Takotsubo Cardiomyopathy during sleep apnea Crisis: Case Report
- سال انتشار: 1397
- محل انتشار: کنگره ملی گزارش های موردی بالینی
- کد COI اختصاصی: CCRMED02_205
- زبان مقاله: انگلیسی
- تعداد مشاهده: 439
نویسندگان
Medical student of Ardabil University of medical sciences, research committee, Ardabil, Ardabil, Iran
Medical student of Ardabil University of medical sciences, research committee, Ardabil, Ardabil, Iran
Assistant professor of Pathology, medical university of Ardabil, Ardabil, Iran
چکیده
Takotsubo cardiomyopathy (TC) is rapidly reversible heart failure that usually mimics the symptoms of acute myocardial infarction. Regional wall-motion abnormalities and apical ballooning are characteristics of TC. Takotsubo cardiomyopathy is usually associated with stressful events and most commonly appears in postmenopausal women. The major pathophysiological mechanism is disproportionate secretion of catecholamines. Sleep apnea is serious sleep disorder that occurs when breathing is interrupted during sleep. Patients with sleep disorders can develop Takotsubo stress cardiomyopathy (TSC) due to stress and high level of circulating catechol amines. We report patient who developed recurrent Takotsubo cardiomyopathy during sleep apnea disorder. 49-year-old woman which presented with shortness of breath, pain between scapulae and chest pain during sleep apnea crises in nights and early fatigue in daily activities. Electrocardiogram (ECG) showed inverted wave and ST segment elevation in anterolateral leads with heart rate of 115. Paraclinical tests showed high levels of CPK-MB (32) and troponin (2.923). Coronary angiogram was unremarkable for occlusive coronary disease. Echocardiogram revealed severe mitral regurgitation (MR) and reduced wall motion with apical and mid left ventricle hypokinesia which reduced left ventricle ejection fraction to 20%.The patient was medically managed with an intra-aortic balloon pump(IABP) for preventing hemodynamic dysfunction. For heart failure we prescribe Aspirin, intravenous Heparin, ACE inhibitors and B-blockers with continuous ECG monitoring. Once left ventricle systolic dysfunction resolved, heart-failure medications were discontinued except Aspirin. After days, she was discharged from the hospital with stable condition. We recommended her nutrition consultation for decreasing weight and using CPAP under supervision of pulmonologist for her sleep apnea. This case represents connection between Takotsubo cardiomyopathy, sleep apnea and MR. Most patients recover in 6-12 weeks and Prognosis is generally good but recent meta-analysis showed in-hospital mortality of 1-4.5% and recurrence rate of 5-10% during five year follow-up.کلیدواژه ها
Takotsubo cardiomyopathy, apical ballooning, sleep apnea disorder, left ventricle hypokinasiaاطلاعات بیشتر در مورد COI
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