and elevated catecholamine levels in CKD/ESRD patients, an acute stress such as infection/sepsis or surgery makes these patients highly susceptible to TKCM. Multiple isolated case reports of TKCM in CKD/ESRD patients have been reported. We here present the first scoping study of such cases. The purpose of this review is to identify the characteristic features of ESRD/CKD who developed TKCM. Analysis of 30 cases of TKCM in CKD/ESRD primarily happens in women (87% of the cases) with a mean age of 64 ± 13 yrs (Median 63 yrs). Dyspnea (60%) was most presenting complaint, followed by chest pain (37%), fatigue (10%), lower limb edema (3%), seizures (3%) and confusion (3%). The majority of TKCM was noted after exposure to an acute physiological or psychological stressor. Physicians should have a high clinical suspicion for TKCM amongst other differential diagnosis in CKD/ESRD patients who present with chest pain or dyspnea in the setting of acute physiological or psychological stressor.
摘要：
交感神经系统过度活跃和儿茶酚胺水平升高是慢性肾病(CKD)的已知特征。另一方面,CKD本身是心血管疾病（CVD）的高风险，实际上大多数CKD患者在达到透析之前死亡。此外，许多CKD危险因素如肥胖，高血压,糖尿病也与交感神经过度活动有关。交感神经过度活跃和儿茶酚胺水平升高也在Takotsubo心肌病（TKCM）的发病机理中起关键作用。由于CKD/ESRD患者的交感神经紧张和儿茶酚胺水平升高，感染/败血症或手术等急性应激使这些患者对TKCM高度敏感。已经报道了CKD/ESRD患者中TKCM的多个孤立病例报告。我们在这里提出了此类病例的第一个范围研究。这篇综述的目的是确定开发TKCM的ESRD/CKD的特征。分析30例CKD/ESRD中的TKCM主要发生在女性（占病例的87％），平均年龄为64±13岁（中位数为63岁）。呼吸困难（60％）是最常见的主诉，其次是胸痛（37%），疲劳（10%），下肢水肿（3%），癫痫（3％）和混乱（3％）。大多数TKCM是在暴露于急性生理或心理压力源后发现的。在急性生理或心理应激源背景下出现胸痛或呼吸困难的CKD/ESRD患者中，医师应高度怀疑TKCM以及其他鉴别诊断。
