文档介绍：应激性心肌病StressCardiomyopathy,SCDiagnosis,Pathophysiology,Management,andPrognosis武汉亚洲心脏病医院徐承义History1991年日本学者Dote等报道心理或躯体应激状态可以诱发一过性左心室功能不全,由于在收缩末期左心室造影呈底部圆隆、颈部狭小的图像,类似日本古代捉捕章鱼的篓子,而被命名为“Tako-tsudo”(章鱼瘘)心肌病1997年法国的心脏病学家DominiquePavin报道了2例类似的病例,指出应激状态时儿茶酚***水平升高和该病明显相关,并且提出了应激性心肌病的概念2006年AHA关于心肌病的科学声明中,将其分类为一种独立的心肌病,正式命名为应激性心肌病DefinitionSCisareversiblecardiomyopathy,withaclinicalpresentationmimickingAcutecoronarysyndromeintheabsenceofsignificantcoronaryarterydiseaseTako-tsubocardiomyopathy,ApicalBallooningsyndrome,andampullacardiomyopathyBrokenHeartsyndrome,TransientCardiacBallooningsyndrome应激性心肌病是应激因素诱发的类似急性冠脉综合征临床表现,伴有可逆性左室收缩功能障碍的一种临床综合征MayoCriteriaTransienthypokinesis,akinesis,ordyskinesisintheleftventriclemidsegmentswithorwithoutapicalinvolvement,regionalwallmotionabnormalityextendingbeyondasingleepicardialvasculardistribution,thepresenceofastresstrigger左心室心尖和中部区域室壁运动短暂、超出单一血管供血范围的可逆性收缩功能丧失或异常,并存在应激因素CriteriaproposedbytheMayoClinicin2004andmodifiedin2008Absenceofobstructivecoronarydiseaseorangiographicevidenceofacuteplaquerupture冠脉造影示冠状动脉管狭窄程度<50%,或无急性斑块破裂证据Newelectrographicabnormalitiesand/ormodestelevationinserumcardiacenzymes新出现心电图异常或心肌酶学轻度升高Absenceofpheochromocytomaormyocarditis排除嗜铬细胞瘤、心肌炎All4criteriamustbepresentINCIDENCETheincidenceofSCislikelyunderrecognizedApproximately1%to2%ofpatientspresentingwithaninitialdiagnosisACSactuallyhaveSC发病率不明确,1%-2%的ACS患者实为SCUnderestimatedforavarietyofreasons:monlyinpostmenopausalWomen(90%),meanagebetween58and75yrsSCseemstohaveanassociationwithhypertension,COPD,andbronchialasthmaSCmimicsACSinmostpatients,,syncope,andcardiacarresthavebeenreportedrarely2/monfindings胸前导联ST段抬高及多导联T波倒置最为常见DifferentiateSCfromanteriorSTEMIPresenceofSTsegmentdepressioninleadavRandabsenceofSTsegmentelevationinleadV1identifiedSCwith91%sensitivity,96%specificity,and95%