应激性心肌病——“鞭打快牛”还是“休养生机”?

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

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 sepsisrelated cardiomyopathy and TTS.