背景:Takotsubo综合征与微血管急性冠脉综合征相当。它可能部分共享蝎毒(SE)期间争论的相同病理生理学,肾上腺素风暴,由于没有冠状动脉狭窄而没有心肌梗塞。Takotsubo心肌病可以帮助更好地了解蝎毒期间心脏受累的病理生理学。然而,在SE后心力衰竭患者的文献中,Takotsubo综合征似乎被低估了。
方法:在这篇综述中,我们的目标是详细描述所有描述的案例,机制,以及蝎毒并发Takotsubo心肌病的结果。我们通过在MeSH研究中使用以下关键字来使用PubMed数据库:蝎子病毒,Takotsubo心肌病,和Takotsub综合征。
结果:文献分析显示,只有4例确诊为严重SE后的Takotsubo心肌病。在没有冠状动脉疾病的情况下,所有四名患者都出现了短暂的可逆性左心室收缩功能障碍,遵循蝎子毒害的积极历史。所有病例均进行了心脏MRI检查,在所有情况下,左心室均显示与左心室射血分数相关的球囊扩张。所有患者经对症治疗后好转,并观察到壁运动的完全恢复。
结论:Takotsubo综合征,尽管文献中不经常报道严重的SE,可以代表解释SE期间心脏受累的病理生理学的有效假设。在严重的蝎子毒害中,存在多种机制,可以解释Takotsubo综合征的发展。它的管理基于氧气,呼吸衰竭和/或心源性休克患者的有创或非有创呼吸机支持。β受体阻滞剂,盐皮质激素受体拮抗剂,利尿剂通常用于Takotsubo综合征。然而,在严重的蝎子毒害中,所有报告的Takotsubo心肌病病例均与心源性休克和急性肺水肿相关.因此,我们建议使用多巴酚丁胺,因为已经证实,在多巴酚丁胺输注下,蝎毒后的心功能障碍得到了良好和安全的改善.
BACKGROUND: Takotsubo syndrome is comparable to microvascular acute coronary syndrome. It may partly share the same pathophysiology debated during
scorpion envenomation (SE), with an adrenergic storm, without myocardial infarction due to the absence of coronary artery stenosis. Takotsubo cardiomyopathy can help to better understand the pathophysiology of cardiac involvement during scorpion envenomation. However, Takotsubo syndrome seems to be underestimated in the literature in patients suffering from cardiac failure following SE.
METHODS: In this review, we aimed to detail all described cases, the mechanism, and outcomes of
scorpion envenomation complicated by Takotsubo cardiomyopathy. We used the PubMed database by using the following keywords in MeSH research:
scorpion envenomation, Takotsubo cardiomyopathy, and Takotsubo syndrome.
RESULTS: The literature analysis showed the existence of only four cases of confirmed Takotsubo cardiomyopathy following severe SE. All four patients developed a transient reversible left ventricular systolic dysfunction in the absence of coronary artery disease, following a positive history of scorpion envenomation. A cardiac MRI was performed in all cases, showing a ballooning in the left ventricle associated with a left ventricular ejection fraction in all cases. All patients were improved under symptomatic treatment, and complete recovery of the wall motion was observed.
CONCLUSIONS: Takotsubo syndrome, although not often reported in the literature in severe SE, can represent an effective hypothesis explaining the pathophysiology of cardiac involvement during SE. In severe
scorpion envenomation, multiple mechanisms exist and can explain the development of Takotsubo syndrome. Its management is based on oxygen, with invasive or non-invasive ventilator support in patients with respiratory failure and/or cardiogenic shock. Beta-blockers, mineralocorticoid receptor antagonists, and diuretics are usually used in Takotsubo syndrome. However, in severe
scorpion envenomation, all reported cases of Takotsubo cardiomyopathy are associated with cardiogenic shock and acute pulmonary edema. As a consequence, we advise the use of Dobutamine since it has already been confirmed that cardiac dysfunction following scorpion envenomation improves well and safely under Dobutamine infusion.