心尖球及囊样综合征.pptVIP

Apical Ballooning Syndrome Cardiovascular Department Contents History 1st described in Japan in 1991 By Dote and his colleagues Reported 5 cases an onset of chest pain electrocardiogram changes normal coronary arteries on cardiac catheterization Call the cases “ tako tsubo(octopus trap ) cardiomyopathy ” History octopus trap(捕章鱼套) Other Names Apical ballooning syndrome 心尖球囊样综合征 Stress-induced cardiomyopathy 应激性心肌病 Broken heart syndrome 心碎综合征 Ampulla cardiomyopathy 圣瓶样心肌病 Definition Cardiomyopathy characterized by transient apical and midventricular LV dysfunction in the absence of significant coronary artery disease. Often triggered by emotional or physical stress. Pathogenesis Unclear Possible causes : 1. Catecholamine (儿茶酚胺) excess 2. Coronary artery spasm(痉挛) Clinical Feature Much more common in women (~90%), especially postmenopausal（绝经的） women Mean age 58-75 years Emotional or physical Triggers: death of loved one, other catastrophic news, devastating financial losses,natural disasters, physical illness, etc Clinical Feature Substernal chest pain Dyspnea Shock Syncope Elevated cardiac biomarkers Clinical Feature ECG abnormalities ST elevation (usually anterior precordial leads) ST depression T wave inversion QT prolongation Abnormal Q waves Acute left ventricular systolic dysfunction evident on echocardiography No angiographically coronary artery disease Diagnosis Transient a/dyskinesis of apical and midventricular segments in association with regional wall motion abnormalities that extend beyond the distribution of a single epicardial vessel. Diagnosis 2. Absence on angiography of obstructive coronary artery disease or evidence of acute plaque rupture Diagnosis 3.New ST segment elevation or T wave inversions on ECG Diagnosis 4. Absence of recent significant head trauma, intracranial bleeding, pheochromocytoma, myocarditis, or hypertro