脳塞栓発症経過中にQT延長を伴うelectrical stormを生じ，その原因として，たこつぼ心筋症が疑われた1例

A Suspected Case of Takotsubo Cardiomyopathy Associated with the Emergence of Electrical Storm after QT Prolongation during the Course of Acute Ischemic Stroke

要旨　患者は76歳，女性．右半身麻痺，失語により搬送され，頭部MRI検査で左中大脳動脈領域に急性期脳梗塞の所見を認め入院となった．入院第14日目，非持続性心室頻拍が出現し，うっ血性心不全が悪化した．多形性心室頻拍が頻発したためリドカイン，アミオダロンを投与したが効果なく，ランジオロールおよびプロポフォール持続投与開始したところ心室頻拍は沈静化した．侵襲的冠動脈造影(CAG)の結果，冠動脈に器質的狭窄病変は認めなかった．本例は，脳血管障害による交感神経過活性状態において，たこつぼ心筋症類似の病態が生じ，陰性T波によるQT延長を契機にelectrical stormが出現したと考えられた．ランジオロールおよびプロポフォールによる交感神経抑制がelectrical stormの沈静化に関与したと推察された．

　A 76-year-old woman was transferred to our hospital for right hemiplegia and expressive aphasia. Brain magnetic resonance imaging(MRI)showed acute ischemic infarct in the left middle cerebral artery territory. Fourteen days after admission, nonsustained ventricular tachycardia and worsened congestive heart failure occurred. The patient has repeated episodes of torsades de pointes(TdP)refractory to infusion of lidocaine and amiodarone. However, ventricular tachycardia was controlled by injection of landiolol during deep sedation with propofol. Coronary angiography(CAG)showed no abnormalities. In the present case, the electrical storm might have been due to QT prolongation following the condition suggesting takotsubo cardiomyopathy caused by an overactive sympathetic nervous system from acute ischemic stroke. Suppression of the sympathetic nervous system by landiolol and propofol may serve to suppress electrical storm.