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中华重症医学电子杂志 ›› 2020, Vol. 06 ›› Issue (02) : 117 -119. doi: 10.3877/cma.j.issn.2096-1537.2020.02.001

所属专题: 重症医学 文献

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应激性心肌病—"鞭打快牛"还是"休养生机"?
安友仲1,(), 吕杰1, 王梦楠1   
  1. 1. 100044 北京大学人民医院重症医学科
  • 收稿日期:2019-12-26 出版日期:2020-05-28
  • 通信作者: 安友仲

Stress cardiomyopathy-"whipping fast cow" or "recuperating vitality"

Youzhong An1,(), Jie Lyu1, Mengnan Wang1   

  1. 1. Department of Critical Care Medicine, Peking University People′s Hospital, Beijing 100044, China
  • Received:2019-12-26 Published:2020-05-28
  • Corresponding author: Youzhong An
  • About author:
    Corresponding author: An Youzhong, Email:
引用本文:

安友仲, 吕杰, 王梦楠. 应激性心肌病—"鞭打快牛"还是"休养生机"?[J]. 中华重症医学电子杂志, 2020, 06(02): 117-119.

Youzhong An, Jie Lyu, Mengnan Wang. Stress cardiomyopathy-"whipping fast cow" or "recuperating vitality"[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(02): 117-119.

Takotsubo综合征(TTS)又称为应激性心肌病(SCM)、心碎综合征等,是以左心室尖部运动缺失和类似急性冠脉综合征的基底部收缩增强为特征的一种短暂的心脏综合征。1990年日本学者Sato等首次报道了1例胸痛伴典型急性心肌梗死患者的心电图改变,但冠状动脉造影正常,其特征性左心室收缩状态,与日本传统章鱼鱼篓的圆形底部和窄口形似。随后,Pavin等研究发现TTS常发生在强烈情绪应激之后,且提示与应激状态下儿茶酚胺水平升高明显相关,从而提出了其应激性特征。重症监护病房患者由于严重感染、创伤、休克等危重病态的刺激而导致严重的应激状态并且儿茶酚胺水平激增,尤其是脓毒症的患者常伴有心功能障碍,其病理机制与SCM相近,但目前的研究并没有将脓毒症相关心肌病与TTS进行明确区分。

Takotubo syndrome (TTS), also known as stress cardiomyopathy (SCM), heartbreak syndrome, apical balloon syndrome, is a transient cardiac syndrome characterized by left ventricular apical motor loss and basal systolic enhancement similar to acute coronary syndrome. As early as 1990, the Japanese scholar Sato and others reported for the first time the ECG changes of a case of chest pain with typical acute myocardial infarction, but the coronary angiography was normal, showing the characteristic left ventricular systolic state, which is similar to the round bottom and narrow mouth of the traditional Japanese Octopus basket. Subsequently, Pavin found that TTS often occurs after strong emotional stress, and suggested that TTS is significantly related to the increase of catecholamine level under stress status, thus proposed its stress characteristics. ICU patients have severe stress and severely increased catecholamine levels due to severe infections, trauma, shock and other stimuli. Therefore, SCM is not uncommon in ICU. In particular, sepsis is a common critical illness in ICU, nearly 60% patients with sepsis have cardiac dysfunction, and its pathological mechanism is similar to that of SCM. At this stage of the study, there is no clear distinction between sepsis-related cardiomyopathy and TTS.

1
Dote K, Sato H, Tateishi H, et al. Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases[J]. J Cardiol, 1991, 21(2): 203-214.
2
Pavin D, Le Breton H, Daubert C. Human stress cardiomyopathy mimicking acute myocardial syndrome[J]. Heart, 1997, 78(5): 509-511.
3
Maron Barry J, Towbin Jeffrey A, Thiene G, et al. Contemporary Definitions and Classification of the Cardiomyopathies[J]. Circulation, 2006, 113(14): 1807-1816.
4
Vieillard-Baron A, Caille V, Charron C, et al. Actual incidence of global left ventricular hypokinesia in adult septic shock[J]. Critical Care Medicine, 2008, 36(6): 1701-1706..
5
Deshmukh A, Kumar G, Pant S, et al. Prevalence of Takotsubo cardiomyopathy in the United States[J]. American Heart Journal, 2012, 164(1): 66-71. e61.
6
El-Sayed AM, Brinjikji W, Salka S. Demographic and Co-Morbid Predictors of Stress (Takotsubo) Cardiomyopathy[J]. Am J Cardiol, 2012, 110(9): 1368-1372.
7
Isogai T, Yasunaga H, Matsui H, et al. Out-of-hospital versus in-hospital Takotsubo cardiomyopathy: Analysis of 3719 patients in the Diagnosis Procedure Combination database in Japan[J]. Int J Cardiol, 2014, 176(2): 413-417.
8
Belcour D, Jabot J, Grard B, et al. Prevalence and risk factors of stress cardiomyopathy after convulsive status epilepticus in ICU patients[J]. Critical Care Medicine, 2015, 43(10): 2164-2170.
9
Vallabhajosyula S, Deshmukh AJ, Kashani K, et al. Tako-tsubo cardiomyopathy in severe sepsis: nationwide trends, predictors, and outcomes[J]. J Am Heart Assoc, 2018, 7(18): e009160-e009160.
10
Wittstein IS, Thiemann DR, Lima JAC, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress[J]. N Engl J Med, 2005, 352(6): 539-548.
11
Frustaci A, Loperfido F, Margante E, et al. Catecholamine-induced cardiomyopathy in multiple endocrine neoplasia. A histologic, ultrastructural, and biochemical study[J]. Chest J, 1991, 2(99): 382-385.
12
Ghadri JR, Wittstein IS, Prasad A, et al. International expert consensus document on takotsubo syndrome (Part II): diagnostic workup, outcome, and management[J]. Eur Heart J, 2018, 39(22): 2047-2062.
13
Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy[J]. New England Journal of Medicine, 2015, 373(10): 929-938.
14
Yoshioka Y, Kondo H, Tabata Y, et al. Automatic control method of NO removal by a combination of ozone injection and exhaust gas recirculation[J]. IEEE Transactions on Industry Applications, 2010, 46(3): 1166-1174.
15
Bonacchi M, Maiani M, Harmelin G, et al. Intractable cardiogenic shock in stress cardiomyopathy with left ventricular outflow tract obstruction: is extra-corporeal life support the best treatment?[J]. European Journal of Heart Failure, 2009, 11(7): 721-727.
16
Brinjikji W, El-Sayed AM, Salka S. In-hospital mortality among patients with takotsubo cardiomyopathy: A study of the National Inpatient Sample 2008 to 2009[J]. American Heart Journal, 2012, 164(2): 215-221.
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