心尖球囊样综合征

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1、ApicalBallooningSyndromeCardiovascularDepartmentNov.23,2009HuangXiaojiaoContents1.History4.ClinicalFeature3.Pathogenesis2.Definition6.Management5.Diagnosis7.Prognosis8.PerspectiveHistory1stdescribedinJapanin1991ByDoteandhiscolleaguesReported5casesanonsetofchestpainelectrocardiogramchangesnormalcoro

2、naryarteriesoncardiaccatheterizationCallthecases“takotsubo(octopustrap)cardiomyopathy”}similartothoseofanAMIHistoryoctopustrap(捕章鱼套)TheechocardiographynotedinthosePatients.OtherNamesApicalballooningsyndrome心尖球囊样综合征Stress-inducedcardiomyopathy应激性心肌病Brokenheartsyndrome心碎综合征Ampullacardiomyopathy圣瓶样心肌病

3、DefinitionCardiomyopathycharacterizedbytransientapicalandmidventricularLVdysfunctionintheabsenceofsignificantcoronaryarterydisease.Oftentriggeredbyemotionalorphysicalstress.PathogenesisUnclearPossiblecauses:1.Catecholamine(儿茶酚胺)excess2.Coronaryarteryspasm(痉挛)ClinicalFeatureMuchmorecommoninwomen(~90

4、%),especiallypostmenopausal（绝经的）womenMeanage58-75yearsEmotionalorphysicalTriggers:deathoflovedone,othercatastrophicnews,devastatingfinanciallosses,naturaldisasters,physicalillness,etcClinicalFeatureSubsternalchestpainDyspneaShockSyncopeElevatedcardiacbiomarkersClinicalFeatureECGabnormalitiesSTeleva

5、tion(usuallyanteriorprecordialleads)STdepressionTwaveinversionQTprolongationAbnormalQwavesAcuteleftventricularsystolicdysfunctionevidentonechocardiographyNoangiographicallycoronaryarterydiseaseDiagnosisTransienta/dyskinesisofapicalandmidventricularsegmentsinassociationwithregionalwallmotionabnormal

6、itiesthatextendbeyondthedistributionofasingleepicardialvessel.Proposeddiagnosticcriteria:Diagnosis2.AbsenceonangiographyofobstructivecoronaryarterydiseaseorevidenceofacuteplaqueruptureDiagnosis3.NewSTsegmentelevationorTwaveinversionsonECGDiagnosis4.Absenceofrecentsignificantheadtrauma,intracranialb

7、leeding,pheochromocytoma,myocarditis,orhypertrophiccardiomyopathy颅内出血嗜铬细胞瘤心肌炎肥厚性心肌病DiagnosisAcutemyocardialinfarctionDifferentialDiagnosis:coronaryangiography（冠脉造影术）ManagementNodoubleblindrandomizedstudiest