中文题目一个合并有甲状腺风暴及糖尿病酮酸血症之预后不佳之.doc

中文題目：一個合併有甲狀腺風暴及糖尿病酮酸Takotsubo 心肌病變 英文題目：A case of Takotsubo cardiomyopathy precipitated by thyroid storm and diabetic ketoacidosis with poor prognosis – A rare case report 1 黃虹綾1,許栢超2,3 服務單位：高雄醫學大學附設中和紀念醫院1內科部心臟血管內科, 2高雄醫學大學醫學院醫學系內科 Introduction Takotsubo cardiomyopathy (TCMP) is also named as stress cardiomyopathy, broken-heart syndrome, or apical ballooning syndrome, which is a form of reversible, transient systolic dysfunction over the left ventricle [1-2]. Generally, TCMP can be triggered by physical or emotional stress [3]. Both of thyroid storm and diabetic ketoacidosis (DKA) were rare causes of TCMP [4-11]. Herein, we reported a rare case of TCMP precipitated by thyroid storm and DKA simultaneously and finally leaded to catastrophic clinical outcome Case report An 81-year-old female was a case of type-2 diabetes mellitus (DM), hypertension and old cerebral vascular accident. This time, she suffered from palpitation, chest tightness, and abdominal fullness in combination with vomiting and diarrhea, and was brought to our emergency department (ED) for help. Anxiety and excessive sweating were also noted in recent three months. On arrival at our ED, vital signs were pulse rate 146 beats/min, respiratory rate 22/ min, blood pressure 110/60 mmHg, and body temperature 38.5??C. Electrocardiogram (ECG) revealed sinus tachycardia with ST elevation over V2-V4 (Figure 1A). Chest X-ray (CXR) showed cardiomegaly and pulmonary congestion (Figure 2A). Because ST elevation myocardial infarction was highly suspected, emergent coronary angiography was performed but showed nearly normal finding. In addition, echocardiography revealed impaired left ventricular systolic function (Ejection fraction: 35.4%) with apical hypokinesia to akinesia, which was compatible with apical ballooning sign of TCMP (Figure 1B). Due to impending respiratory failure caused by decompensate heart failure, the patient was then intubated under mechanical ventilator support. Initial laboratory