脓毒症引起的心肌抑制和takotsubo综合征。

Acute cardiac care Pub Date : 2014-09-01 Epub Date: 2014-06-23 DOI:10.3109/17482941.2014.920089
Shams Y-Hassan, Magnus Settergren, Loghman Henareh
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引用次数: 47

摘要

背景和目的:脓毒症和脓毒性休克时心肌抑制是常见的,并且长期以来一直被认识到。本研究的目的是找出脓毒症和takotsubo综合征(TS)之间的关联和因果关系。方法:对15例TS患者进行分析。我们对脓毒症与心肌抑制的相关文献进行了综述。结果:我们报道了15例脓毒症引起的TS。53%的患者是男性。年龄39 ~ 76岁,平均60岁。三分之二的患者有st段抬高型心肌梗死心电图改变。80%的患者出现并发症。没有特定类型的败血症或微生物与TS的发展相关。对败血症引起的心肌抑制的重要回顾显示,左心室功能障碍在1 - 2周内是可逆的,以节段性心室功能障碍为特征,四分之一的病例累及右心室。这些特征也与TS一致。结论:败血症可诱发TS,这可能是大多数败血症所致心肌抑制的原因。急性心脏交感神经中断伴去甲肾上腺素溢出可能是败血症诱导的TS的原因。
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Sepsis-induced myocardial depression and takotsubo syndrome.

Unlabelled: Abstract Background and objectives: Myocardial depression in the setting of sepsis and septic shock is common and has been recognized for a long time. The aim of this study is to find out an association and causal link between sepsis and takotsubo syndrome (TS).

Methods: Fifteen cases of TS were studied. Critical review of the literature dealing with sepsis and myocardial depression was done Results: Fifteen cases of sepsis-induced TS are described. Fifty-three per cent of the patients were men. The ages ranged from 39 to 76 years (mean age 60 years). Two-thirds of the patients had ST-elevation myocardial infarction ECG changes. Complications occurred in 80% of the patients. No specific types of sepsis or micro-organisms were associated with the development of TS. Critical review of the sepsis-induced myocardial depression shows that the left ventricular dysfunction, which is reversible within one-to-two weeks, is characterized by segmental ventricular dysfunction, and involvement of the right ventricle in one fourth of cases. These features are also consistent with TS.

Conclusions: Sepsis triggers TS, which may be the cause of the majority of cases of sepsis-induced myocardial depression. Acute cardiac sympathetic disruption with noradrenaline spill-over may be the cause of sepsis-induced TS.

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