Takotsubo cardiomyopathy with LVOT obstruction in a case of STEMI: a rare cause of peri-PCI hypotension.

STEMI 病例中伴有 LVOT 梗阻的 Takotsubo 心肌病 ： PCI 围手术期低血压的罕见原因。

• 发表时间: Jan 2021 28
• 来源期刊: BMJ Case Rep
• DOI: 10.1136/bcr-2020-236171
• PMID: 33509857
• 文章类型: Case Reports
• 作者列表: Fatima S,Romeo J,Pacella J

关键词: clinical diagnostic tests; heart failure; interventional cardiology

Mesh: Adrenergic beta-Antagonists / therapeutic use; Cardiotonic Agents / adverse effects; Coronary Angiography; Drug-Eluting Stents; Echocardiography; Female; Heart Ventricles; Humans; Hypotension / drug therapy etiology; Intraoperative Complications / drug therapy etiology; Middle Aged; Percutaneous Coronary Intervention; Phenylephrine / therapeutic use; Postoperative Complications / drug therapy etiology; ST Elevation Myocardial Infarction / complications diagnosis surgery; Takotsubo Cardiomyopathy / complications diagnostic imaging; Thrombectomy; Thrombosis; Vasoconstrictor Agents / therapeutic use; Ventricular Outflow Obstruction / complications diagnostic imaging

Abstract

Takotsubo cardiomyopathy (TCM) associated with left ventricular outflow tract (LVOT) obstruction in the event of an ST-elevation myocardial infarction (STEMI) is a rare cause of hypotension during percutaneous coronary intervention (PCI). Herein, we describe a 57-year-old woman who presented with STEMI and underwent PCI. She developed hypotension which worsened during inotropic therapy. Echocardiography revealed evidence of LVOT obstruction in the setting of TCM. Therefore, inotropic support was promptly discontinued. Beta blockers and phenylephrine were rapidly administrated, resulting in improved blood pressure and stabilisation of the patient.

摘要

在ST段抬高型心肌梗死（STEMI）的情况下，与左心室流出道（LVOT）阻塞相关的Takotsubo心肌病（TCM）是经皮冠状动脉介入治疗（PCI）期间低血压的罕见原因。在这里，我们描述了一名57岁的女性,她出现了STEMI并接受了PCI治疗.她出现低血压，在变力治疗期间恶化。超声心动图显示中医背景下存在LVOT梗阻的证据。因此,正性肌力支持立即停止。迅速服用β受体阻滞剂和去氧肾上腺素，改善血压和患者的稳定。