Miocardiopatia de Takotsubo pós-parto: relato de caso / Postpartum Takotsubo cardiomyopathy: case report

Ocorrendo habitualmente após um stress físico ou emocional intenso, a miocardiopatia de Takotsubo caracteriza-se por disfunção aguda e transitória do segmento apical do ventrículo esquerdo, mimetizando uma síndrome coronária aguda. Essa é uma síndrome rara, na qual o diagnóstico diferencial assume particular importância. Um elevado nível de suspeição é essencial, pelo que obstetras e o restante da equipe devem estar preparados para diagnosticar e lidar com esse evento inesperado. O tratamento é fundamentalmente de suporte, verificando-se reversão espontânea e completa das alterações num intervalo de dias a semanas. A ocorrência de complicações podem ditar um prognóstico menos benigno. Apresentamos o caso de uma mulher de 39 anos, sem antecedentes relevantes. Submetida à cesariana por suspeita de sofrimento fetal. Terminada a intervenção iniciou quadro de bradicardia e precordialgia, com edema pulmonar. Apresentava alterações de enzimas cardíacas e do electrocardiograma. O ecocardiograma revelou disfunção sistólica do ventrículo esquerdo com hipocinésia de toda a parede anterior. O cateterismo cardíaco excluiu doença coronária obstrutiva.

Takotsubo cardiomyopathy is characterized by acute and transient dysfunction of the apical segment of the left ventricle usually after an intense physical or emotional stress, mimicking an acute coronary syndrome. Because this is a rare syndrome, the differential diagnosis is particularly important and a high level of suspicion is essential. Obstetricians should be aware to diagnose and deal with this unexpected event. Treatment is essentially supportive, with spontaneous and complete reversal of the changes within days or weeks. The occurrence of complications may dictate a less benign prognosis. We report a case of Takotsubo cardiomyopathy in a 39-year-old woman who underwent Cesarean delivery. She presented with bradycardia, chest pain and pulmonary edema immediately after the delivery. Her echocardiography showed and apical ballooning. Cardiac biomarkers and electrocardiogram were altered and echocardiogram showed severe left ventricular dysfunction with hypokinesia of the anterior wall. Coronary angiography excluded obstructive coronary artery disease.

Síndrome de Takotsubo: experiencia en tres instituciones de la ciudad de Córdoba / Takotsubo Syndrome: experience in three institutions of Cordoba City

Takotsubo es una miocardiopatía adquirida que se caracteriza por la aparición transitoria de acinesia o discinesia antero-apical del ventrículo izquierdo, síntomas y cambios electrocardiográficos que simulan un síndrome coronario agudo, leve elevación de enzimas cardíacas y coronarias sin lesiones ateroscleróticas significativas. Afecta predominantemente a mujeres post menopáusicas y frecuentemente es precedido por situaciones de estrés físico o psicológico. La fisiopatología no ha sido completamente dilucidada pero existe consenso sobre el papel central de la descarga masiva de catecolaminas, secundaria a dichas situaciones de estrés, como mecanismo desencadenante. Se presentan 32 casos diagnosticados en tres instituciones de Córdoba. La edad promedio fue 61 años, el 28 (88%) fueron mujeres, y todos se presentaron simulando síndromes coronarios agudos. Doce pacientes (37.5%) evolucionaron con insuficiencia cardíaca y dos (6%) desarrollaron shock cardiogénico. La función ventricular se normalizó más rápidamente que los cambios electrocardiográficos. La tasa de recurrencia fue del 25%. El pronóstico fue benigno, ya que solo se produjo una muerte como consecuencia de una recidiva. Estos hallazgos son, en general, similares a los publicados en la literatura. También se analizaron recientes progresos sobre la fisiopatología de esta miocardiopatía que permitieron desarrollar un planteo racional de tratamiento.

Takotsubo Syndrome is an acquired cardiomyopathy characterized by a transient left ventricular antero-apical asynergy or disynergy (apical ballooning), symptoms and electrocardiographic changes are suggestive of an acute coronary syndrome, moderate cardiac enzymatic release and absence of significant atherosclerotic lesions in coronary arteries. It predominantly affects postmenopausal women and it is frequently preceded by situations of physical or psychological stress. The physiopathology is not completely understood but there is consensus that it is triggered by a surge of catecholamines consequent to the aforementioned stress conditions. The study of 32 cases diagnosed at three medical institutions in Córdoba, Argentina, is reported. The mean age was 61 years, and 28 were female. All cases simulated acute coronary syndromes. Congestive heart failure developed in twelve cases (37.5%) and two patients (6.3%) developed cardiogenic shock. The left ventricular function normalized more rapidly than the electrocardiographic changes. The recurrence rate was 25%, the prognosis was benign considering that only one death occurred following a relapse. In general the findings are similar to previously published studies. Recent advances in the comprehension of the physiopathology of this cardiomyopathy gave way to the development of a rational therapeutic approach.

Apical ballooning syndrome or Tako- tsubo cardiomyopathy: What we know about it

Apical ballooning syndrome [ABS] is a reversible cardiomyopathy with presentation mimicking an acute coronary syndrome. So in clinical practice, it is essential to consider it in the differential diagnosis of patients presenting with chest pain, especially in postmenopausal women. Coronary angiography is usually indicated to achieve a proper diagnosis. Typically, patients do not have significant coronary artery lesions. Left ventriculography and echocardiography reveal a regional systolic dysfunction with akinesis of the midventricle, apex and compensatory hyperkinesis of the basal ventricular segments. Occurrence of an emotionally or physically stressful event is a feature of ABS but its absence does not exclude this diagnosis. Several pathophysiologic mechanisms had been proposed. The prognosis of ABS is good. In this review, we highlight the clinical manifestations, pathophysiology and management of this syndrome

Tako-tsubo cardiomyopathy

Tako-tsubo cardiomyopathy [transient left ventricular apical ballooning] is a reversible form of cardiomyopathy of unknown etiology. Tako-tsubo Cardiomyopathy [TTC] is typically precipitated by sudden emotional or physical stress, and is associated with excessive sympathetic stimulation and catecholamine release. Its clinical presentation is similar to that of acute coronary syndrome. The diagnosis of TTC must be considered in all patients who develop a transient left ventricular apical [or mid ventricular] ballooning in the absence of obstructive coronary artery disease. Although the prevalence of TTC remains unknown, approximately 2% of all patients presenting with a presumed diagnosis of acute myocardial infarction have been found to have this syndrome. An illustrative case report and literature review is provided