应激性心肌病StressInduced.ppt

Stress-Induced Cardiomyopathy(Tako-tsubo syndrome)應激性心肌病 病情介紹 女性，70歲 (住院號：08-4361) 　 主訴：胸痛1小時。 AED (2008.2.28 21:45)： BP 156/84mmHg, HR 90bpm 　 EKG ? 2008.2.28 21:54 2008.2.29 08:13 心肌酶譜變化 病情介紹 入院查體：BP 127/70mmHg，HR 82bpm 既往史：10多年前因右腎結石行右腎切除術，1991年曾患十二指腸潰瘍。不嗜煙酒。有上感史多天。 入院診斷：ACS？ Coronary angiogram Left ventriculogram Echocardiogram One month later 住院期間 BP 100-130/60-80mmHg X-Ray：輕度肺瘀血；心影橫徑增大(c/t=0.63)，左室大。 Holter：極偶發室上性早摶部分成對出現 血生化：TG 2.0mmol/L，HDL 1.1mmol/L，血糖、肝腎功能正常 出院帶藥： Betaloc-zok 12.5mg qd Acertil 2mg qd Aspirin 0.1 qd Vasteral MR 35mg bid NMR 2.5mg bid 病史小結 危險因素：絶經期後女性，血脂升高 誘因：因丈夫去世而情緒激動 表現：胸痛30min 檢查：心電圖有動態變化，血心肌酶↑ CAG：冠脈無明顯狹窄 Echo：心尖摶動瀰漫性減弱，各房室不大 住院期間：生命體征平穩，無心衰及心律失常 Stress-Induced Cardiomyopathy(Tako-tsubo syndrome)應激性心肌病 In 1990 Hikaru Sato and colleagues from Japan described a novel cardiac syndrome, characterised by: transient left ventricular dysfunction with chest pain, ECG changes minimal release of myocardial enzymes mimicking an AMI Left ventriculogram revealed : left ventricle had a peculiar shape (a round bottom and narrow neck) resembled a type of bottle used in Japan for trapping octopus. Sato and colleagues termed the syndrome Tako-tsubo cardiomyopathy – “tako” meaning octopus, and “tsubo”, bottle. More recently, it has also been called : acute left ventricular ballooning reversible stress cardiomyopathy broken heart syndrome stress-induced myocardial stunning Apical ballooning syndrome Stress appears to be key to the development of Tako-tsubo: can be emotional, physical or psychological in nature Studies show Tako-tsubo has occurred : after earthquakes death of a relative car accidents surprise parties fierce arguments court appearances and armed robberies Clinical features Chest pain is the most common symptom - up to 90% dyspnoea palpitations syncope As with AMI features of high circulating