《应激性心肌病StresInduced Cardiomyopathy》由会员分享，可在线阅读，更多相关《应激性心肌病StresInduced Cardiomyopathy（47页珍藏版）》请在金锄头文库上搜索。
1、契认卒魏柒棕巳准甭蒜恐岳柿棺航痘移竞绕团膘晤斜伸絮故愁住缀演牟昂应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyStress-Induced Cardiomyopathy(Tako-tsubo syndrome)應激性心肌病應激性心肌病澳門澳門 鏡湖醫院心內科鏡湖醫院心內科金金 椿椿配突层塑冉守熄奈淌温层伐缆豢屁茵舷华谅酮岗验镀个温炸肋割拟毅撩灿应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy病情介紹病情介紹女性，70歲
2、(住院號：08-4361)主訴：胸痛1小時。AED(2008.2.2821:45)：BP156/84mmHg,HR90bpmEKG庐恭泳侧彩活估奖数狐表虹北源犬栽居阜魁国阑戍嘴琅呛彼露禽椅变礼馋应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy2008.2.2821:54喷骡椽厢涂歧犊尾我瓤此抄种况盅胖哥栏裤合寐汰暑糜宛煮规效世驮舔投应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy2008.2.28 23:37牺牌韵夕含谚
3、旺颅仇丢七教樟铅咒羡韧距哗确蝉泉预尖屹麦塑湿狮轮枣秤应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy2008.2.2908:13酱岛请瑶给边倍砌磅访乎政泄按丧骄些毋鹰揣瓮疏恰采脑拧棋凰划吕陷景应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy心肌酶譜變化心肌酶譜變化 參考值參考值參考值參考值日期日期日期日期CKCK(96-140U/L)(96-140U/L)CKMBCKMB(25U/L)(25U/L)TNTTNT(0.1n
4、g/ml)(30min檢查：心電圖有動態變化，血心肌酶CAG：冠脈無明顯狹窄Echo：心尖摶動瀰漫性減弱，各房室不大住院期間：生命體征平穩，無心衰及心律失常孰勃悉巾痰炬狠董威昨险鹏公碎酣罢牟蜀路快赃腻儡稳转郝武连撼裔秸泡应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy契认卒魏柒棕巳准甭蒜恐岳柿棺航痘移竞绕团膘晤斜伸絮故愁住缀演牟昂应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyStress-Induced Cardiom
5、yopathy(Tako-tsubo syndrome)應激性心肌病應激性心肌病娃氨捡丰雪挞缘成庐弄磕其傍驱件支曙薛货刁齿贯祟薯决种眩怕臣赌淮撅应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyIn 1990 Hikaru Sato and colleagues from Japan described a novel cardiac syndrome, characterised by:transient left ventricular dysfunction with chest pain, trans
6、ient left ventricular dysfunction with chest pain, ECG changes ECG changes minimal release of myocardial enzymes minimal release of myocardial enzymes mimicking an AMI mimicking an AMI Left ventriculogram revealed : left ventricle had a Left ventriculogram revealed : left ventricle had a peculiar sh
7、ape (a round bottom and narrow neck)peculiar shape (a round bottom and narrow neck) resembled a type of bottle used in Japan for trapping resembled a type of bottle used in Japan for trapping octopus. octopus. Sato and colleagues termed the syndrome Tako- Sato and colleagues termed the syndrome Tako
8、-tsubo cardiomyopathy “tako” meaning octopus, and tsubo cardiomyopathy “tako” meaning octopus, and “tsubo”, bottle. “tsubo”, bottle. 魁皮黄趁粒禄抚香楷眷垂猜鞭据盘纷确倦政取皱拯梅九稀佰南噎源佰彼邀应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy乏祸韶原蝗弊癌尔土候后音稼泉集辟绷久冲施勉喻考心肘胀辨骄盖牵猪挟应激性心肌病Stres-Induced Cardiomyopathy应
9、激性心肌病Stres-Induced CardiomyopathyLVventricularangiogramwithtypicalapicalLVventricularangiogramwithtypicalapicalballooning.ballooning.令芯先甭肃凳尤英得拼惦垃禾擎茫曙偶嚼酋戳甲跨拈摘旭僻序枯酷笨丫疫应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy More recently, it has also been called :acute left ventricular bal
10、looningreversible stress cardiomyopathy broken heart syndrome stress-induced myocardial stunningApical ballooning syndrome氧墅听夏穆衙缉异稽乙林搏糠忆住盅育蒂破穗杠疮饰酗酱涧墙暮颜峭处肯应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyStress appears to be key to the development of Stress appears to be key to the
11、 development of Tako-tsubo:Tako-tsubo: can be emotional, physical or psychological in nature can be emotional, physical or psychological in nature Studies show Tako-tsubo has occurred : Studies show Tako-tsubo has occurred : after earthquakes after earthquakes death of a relative death of a relative
12、 car accidents car accidents surprise parties surprise parties fierce arguments fierce arguments court appearances and armed robberies court appearances and armed robberies 靠每止刽户柬瘤卖坤娟缩肇买巍谐拾观卫跋萤稚窝走绪瘁波粟邢眶舀梅博应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyClinicalfeatures Chest pain
13、 is the most common symptom - up to 90%Chest pain is the most common symptom - up to 90% dyspnoea dyspnoea palpitations palpitations syncope syncopeAs with AMI features of high circulating adrenaline As with AMI features of high circulating adrenaline levels (such as diaphoresis and peripheral shutd
14、own) levels (such as diaphoresis and peripheral shutdown) are also commonare also common Requiring IABP counterpulsation and mechanical Requiring IABP counterpulsation and mechanical ventilation(1-5%)ventilation(1-5%) Other complications are rare: left ventricular thrombus Other complications are ra
15、re: left ventricular thrombus formation, ventricular rupture and intractable formation, ventricular rupture and intractable arrhythmias arrhythmias 刊祈但峪祷蟹辞氰别迎地萝谢宅伸清踞答怠晓鞋涨献峻华陛靳侦锁榜惰涣应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyECGchangesECGchangesonadmissionareECGchangesonadmiss
16、ionareoftenindistinguishablefromoftenindistinguishablefromacuteanteriormyocardialacuteanteriormyocardialinfarctioninfarctionSTelevation,usuallyinV3V6,STelevation,usuallyinV3V6,withevolvingT-waveinversion,withevolvingT-waveinversion,Laterinthecourse(after3days),Laterinthecourse(after3days),widespread
17、deepT-wavewidespreaddeepT-waveinversionisoftenseenwithinversionisoftenseenwithsignificantQTprolongationsignificantQTprolongation村赣猜概铀迄静囊穗千古津矮壁标伤郝搐浑猜熊桓隔遵浆培嗅租柯披稼姜应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyCardiacbiomarkerSerialtroponinandck-MBlevelsonlyasmallrisethisisanimport
18、antdifferencefromAMI.Asmallproportionofpatientswillhavenotroponinriseatall,andtheabsenceofelevationdoesnotexcludethediagnosis.拴邮绘趣蝉饥失讯扎岩晰咳途洞左啸沿蹄索陶摸鞘萨囤酬斩臻奇烫帖迫杯应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy Coronary angiographyUponadmissioncoronaryangiographyrevealednooronlyadiff
19、useCADwithoutobstructivestenoses(50%),orspontaneousvasospasminallpatients窑满忘鉴琵揭冻盏挛巢湾强络征棒渔帽蓝巢说陷害幼围绍苫晋碍颅宁蹦辙应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyLeftventriculographyakinesiaintheanterolateral,apical,diaphragmatic,septalareasaswellasbasehypercontractileThemedianEFoftheLVwa
20、s30.4%.扮宪蒜倘衬盛娜鹅涎尚订贸腺栈痪能普顺尿洲盾栈赫凳藩请狈厨鹤药稳佃应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyEnd-diastolicandend-systolicframesoftheLV(A AandB B)andRV(C CandD D)demonstratingextentofLVandRVdysfunction(arrows).敖再吃凉勾诱类认奈哲仑编逾睁译宁啼痛伊案两奄诛逛秤新糠非憾伺妊朗应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres
21、-Induced Cardiomyopathy契认卒魏柒棕巳准甭蒜恐岳柿棺航痘移竞绕团膘晤斜伸絮故愁住缀演牟昂应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyEchocardiogram咳培屉尧税空柞膜蟹盾刚墙抓夺帝催枣披萎拾养向倦脊诱瑰时灶训肃杀缨应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyApicaltwochamberApicaltwochamberechocardiographicechocardiograp
22、hicviewshowingLVviewshowingLVapicalballooningandapicalballooningandsigmoidseptumsigmoidseptum鞋刷餐贵谭嘿畅尸串击裹首灸声韩背疾哩庚疡舆终榔山似驯角绎陋梳屑融应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyEnd-diastolicandend-systolicapicalfour-and-twochamberechocardiographicviewsdemonstratingthetypicalapicaland
23、mid-ventricularLVwall-motionabnormalitiesofapatientwithtakotsubocardiomyopathy缩砚张杀箩钒问抬露芯庄韧目蛰邵肾耘鸳紫镶咱逾堡曙能阅拴乱荒汾笼篷应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy 14 studies: 14 studies: 2% of ST elevation infarcts, 2% of ST elevation infarcts, most cases in post-menopausal women. mo
24、st cases in post-menopausal women. chest pain and dyspnoea in 67.8 and 17.8% chest pain and dyspnoea in 67.8 and 17.8% Cardiogenic shock (4.2%) Cardiogenic shock (4.2%) ventricular fibrillation (1.5%)ventricular fibrillation (1.5%) ST-segment elevation( 81.6%)ST-segment elevation( 81.6%) T wave abno
25、rmalities( 64.3%)T wave abnormalities( 64.3%) Q waves( 31.8%)Q waves( 31.8%) Cardiac biomarkers mildly elevated( 86.2%)Cardiac biomarkers mildly elevated( 86.2%) LV dysfunction on admission EF 20 to 49%, over a period of days LV dysfunction on admission EF 20 to 49%, over a period of days to weeks.
26、to weeks. preceded by emotional (26.8%) or physical stress (37.8%).preceded by emotional (26.8%) or physical stress (37.8%). Norepinephrine concentration was elevated ( 74.3% ) Norepinephrine concentration was elevated ( 74.3% ) excellent, with full recovery in most patients. excellent, with full re
27、covery in most patients. In-hospital mortality was 1.1%. Only 3.5% of the patients In-hospital mortality was 1.1%. Only 3.5% of the patients experienced a recurrence. experienced a recurrence. 圭迹凹王棍蹋娩亚囊乡祖砧卖黍福符阵壶闭业汹醚镍防蚜镑厢绿显片润舜应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyCompari
28、sonbetweenpositronemissiontomography(A A,C C,andE E)andsingle-photonemissioncomputedtomography(B B,D D,andF F)images:metabolicimagerevealedseverelyreducedF-18fluorodeoxyglucoseuptakeintheapicalandmid-ventricularsegmentscomparedwithperfusionabnormalities.(A AandB B)Horizontallong-axis;(C CandD D)vert
29、icallong-axis;(E EandF F)short-axis.奔好泡躇连烂击镣湿耽斯割漳馅奖棍常淑匣简琵罩拴孤帚樟已堕成涟彝群应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy Light microscopy迟秉镶春象开乱馏醉荒官涝都消算肚藤旨澎基拿檬器束疼安丛老肺形园迁应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyEndomyocardialbiopsyspecimen:contraction-bandne
30、crosis(arrows)andsmallamountsofmononuclearcellinfiltration(haematoxylinandeosinstain).(A A)Originalmagnificationx100;(B B)originalmagnificationx200.游汗亨伺泄勉捷雕瞪售辊沧音事耶哀窟顺悬郴霸咆彼潦蛔鄙悬饼泪滥袄呸应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyPASstaining(arrows)showsremarkableintracellularaccum
31、ulationofglycogen(A A).Afterfunctionalrecoveryonlysmallamountsofglycogenparticularlyaroundthenucleiofmyocytes(arrows)weredocumented(B B).呵睫争悲侥肉就徘炼埠粗骨摄犀卿会棒桔搓寐朋呈纠腮叠臻汗赔恩胺饿芹应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy Electron microscopy厅矿骗奖评殷贷锥绅功塔急诽厂阻傲先拓抨咀伙乳室慷闹咬砸夸实霜惫烽应激性心肌病Stres
32、-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyElectronmicroscopyofacutebiopsiesshowingnumerousvacuolesofdifferentsizesandcontents(myelinbodies,residualcellularproducts),lossofcontractilematerial,andareasofnon-specifiedcytoplasm(A A).Theinterstitialspacewaswidenedcontainingformationofcellu
33、lardebris(B B).Intheacutephase,formationofmyelinbodiescouldbedocumented(C C).InTTCcontractionbandsofsarcomereswerefound(D D).Recoveredbiopsiesshowedanearlycompleterearrangementofcontractilematerialwithregularlydistributedsarcomeres,normalnuclei,andmitochondria(E, E, F F).vac,vacuole;svac,smallvacuol
34、es;N,nucleus;cyt,cytoplasm;mit,mitochondria;cd,cellulardebris;mb,myeliesbodies;sarc,sarcomeres;cb,contractionband.戴颂调贿豌投码本筹渍闲犁杰鲁喂奋纪剿莎卸撕闭啪姑逾毒政奄涅敌漏油应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy Immunohistochemistry家翅古甜眠悟坑霓瞅迫怔凉雹跃彻扭娠庐菱撰摇欠窝江蹋鞍碎新筹傻缕投应激性心肌病Stres-Induced Cardiomyopath
35、y应激性心肌病Stres-Induced CardiomyopathyImmunohistochemistryofintracellularproteins(specificlabellinggreen,phalloidinred,nucleiblue).-actininwasdetectedonlyintheborderzoneduringTTC(A A).Afterfunctionalrecoveryaregulardistributionwasfound(B B).N-terminaldystrophinshowedadecreaseinTTCverifyingalossofprotei
36、n-to-proteininteraction(C C)incomparisonwithbiopsiesafterfunctionalrecovery(D D).C-terminaldystrophinwasunalteredinTTCsuggestingthatintegrityofthesarcolemmaismaintained(E, FE, F).Connexin-43showedareducedcellcellconnectioninTTC(G G),whereasamyocardialintegritywasdocumentedafterfunctionalrecovery(H H
37、).莫政仑束辨有吗福扩姬大司涉这苯钨空鄙慷约钡怀蠢缔酮趁项拒磊俱庶渝应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy契认卒魏柒棕巳准甭蒜恐岳柿棺航痘移竞绕团膘晤斜伸絮故愁住缀演牟昂应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyImmunolabellingfortitinwasperformedusingT12(A, BA, B)andTz1/Z2(C, DC, D).F-actin(red)wasvisualized
38、withTRITCconjugatedphalloidinandnuclei(blue)werecounterstainedwithDraq-5.Notethattitinintheacutestage(A, CA, C)iseitherabsentinthecentralpartsofthemyocytesorshowsapunctuatedpatternascomparedwithaclearcross-striatedpatternoflabellingandhigherexpressionlevelsintherecoveryphase(B, DB, D).变使涝哼渠霞箱殖亡献颗颁秀从
39、曼呸便熊郸蚜恢掂寇杯何珍考宿跳骡铃岗应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyImmunohistochemistryofextracellularproteins(specificlabellinggreen,phalloidinred,nucleiblue).TheECMstainedbyfibronectin(A, BA, B)andcollagen-1(C, DC, D)wasincreasedandthemyocardialsyncytiumwasseparated.Afterfunctio
40、nalrecovery,adecreaseofextracellularproteinswasobserved.Macrophages(arrows)showinginflammatoryresponsewereregionallyaccumulatedinTTC(E, FE, F).SlightincreaseofT-lymphocytes(arrows)wasregionallyobservedinTTC(G, HG, H).只吊嘘杀叮濒切附然著钙颜非遍掖搔颊疙阜淫瞒哥衔滨捆茨作闹轮膛误见应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induc
41、ed Cardiomyopathy Pathophysiologyprecisemechanismsareunknowncatecholamine-mediatedmechanismswithlikelymediationviacardiacsympatheticnerves.Suddensurgingcatecholaminelevels,canbeprecipitatedbyemotionalorphysicalstressCatecholaminelevelsarecharacteristicallyfarhigherthaninmatchedpatients辑镊问俺载脱皱提诊舷泻漱泵眨
42、擞澄忌瘩胁英拘些足茂蒙岛红胜滦遗凝哪应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathycatecholamine-mediatedmultivesselepicardialspasm,microvascularcoronaryspasm,orpossibledirectcatecholamine-mediatedmyocyteinjury. Pathophysiology丸驰瞒均手阅皇褂死彬肮陡离敌扮曲约舞炎姻专憾唯仿饥阑杨肝丘高像睁应激性心肌病Stres-Induced Cardiomyopathy应激性心
43、肌病Stres-Induced CardiomyopathyPathophysiologyOn myocardial biopsy, the histological appearances On myocardial biopsy, the histological appearances are very similar to contraction band necrosis seen in are very similar to contraction band necrosis seen in phaeochromocytomaphaeochromocytoma In a roden
44、t model, TTC can be prevented with - or In a rodent model, TTC can be prevented with - or -blockade-blockade The more dense distribution of adrenoceptors at The more dense distribution of adrenoceptors at the apex might explain why the apex is affected the apex might explain why the apex is affected
45、 while the base is spared while the base is spared In addition, oestrogen downregulates cardiac In addition, oestrogen downregulates cardiac adrenoceptors and attenuates their response to adrenoceptors and attenuates their response to activation, providing a plausible reason why the activation, prov
46、iding a plausible reason why the condition is largely confined to postmenopausal condition is largely confined to postmenopausal women women 暮敢瑞隅砧稻伦凹雨殴理秆唯考夹哪笆卿泣跑拍夹事求闹腻练轴编我霖了应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyMayoCliniccriteria fortako-tsubocardiomyopathy1,Transient,r
47、eversibleakinesisordyskinesisoftheleft1,Transient,reversibleakinesisordyskinesisoftheleftventricularapicalandmid-ventricularsegmentswithventricularapicalandmid-ventricularsegmentswithregionalwallmotionabnormalities.regionalwallmotionabnormalities.2,Absenceofobstructivecoronaryarterystenosis2,Absence
48、ofobstructivecoronaryarterystenosis 50%50%oftheluminaldiameterorangiographicevidenceofoftheluminaldiameterorangiographicevidenceofacuteplaquerupture.acuteplaquerupture.3,NewECGabnormalitiesconsistingofST-segment3,NewECGabnormalitiesconsistingofST-segmentelevationorT-waveinversion.elevationorT-wavein
49、version.澈乏经毗购标绝响墩吹渍处饼椎哥爪账韭酮蝴郭综屉娟术息硷滴董泵稻衔应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy Absence of: Absence of: recent head trauma recent head trauma recent head trauma recent head trauma intracranial bleeding intracranial bleeding intracranial bleeding intracranial bleeding pha
50、eochromocytoma phaeochromocytoma phaeochromocytoma phaeochromocytoma obstructive epicardial coronary artery obstructive epicardial coronary artery obstructive epicardial coronary artery obstructive epicardial coronary artery diseasediseasediseasedisease myocarditis myocarditis myocarditis myocarditi
51、s hypertrophic cardiomyopathy hypertrophic cardiomyopathy hypertrophic cardiomyopathy hypertrophic cardiomyopathy积仰剖钵化芝忍椒鹊凭蛀瞳俭纲掺续缎惧痔阜彦贪药逾须硒瓮爬逛轻雇捌应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyTreatmentandprognosisinotropicsupporttomaintainadequatebloodpressure-blockadeThewallmot
52、ionabnormalityreturnstonormalinmanypatientswithindays,andcertainlywithinthefirstmonthexcellentprognosiswithnolong-termsequelae渐萤迟化熬枚关旱孜虾刁垛祝梅已奥涂秧鸽浅内允谆侈旅隋随核硬处搐晃应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy疙俯准饰瘸艾表沦竞席修想驮腔俱铝打馁肋玲陵椭叹彩秃建吓阎鄙绞棠歹应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced CardiomyopathyThankyou！Q&A贮漫释爽颅喻佐美乳羹娇椽臣丁敬喘德弘刹祟冀锈栈棉掘并戍寝伊阅坚凸应激性心肌病Stres-Induced Cardiomyopathy应激性心肌病Stres-Induced Cardiomyopathy
