■尽管Takotsubo综合征(TTS)通常被认为是良性疾病,最近的报告显示,由于左心室流出道阻塞(LVOTO)引起的心源性休克的发生率,二尖瓣反流(MR),一次泵故障估计为6-20%。
一名78岁的女性因肺癌手术2天后出现胸痛和冷汗。根据她的症状怀疑急性冠脉综合征,心电图,经胸超声心动图(TTE),和实验室数据;因此,进行了紧急导管插入术.观察到正常的冠状动脉,左心室底部运动过度,心尖收缩,从而诊断出TTS的顶端膨胀型。左心室心尖(168/8/28mmHg)和主动脉(94/50/64mmHg)之间的压力差表明存在LVOTO。TTS发病后两天,她出现心源性休克(血压为54/38mmHg)。经胸超声心动图显示由LVOTO引起的二尖瓣收缩期前运动引起的急性MR,阵发性房颤进一步加剧。液体复苏,静脉注射β受体阻滞剂,和胺碘酮用于降低左心室流出道的压力梯度,速率控制,和维持窦性心律。她的病情随着MR好转,从而改善LVOTO和维持窦性心律。
■Takotsubo综合征应被视为LVOTO引起的急性MR的潜在原因。导管插入和多次随访TTE在这种情况的早期发现中起着重要作用。
UNASSIGNED: Although Takotsubo syndrome (TTS) is generally considered a benign disease, recent reports showed the incidence of cardiogenic shock due to left ventricular outflow tract obstruction (LVOTO), mitral regurgitation (MR), and primary pump failure was estimated to be 6-20%.
UNASSIGNED: A 78-year-old woman presented with chest pain and cold sweats 2 days after surgery for lung cancer. Acute coronary syndrome was suspected based on her symptoms, electrocardiography, transthoracic echocardiography (TTE), and laboratory data; thus, emergency catheterization was performed. Normal coronaries were observed, with hyperkinesis at the base of the left ventricle and akinesis at its apex, leading to the diagnosis of the apical ballooning type of TTS. Pressure differences between the apex of the left ventricle (168/8/28 mmHg) and aorta (94/50/64 mmHg) indicated the presence of LVOTO. Two days after TTS onset, she developed cardiogenic shock (blood pressure was 54/38 mmHg). Transthoracic echocardiography showed acute MR due to systolic anterior motion of the mitral valve caused by LVOTO, which was further exacerbated by paroxysmal atrial fibrillation. Fluid resuscitation, intravenous β-blockers, and amiodarone were administered for reduction of the pressure gradient in the left ventricular outflow, rate control, and sinus rhythm maintenance. Her condition improved along with the MR, thereby improving LVOTO and maintaining sinus rhythm.
UNASSIGNED: Takotsubo syndrome should be kept in mind as a potential cause of acute MR due to LVOTO. Catheterization and multiple follow-up TTE play a major role in early detection for this condition.