心尖球囊样综合征合并哮喘的诊断和治疗(附1例报告)

Diagnosis and treatment of apical ballooning syndrome complicated with asthma: a case report and literature review

目的提高对心尖球囊样综合征合并哮喘的临床特征、诊断和治疗的认识。方法和结果患者为73岁女性,有哮喘病史10年,反复胸闷4年,咳嗽伴胸闷半个月,胸痛7h入院。行急诊经皮冠状动脉介入术(PCI),术中冠状动脉造影示前降支近中段第一对角支分出后主支狭窄约40%,其余血管未见明显狭窄;左室造影显示心尖呈球囊样。超声心动图检查示左室射血分数(EF)为35%。诊断为心尖球囊样综合征合并哮喘。经对症治疗后心功能逐渐恢复。结合文献,表明心尖球囊样综合征与急性心肌梗死鉴别困难,而治疗和预后相距甚远;心尖球囊样综合征合并哮喘发作急性左心衰时,与肺源性哮喘鉴别较困难,治疗迥异。结论临床工作中应提高对心尖球囊样综合征的认识,注意鉴别诊断,制定正确的治疗方案。

Objective To improve our knowledge on the clinical characteristics,diagnosis,and treatment of apical ballooning syndrome（ABS） complicated with asthma. Methods and results A 73 year-old female patient,with a 10-year history of asthma and a 4-year history of recurrent chest distress,was admitted due to chest distress,cough for 15 days and chest pain for 7 hours.Coronary arteriography during emergent percutaneous coronary intervention（PCI） showed a 40% stenosis in the anterior descending artery,and stenosis was not found in other vessels.Left ventriculographic showed apical ballooning,echocardiography showed a 35% left ventricular ejection fraction,and the patient was diagnosed as having ABS with asthma.The cardiac function gradually recovered after symptom-targeted treatment.Literatures showed that it was difficult to distinguish between ABS and acute myocardial infarction;the treatments and prognoses of them were very different.When acute left ventricular failure was complicated with ABS and asthma,it was difficult to distinguish from pulmonary asthma and the treatment was very different.Conclusion Clinicians should improve the knowledge of ABS and put more emphasis on differential diagnosis so as to make the right treatment decision.