たこつぼ型心筋症を発症した気管支喘息重積発作の1例  [in Japanese] A CASE OF STATUS ASTHMATICUS COMPLICATED BY TAKOTSUBO CARDIOMYOPATHY  [in Japanese]

症例は51歳代女性.咳嗽・呼吸困難のため近医に入院し,気管支喘息発作の診断で気管支拡張剤や副腎皮質ステロイド薬の点滴治療を受けたが改善は思わしくなかった.エピネフリンは使用されていない.翌日の心電図上,II・III・aV_F,及びV_<2-6>誘導でST上昇し心筋梗塞が疑われ当院循環器科に転院.冠動脈造影にて有意狭窄はなく,左室造影にてたこつぼ型心筋症と診断した.血中カテコラミン3分画はいずれも高値であった.喘鳴増強,呼吸不全進行したため人工呼吸管理を開始.心エコー上,徐々に左室壁運動は改善し,第4病日に心電図上のSTレベルは基線に戻った.呼吸不全の原因は気管支喘息と考え当科転科の上,メチルプレドニゾロン500mg/日を3日間使用後,プレドニゾロン60mg/日とし徐々に減量.第15病日に抜管し,吸入ステロイド薬を導入した.現在気管支喘息は安定しており,心エコー上壁運動は正常である.気管支喘息発作というストレスが血中カテコラミン動態に影響を及ぼし,たこつぼ型心筋症を発症したと考えられた.

A 51-year old woman was admitted to our hospital because of status asthmaticus. Electrocardiography (ECG) revealed ST-segment elevation in leads II・III・aV_F, and V_2 through V_6 accompanied by T-wave inversion in leads V_3 through V_6. The serum levels of creatine kinase, its MB isozyme, and troponin T were slightly elevated, whereas the markedly high levels of serum catecholamine were observed. Despite the ECG changes and elevated cardiac markers, coronary angiography demonstrated normal findings. Left ventriculography revealed apical akinesis and basal hyperkinesis. Takotsubo cardiomyopathy was diagnosed on the basis of these characteristic findings. Methylprednisolone and theophylline were administrated intravenously under mechanical ventilation. The abnormal findings in ECG had improved on day 4 followed by complete recovery from the motional abnormalities of left ventricular wall on day 7. The mechanical ventilation was discontinued on day 15 due to the improvement of respiratory symptoms. Takotsubo cardiomyopathy is a recently described cardiac syndrome that is possively caused by direct action of excessively released catecholamines on cardiac adrenoceptors when emotional or physical stress is loaded, especially in postmenopausal women. This report has presented a typical case of stress-induced Takotsubo cardiomyopathy in a postmenopausal woman with bronchial asthma.