酷似急性心肌梗死的Takotsubo 综合征临床特点及预后分析
Clinical Charateristics and Prognosis of Takotsubo Syndrome Mimicking Acute Myocardial Infarction
- 中山大学学报（医学科学版） 2020年41卷第4期 页码：627-634
- 作者机构：
广东省第二人民医院心内二科，广东 广州 510317
- 作者简介：
LIU Jun; E-mail: liujunarmy@163.com
- 基金信息：广东省医学科研基金(B2019237)
DOI：
中图分类号： R541纸质出版日期：2020-07-15，
收稿日期：2020-02-11，
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刘君,赖俊,何咏聪等.酷似急性心肌梗死的Takotsubo 综合征临床特点及预后分析[J].中山大学学报（医学科学版）,2020,41(04):627-634.
LIU Jun,LAI Jun,HE Yong-cong,et al.Clinical Charateristics and Prognosis of Takotsubo Syndrome Mimicking Acute Myocardial Infarction[J].Journal of Sun Yat-sen University(Medical Sciences),2020,41(04):627-634.
摘要
目的
2
探讨Takotsubo 综合征的临床特点，影像学特征及预后，避免漏诊、误治，及时采取正确的治疗手段。
方法
2
回顾性分析10例酷似急性心肌梗死的Takotsubo 综合症综合征（TTS）的病例资料及转归。
结果
2
10 例TTS患者的心电图均表现为ST段抬高及后期较大的动态改变；男女比例1：9，年龄49~83岁。实验室检查提示cTn水平轻中度升高，但NT-proBNP明显升高伴有左心室功能障碍。10例均行冠脉造影未发现冠脉明显病变，但4例出现慢血流，其中9例行左室造影明确TTS；1例因低血压行IABP，其余均予药物保守治疗。1例合并肺癌复发，心衰恶化，起病后4 d死亡；其余9例好转出院，且复查心脏彩超左室功能明显改善。9例患者随访（2～24月）均存活且无复发。
结论
2
TTS在临床表现与心肌梗死极为相似，极易误诊及漏诊，一般预后良好，但治疗后NT-proBNP指标升高无改善提示预后差。
Abstract
Objective
2
To explore the clinical characteristics
imaging characteristics and prognosis of Takotsubo syndrome (TTS)
so as to avoid missing diagnosis and mistreatment
and to take corrective measures in time.
Methods
2
Retrospective analysis of the data and outcome of 10 cases of TTS mimicking acute myocardial infarction.
Results
2
The ECG of 10 patients with TTS showed ST-segment elevation and large territory changes in the later stage. Male to female ratio was 1/9. The patients’ age range was 49~83 (69.70±9.83) years. Laboratory tests of CTnI increased moderately
but NT-proBNP increased significantly
accompanied by left ventricular dysfunction; all 10 cases of coronary angiography did not show obvious coronary lesions
but slow-flow occurred in 4 cases
of which 9 patients had left ventricular angiography to confirm TTS. One patient underwent IABP due to hypotension
the rest were treated conservatively with medication. One patient had lung cancer recurrence
worsening heart failure
and died 4 days after onset. Nine patients improved and were discharged from the hospital and the left ventricular function of their cardiac color Doppler ultrasound finding was significantly improved. In the 2 to 24 months follow-up
9 discharged patients all survived without recurrence.
Conclusions
2
The clinical manifestations of TTS are very similar to those of myocardial infarction
and it can be easily misdiagnosed or missed. Generally
it has good prognosis. However
the increased NT-proBNP index after treatment may indicate a poor prognosis.
关键词
Takotsubo综合征应激性心肌病急性心肌梗死临床特征
Keywords
Takotsubo syndromestress cardiomyopathyacute myocardial infarctionclinical characteristics
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