Octopus Pot: What Does That Have to Do with Adrenergic-Related Cardiac Electro-Mechanical Dysfunction?

摘要

The octopus has been called the "devil fish," for it is an ugly predatory mollusk with eight arms containing two rows of suction discs on each arm, as well as an ink sac that it uses to darken the water when it senses danger. The octopus is related to snails, and this latter mollusk was used by Dr. Eric Randel in his classical Nobel Prize-winning work that provided fundamental insight into the electropliysiology of memory.1 The octopus has not been a favored animal for the study of cardiac electrophysiology. However, for many centuries, the Japanese have used a bottle with a round bottom and a narrow neck for catching octopuses. This bottle with its unique shape is described by the Japanese word "tako-tsubo," in which tako means octopus and tsubo means pot. So what does that have to do with cardiac electro-mechanical dysfunction?In 1991, Dote et al. reported five patients who experienced acute chest pain with marked electrocardiographic T-wave inversions in the precordial leads, QT interval prolongation, transient left ventricular dysfunction, minimal my-ocardial enzyme release, and no significant coronary artery disease.2 Acute left ventriculography revealed hyperkinesis of the basal area and hypokinesis or akinesis of the mid-portion to the apex of the ventricle. The authors proposed the term "tako-tsubo-like left ventricular dysfunction" because the end-systolic left ventriculogram looked like a tako-tsubo bottle. Subsequent studies suggested that simultaneous mul-tivessel coronary spasm of epicardial arteries and/or intramy-ocardial microvascular vessels might be responsible for this disorder.3"5 In most patients, the left ventricular dysfunction resolved within 1 or 2 weeks. Additional reports revealed that most patients with this syndrome were elderly women and that coronary spasm provocative testing was positive in a majority of the cases. These tako-tsubo cases are similar in some ways to patients, mostly women, as reported by Prinzmetal et al. in 19596 in what was called Prinzmetal-variant angina. That disorder was due to single-vessel coronary spasm, although the age at onset in affected patients was younger in Prinzmental-variant angina than in patients reported with tako-tsubo.