Stress cardiomyopathy is a novel clinical syndrome affecting predominantly elderly female patients. It is characterized by severe reversible left ventricular dysfunction demonstrating a peculiar pattern of extensive apical wall motion abnormality known as "apical ballooning". The syndrome is typically precipitated by acute severe emotional, psychological or physical stress. It mimics acute coronary syndrome exhibiting typical clinical and electrocardiographic features of acute myocardial infarction. At angiography, however, significant coronary artery disease is invariably excluded. In the acute phase, the syndrome may be complicated by cardiogenic shock or ventricular fibrillation. Clinical data indicate that the disease is associated with an extensive increase of endogenous cathecholamine levels which may exhibit a direct toxic effect on the myocytes causing non–ischemic myocardial "stunning". This mechanism may have important implications for the management of patients in the acute phase of the disease. The prognosis of stress cardiomyopahty, however, seems favorable with recovery of global and regional myocardial function within a few weeks in the vast majority of patients. Yet, long–term outcome data in larger patient populations are lacking. We report the case of a female patient presenting with stress cardiomyopathy and review the current knowledge of the disease.

Stress cardiomyopathy mimicking acute coronary syndrome: case presentation and review of the literature.

Ein 56-jahriger Patient unterzog sich einer Adrenalektomie bei benignem Phaochromozytom Intraoperativ entwickelte der Patient bei der Manipulation des Tumors eine hypertensive Krise Postoperativ wurde der Patient hypotensiv, und es kam zum kardiogenen Schock Der Patient blieb intubiert und beatmet und war katecholaminpflichtig Echokardiographisch zeigte sich eine schwer eingeschrankte LV-Funktion mit apikaler Akinesie bei praoperativem Normalbefund Die LV-Angiographie bot das typische Bild des „apical balloonings“ Koronarangiographisch konnten hohergradige Stenosen ausgeschlossen werden Bereits am 2 postoperativen Tag kam es zu einer deutlichen Besserung der LV-Funktion, die sich innerhalb der nachsten Woche nahezu vollstandig normalisierte Hervorgerufen durch die Katecholaminfreisetzung wahrend der Adrenalektomie bei benignem Phaochromozytom, entwickelte dieser Patient intraoperativ eine Takotsubo-Kardiomyopathie mit kardiogenem Schock

Kardiogener Schock nach Adrenalektomie bei Phäochromozytom

Eine 61-jahrige Patientin wurde in schwer reduziertem Allgemeinzustand mit epigastrischen Schmerzen uber die Notaufnahmestation aufgenommen. Bei erhohtem Troponin T und erhohter Kreatininkinase sowie echokardiographisch schwerst reduzierter linksventrikularer Pumpfunktion und T-Wellen-Negativierung anterolateral konnte nach Intubation eine koronare Herzerkrankung angiographisch ausgeschlossen werden. Nach Stabilisierung mittels intraaortaler Gegenpulsation sowie pulmonalarterienkathetergesteuerter Volumen- und Katecholamingabe wurde sonographisch eine Raumforderung im Bereich der rechten Nebenniere gesichert. Der Verdacht eines Phaochromozytoms wurde durch erhohte Katecholaminausscheidung im Urin sowie mittels Computertomographie bestatigt. Nach Rekompensation und anschliesender Therapie mit Phenoxybenzamin erfolgte die Resektion eines benignen Phaochromozytoms.

Kardiogener Schock bei 61-jähriger Patientin mit rezidivierenden Panikattacken

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Kardiogener Schock bei 61-jähriger Patientin mit rezidivierenden Panikattacken