应激性心肌病ppt参考课件.ppt

应激性心肌病Stress Cardiomyopathy，SCDiagnosis, Pathophysiology,Management, and Prognosis * 2020/3/15 History 1991年日本学者Dote等报道心理或躯体应激状态可以诱发一过性左心室功能不全，由于在收缩末期左心室造影呈底部圆隆、颈部狭小的图像，类似日本古代捉捕章鱼的篓子，而被命名为“Tako-tsudo”(章鱼瘘)心肌病 1997年法国的心脏病学家Dominique Pavin报道了2例类似的病例，指出应激状态时儿茶酚胺水平升高和该病明显相关，并且提出了应激性心肌病的概念 2006年AHA关于心肌病的科学声明中，将其分类为一种独立的心肌病，正式命名为应激性心肌病 * * Definition SC is a reversible cardiomyopathy,with a clinical presentation mimicking Acute coronary syndrome in the absence of significant coronary artery disease Tako-tsubo cardiomyopathy, Apical Ballooning syndrome,and ampulla cardiomyopathy Broken Heart syndrome，Transient Cardiac Ballooning syndrome 应激性心肌病是应激因素诱发的类似急性冠脉综合征临床表现，伴有可逆性左室收缩功能障碍的一种临床综合征 * * Mayo Criteria Transient hypokinesis, akinesis, or dyskinesis in the left ventricle midsegments with or without apical involvement, regional wall motion abnormality extending beyond a single epicardial vascular distribution, the presence of a stress trigger 左心室心尖和中部区域室壁运动短暂、超出单一血管供血范围的可逆性收缩功能丧失或异常，并存在应激因素 Criteria proposed by the Mayo Clinic in 2004 and modified in 2008 * * Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture 冠脉造影示冠状动脉管狭窄程度＜50%，或无急性斑块破裂证据 New electrographic abnormalities and/or modest elevation in serum cardiac enzymes 新出现心电图异常或心肌酶学轻度升高 Absence of pheochromocytoma or myocarditis 排除嗜铬细胞瘤、心肌炎 All 4 criteria must be present * * INCIDENCE The incidence of SC is likely underrecognized Approximately 1% to 2% of patients presenting with an initial diagnosis ACS actually have SC 发病率不明确，1%-2%的ACS患者实为SC Underestimated for a variety of reasons： nonavailability of cardiac catheterization facilities in many regions the possibility for noncardiac presentation lack of a consensus of diagnostic criteria may contribute to misdiagnosis * * PRESENTATION It occurs most commonly in postmenopausal Women（90%）, mean age between 58 and 75 yrs SC seems to have an association with hypertension, COPD, and bronchial asthma SC mimics