Journal of Clinical Pediatrics ›› 2026, Vol. 44 ›› Issue (1): 79-83.doi: 10.12372/jcp.2026.24e1172
• Literature Review • Previous Articles Next Articles
Received:2024-11-04
Accepted:2025-03-13
Published:2026-01-15
Online:2026-01-05
CLC Number:
ZHANG Wenting, FENG Juan. Progress in pediatric Takotsubo syndrome[J].Journal of Clinical Pediatrics, 2026, 44(1): 79-83.
Table 1
Differential diagnosis of pediatric Takotsubo cardiomyopathy"
| 项目 | 临床症状 | 心肌酶 | 心衰标志物 | 心电图 | 心脏超声 |
|---|---|---|---|---|---|
| 应激性心肌病 | 晕厥、抽搐、意识丧失多见,病情进展迅速,低心排表现 | CK-MB和hs-cTn升高,但不显著 | BNP和NT-proBNP显著升高,24~72小时达峰值。 | 胸前导联ST段抬高,QT间期延长常见,病理性Q波和ST段压低少见 ,心律失常等 | 左心室功能不全或减低;心腔无明显扩张或轻度扩大;心尖部室壁运动降低,基底部运动增强;心室壁无明显增厚;可有不同程度房室瓣反流,一般不严重;也可累及右心 |
| 扩张型心肌病 | 一般为慢性起病,心力衰竭、心律失常和栓塞是主要特征,常以胸闷气促、咳嗽为首发症状 | 一般不合并CK- MB和hs-cTn的显著升高 | BNP和NT-proBNP可明显升高 | 以ST-T改变最常见,以V5导联最明显;房室肥大以左心房和左心室肥大较常见;心律失常可有多种并存 | 左心/全心功能不全;心腔明显扩大,以左心腔为著;弥漫性心肌活动减弱;心室壁厚度正常或变薄;房室瓣反流常见且明显,也可累及右心 |
| 暴发性心肌炎 | 早期可有嗜睡、腹痛等非特异症状;急性期晕厥、抽搐、意识丧失多见,病情进展迅速,低心排表现 | CK-MB和hs-cTn显著升高 | BNP和NT-proBNP可明显升高 | 多种改变:QRS低电压、ST-T改变;可合并严重心动过速和传导 阻滞 | 左心室功能不全;心腔无明显扩大或轻度扩大;弥漫性心肌活动减弱;疾病早期心室壁增厚;很少累及 右心 |
| 脓毒症性心肌病 | 严重感染的基础临床表现,心功能减退/不全表现 | CK-MB和cTn可升高,差异较大 | BNP和NT-proBNP升高但水平差异较大 | 表现不特异,可有ST-T段抬高或压低,传导阻滞等多种表现 | 左心/全心功能减退/不全;左心室扩张;不伴有局部心室壁收缩或舒张功能障碍 |
| [1] |
Tsitsipanis C, Miliaraki M, Michailou M, et al. Severe and atypical presentation of Takotsubo cardiomyopathy in a pediatric patient after a serious crash injury—case report and literature review[J]. Pediatr Rep, 2023, 15(3): 396-402.
doi: 10.3390/pediatric15030036 pmid: 37489410 |
| [2] |
Sendi P, Martinez P, Chegondi M, et al. Takotsubo cardiomyopathy in children[J]. Cardiol Young, 2020, 30(11): 1711-1715.
doi: 10.1017/S1047951120002632 |
| [3] |
Citro R, Radano I, Bellino M, et al. Epidemiology, patho-genesis, and clinical course of Takotsubo syndrome[J]. Heart Fail Clin, 2022, 18(1): 125-137.
doi: 10.1016/j.hfc.2021.08.001 |
| [4] |
Arcari L, Núñez Gil IJ, Stiermaier T, et al. Gender differences in Takotsubo syndrome[J]. J Am Coll Cardiol, 2022, 79(21): 2085-2093.
doi: 10.1016/j.jacc.2022.03.366 pmid: 35618345 |
| [5] | Annino N, Cantais A, Javouhey E, et al. Stress cardio-myopathy in the paediatric population: a case series[J]. Eur Heart J Case Rep, 2024, 8(3): ytae030. |
| [6] |
Vazirani R, Rodríguez-González M, Castellano-Martinez A, et al. Pediatric Takotsubo cardiomyopathy: a review and insights from a national multicentric registry[J]. Heart Fail Rev, 2024, 29(4): 739-750.
doi: 10.1007/s10741-024-10394-x pmid: 38483658 |
| [7] |
Hernandez LE. Takotsubo cardiomyopathy: how much do we know of this syndrome in children and young adults?[J]. Cardiol Young, 2014, 24(4): 580-592.
doi: 10.1017/S1047951114000080 pmid: 24521539 |
| [8] | Takamizawa K, Shindo T, Ono H, Kato H, et al. Infan-tile Takotsubo cardiomyopathy following human metapneumovirus infection[J]. Pediatr Int, 2022, 64(1): e15125. |
| [9] | Visclosky T, Klekowski N, Sikavitsas A. Pediatric Takotsubo cardiomyopathy resulting from clonidine overdose[J]. Am J Emerg Med, 2023, 63: 179. |
| [10] |
Ziaka M, Exadaktylos A. The heart is at risk: understanding stroke-heart-brain interactions with focus on neurogenic stress cardiomyopathy—a review[J]. J Stroke, 2023, 25(1): 39-54.
doi: 10.5853/jos.2022.02173 |
| [11] | Wang X, Pei J, Hu X. The brain-heart connection in Takotsubo syndrome: the central nervous system, sympathetic nervous system, and catecholamine overload[J]. Cardiol Res Pract, 2020: e4150291. |
| [12] |
Pelliccia F, Camici PG. Acute neurological dysfunction: The missing link in the pathophysiology of Takotsubo syndrome[J]. Int J Cardiol, 2021, 345: 26-28.
doi: 10.1016/j.ijcard.2021.10.147 pmid: 34728261 |
| [13] |
Nagai M, Kato M, Dote K. Amygdalo-insular functional decoupling: a pathogenesis in Takotsubo syndrome?[J]. Int J Cardiol, 2022, 351: 23-24.
doi: 10.1016/j.ijcard.2021.12.041 |
| [14] |
Koyama J, Akutsu N, Kawamura A. Pediatric Takotsubo syndrome caused by hydrocephalus after posterior fossa tumor surgery[J]. Childs Nerv Syst, 2021, 37(12): 3957-3961.
doi: 10.1007/s00381-021-05090-2 |
| [15] | 夏泽阳, 宋云海, 高俜娉, 等. 儿童延髓肿瘤手术诱发应激性心肌病1例并文献复习[J]. 中华神经外科杂志, 2024, 40(5): 519-521. |
| Xia ZY, Song YH, Gao PP, et al. A case of surgically induced stress cardiomyopathy in a pediatric medullary tumor and review of the literature[J]. Zhonghua Shenjingwaike Zazhi, 2024, 40(5): 519-521. | |
| [16] |
Sagray E, Johnson JN, Anderson JH. Dobutamine-induced Takotsubo syndrome in a paediatric heart transplant patient[J]. Cardiol Young, 2023, 33(4): 646-648.
doi: 10.1017/S1047951122002311 |
| [17] |
Napp LC, Bauersachs J. Takotsubo syndrome: between evidence, myths, and misunderstandings[J]. Herz, 2020, 45(3): 252-266.
doi: 10.1007/s00059-020-04906-2 pmid: 32206851 |
| [18] | 张建, 任宏. 应激性心肌病[J]. 中国小儿急救医学, 2022, 29(1): 12-18. |
| Zhang J, Ren H. Takotsubo syndrome in children[J]. Zhongguo Xiaoer Jijiu Yixue, 2022, 29(1): 12-18. | |
| [19] |
Urbinati A, Pellicori P, Guerra F, et al. Takotsubo syndrome in the paediatric population: a case report and a systematic review[J]. J Cardiovasc Med (Hagerstown), 2017, 18(4): 262-267.
doi: 10.2459/JCM.0000000000000446 pmid: 27673581 |
| [20] |
Ludwikowska KM, Tracewski P, Kusa J. Takotsubo syndrome as a cardiac manifestation of multisystem inflammatory syndrome in children[J]. Cardiol Young, 2022, 32(8): 1341-1343.
doi: 10.1017/S1047951121004881 |
| [21] |
Dayco JS, Kherallah RY, Epstein J, et al. Correlation between echocardiographic diastolic parameters and invasive measurements of left ventricular filling pressure in patients with Takotsubo cardiomyopathy[J]. J Am Soc Echocardiogr, 2023, 36(5): 490-499.
doi: 10.1016/j.echo.2022.11.007 |
| [22] | Ramos-Rodriguez A, Fernandez-Bravo C, Estepa-Pedregosa L, et al. The pivotal role of echocardiography in the diagnosis of stress-induced cardiomyopathy presenting with atypical pattern in critically ill children. An illustrative case report[J]. Curr Med Imaging, 2022, 18(9): 1003-1011. |
| [23] | Wittekind SG, Yanay O, Johnson EM, et al. Two pediatric cases of variant neurogenic stress cardiomyopathy after intracranial hemorrhage[J]. Pediatrics, 2014, 134(4): e1211-e1217. |
| [24] |
Topal Y, Topal H, Doğan C, et al. Takotsubo (stress) cardiomyopathy in childhood[J]. Eur J Pediatr, 2020, 179(4): 619-625.
doi: 10.1007/s00431-019-03536-z pmid: 31865427 |
| [25] |
Zhao Y, Da M, Yang X, et al. A retrospective analysis of clinical characteristics and ouTCMomes of pediatric fulminant myocarditis[J]. BMC Pediatr, 2024, 24(1): 553.
doi: 10.1186/s12887-024-05022-4 |
| [26] |
Jammal Addin MB, Young D, McCarrison S, et al. Dilated cardiomyopathy in a national paediatric population[J]. Eur J Pediatr, 2019, 178(8): 1229-1235.
doi: 10.1007/s00431-019-03404-w pmid: 31187263 |
| [27] | Bressieux-Degueldre S, Fenton M, Dominguez T, et al. Exploring the possible impact of echocardiographic diastolic function parameters on OuTCMome in paediatric dilated cardiomyopathy[J]. Children (Basel). 2022, 9(10): 1500. |
| [28] |
Zhuang SX, Shi P, Gao H, et al. Clinical characteristics and mortality risk prediction model in children with acute myocarditis[J]. World J Pediatr, 2023, 19(2): 180-188.
doi: 10.1007/s12519-022-00637-y |
| [29] |
Xie T, Zang X, Xiong Y, et al. Myoglobin and left ventricular ejection fraction as predictive markers for death in children with fulminant myocarditis[J]. Front Pediatr, 2022, 10: 949628.
doi: 10.3389/fped.2022.949628 |
| [30] | 陈静, 何爽, 郑敏, 等. 儿童暴发性心肌炎临床特点及危险因素分析[J]. 中国实用儿科杂志, 2024, 39(3): 223-230. |
| Chen J, He S, Zhang M, et al. Clinical features and risk factors of fulminant myocarditis in children[J]. Zhongguo Shiyong Erke Zazhi, 2024, 39(3): 223-230. | |
| [31] |
Lukić I, Mihić D, Varžić SC, et al. Septic cardiomyopathy[J]. Rev Cardiovasc Med, 2024, 25(1): 23.
doi: 10.31083/j.rcm2501023 |
| [32] | Tetsuhara K, Muraji S, Muraoka M, et al. Takotsubo cardiomyopathy in a toddler with pulmonary atresia and ventricular septal defect[J]. BMJ Case Rep, 2022, 15(7): e251323. |
| [33] | Jeong HS, Lee TH, Bang CH, et al. Risk factors and ouTCMomes of sepsis-induced myocardial dysfunction and stress-induced cardiomyopathy in sepsis or septic shock: a comparative retrospective study[J]. Medicine (Baltimore), 2018, 97(13): e0263. |
| [34] |
Kato K, Lyon AR, Ghadri JR, et al. Takotsubo syndrome: aetiology, presentation and treatment[J]. Heart, 2017, 103(18): 1461-1469.
doi: 10.1136/heartjnl-2016-309783 pmid: 28839096 |
| [35] |
Madias JE. The recurrence rate of Takotsubo syndrome may be higher than currently reported[J]. Curr Probl Cardiol, 2024, 49(3): 102413.
doi: 10.1016/j.cpcardiol.2024.102413 |
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