心尖球形综合征20090411__培训课件.pptVIP

Park, J.-H. et al. Chest 2005;128:296-302 Representative ECG changes and echocardiograms Park, J.-H. et al. Chest 2005;128:296-302 Representative chest radiograph and echocardiogram 与超声心动图一致的表现 对比剂增强显像时，未见到心肌坏死的证据 核磁共振成像 锝99m心脏成像：左室心尖放射性同位素摄取减少 PET：心尖部心肌灌注和代谢不匹配 同位素检查 Abe, Y. et al. J Am Coll Cardiol 2003;41:737-742 Resting technetium-99m tetrofosmin tomographic myocardial imaging Tsuchihashi, K. et al. J Am Coll Cardiol 2001;38:11-18 Scintigraphic and positron emission computed tomographic (PET) findings 冠脉造影：正常或管壁轻度不规整，或者管腔阻塞＜50% 左心室造影：心尖部球样扩张及基底部狭小－－最特征性的表现。 冠脉造影及左心室造影 Ibanez, B et al. Heart 2005;91:102-104 Tsuchihashi, K. et al. J Am Coll Cardiol 2001;38:11-18 Changes in intracardiac pressure recording 　 有关心内膜心肌活检在心血管疾病诊治中作用的科学声明指出:无法解释的心衰都适合应用心内膜心肌活检 心内膜心肌活组织检查（EMB） 最新 AHA/ACC/ESC Abe, Y. et al. J Am Coll Cardiol 2003;41:737-742 Endomyocardial biopsy specimen * * Fig 1. Representative 12-lead ECGs of patients with takotsubo cardiomyopathy (TC), acute myocardial infarction (AMI) group A, and AMI group C. All patients exhibited ST-segment elevation in the precordial leads. ST-segment depression in the inferior leads and lead V6 is apparent in AMI group A, but not in the TC and AMI group C patients. * 典型表现为ST段抬高, 通常在V3-V6；T波广泛对称性倒置，稍晚（大约3天后），可见深的T波倒置伴有QT间期延长， * * Figure 1. Representative ECG changes (top left, A, and top middle left, B) and echocardiograms (top middle right, C, top right, D, bottom middle right, E, and bottom right, F). The patient was a 67-year-old man who had undergone an exploratory laparotomy for advanced stomach cancer 1 month prior to hospital admission. Curative resection was not possible due to peritoneal carcinomatosis. Comprehensive preoperative evaluation of his cardiac function revealed normal ECG findings, normal left ventricular wall motion and ejection fraction (60%) on echocardiography (top middle right, C, and top right, D), and normal myocardial perfusion by stress thallium scan. The patient was readmitted to