Трудности дифференциальной диагностики кардиомиопатии Такоцубо

Abstract

Myocardial infarction sometimes has to be differentiated from acute myocarditis and Takotsubo cardiomyopathy (stress-induced cardiomyopathy), which was first described in the middle of the last century. These diseases have a lot in common both in the clinical picture and in the results of diagnostic studies. A clinical case is presented, in which we made a differential diagnosis between three diseases: myocardial infarction, myocarditis and Takotsubo cardiomyopathy. Patient S., 64 years old, was admitted to the hospital with complaints of incessant vomiting, pronounced general weakness, dizziness, cough with foamy sputum, accompanied by a feeling of lack of air. The results of echocardiography on the day of admission showed a decrease in the Simpson ejection fraction to 40% and the presence of akinesia in the middle and anterior, septum, lateral, lower apical segments. Despite the absence of stenoses during coronary angiography, the patient received treatment for myocardial infarction. After 7 days from admission, we repeated the echocardiography. The ejection fraction increased to 51%. Hypokinesia of the anterior and lateral apical segments persisted. Two months after the onset of symptoms, we detected an ejection fraction of 60% on echocardiography. No signs of scar tissue, decreased myocardial contractility, or dilation of cavities were found. Based on this, we concluded that the patient underwent Takotsubo cardiomyopathy, which was successfully resolved. Thus, this clinical example demonstrates the difficulties of differential diagnosis of diseases accompanied by nonspecific symptoms in the form of pulmonary edema and severe myocardial damage with a significant decrease in its global contractility.