Miocardiopatía de y movimiento sistólico anterior de válvula mitral / Myocardiopaty and sistolic anterior movement of mitral valve

Tako tsubo cardiomyopathy associated with left ventricular outflow tract obstruction (LVOT) is a rare cause of persistent perioperative hypotension. One of the causes of this association is the systolic anterior motion (SAM) of the mitral valve. We report a case of a 67-year-old woman who, after undergoing liver segmentectomy because of metastasis, presents post-operative hypotension that is difficult to manage. Upon evaluation with a transthoracic echocardiogram, the diagnostic suspicion of Tako tsubo syndrome associated with LVOT obstruction secondary to SAM was raised. As initial therapy, a volume expander, in association with propanolol and phenylephrine were administred, achieving partial hemodynamic response. Later, she evolved with signs of heart failure and was transferred to the intensive care unit for management. In this unit, non-invasive ventilatory support, diuretic and vasopressor therapy were required, achieving favorable results on the second post-operative day. Echocardiography was essential to make the differential diagnosis against a persistent post-operative hypotension

La cardiomiopatía de Tako tsubo asociada a obstrucción del tracto de salida del ventrículo izquierdo (TSVI) es una causa poco frecuente de hipotensión persistente en el perioperatorio. Uno de los motivos de esta asociación es el movimiento anormal sistólico (SAM) de la válvula mitral. A continuación, presentamos el caso de una mujer de 67 años que, tras ser sometida a segmentectomía hepática por metástasis, presenta cuadro de hipotensión postoperatoria de difícil manejo. Al ser evaluada con ecocardiograma transtorácico se plantea la sospecha diagnóstica de síndrome de Tako tsubo asociado a obstrucción del TSVI secundario a SAM. Como terapia inicial se realizó aporte de volumen, en asociación con propanolol y fenilefrina, logrando parcial respuesta hemodinámica. Posteriormente, evolucionó con signos de insuficiencia cardiaca y fue trasladada a unidad de cuidados intensivos para su manejo. En esta unidad requirió apoyo ventilatorio no invasivo, terapia diurética y vasopresora, logrando resultados favorables al segundo día postoperatorio. La ecocardiografía fue fundamental para realizar el diagnóstico diferencial frente a un cuadro de hipotensión postoperatoria persistente.

Características clínicas y complicaciones del síndrome de Takotsubo en un centro de referencia de la seguridad social peruana / Clinical features and complications of Takotsubo syndrome in a peruvian social security referral center

RESUMEN Con el objetivo de describir las características clínicas y complicaciones del síndrome de Takotsubo, se realizó un estudio de serie de casos de pacientes que ingresaron con esta patología al Instituto Nacional Cardiovascular-INCOR en Lima-Perú, entre enero de 2013 a diciembre de 2018. Se incluyeron 26 pacientes, con una edad promedio de 69 años y predominio del sexo femenino (96,2%), además un desencadenante se identificó en 23 casos (88,5%). En el electrocardiograma, el 61,5% tuvo supradesnivel del segmento ST; y en la evolución el 92,3% mostró ondas T negativas y el 38,5% un intervalo QTc >500 ms. Las complicaciones intrahospitalarias fueron choque cardiogénico (11,5%), fibrilación auricular (7,7%) y taquicardia ventricular (7,7%). En esta serie, el síndrome de Takotsubo predominó en mujeres posmenopáusicas, generalmente desencadenado por un factor estresante, con una baja tasa de complicaciones y ausencia de mortalidad intrahospitalaria.

ABSTRACT In order to describe the clinical features and complications of Takotsubo syndrome, a case series study was conducted with patients admitted with this pathology to the National Cardiovascular Institute-INCOR in Lima-Peru between January 2013 and December 2018. Twenty-six patients (26) were included, with an average age of 69 years and female predominance (96.2%); additionally, a trigger was identified in 23 cases (88.5%). In the electrocardiogram, 61.5% had ST segment elevation; and, in the evolution, 92.3% showed negative T waves and 38.5% a QTc interval >500 ms. In-hospital complications were cardiogenic shock (11.5%), atrial fibrillation (7.7%) and ventricular tachycardia (7.7%). In this series, Takotsubo syndrome predominated in postmenopausal women, usually triggered by a stressor, with a low complication rate and no in-hospital mortality.

Síndrome de tako-tsubo, caracterización clínica y evolución a un año plazo / Tako-tsubo syndrome: analysis of 37 cases

Background: Tako-tsubo Syndrome (TTS) is characterized by transient regional systolic dysfunction of the left ventricle (LV), mimicking myocardial infarction. It accounts for 0.9-1.2% of all acute coronary syndromes (ACS). Aim: To describe the incidence and characteristics of TTS within our population. Material and Methods: All patients diagnosed with ACS and TTS were selected from a clinical registry of all the coronary angiographies done in our hospital. Clinical features during initial presentation, hospital evolution and one year follow-up were analyzed. Results: The first case diagnosed in our hospital occurred in 2001. Since then, 4,433 coronary angiographies were done to patients with ACS until 2014 and 37 corresponded to TTS (0.83% incidence). The mean age of patients was 64 years, 73% were female, and 62% had hypertension. All patients had an identifiable trigger factor, abnormal EKG and elevated troponin. The coronary angiography did not show lesions in 97%. However, all had the characteristic extensive segmental-motility alteration with a mean ejection fraction of 44%. All patients were treated initially as an ACS. Seven patients had complications, namely acute cardiac failure in six and stroke in one. No patient died. At one year of follow-up, 100% showed normal segmental motility and ejection fraction, no patient had a new episode of TTS and all were alive. Conclusions: TTS is rare and the incidence found in this study is slightly lower than that reported elsewhere. TTS mimics ACS and it should be suspected by its clinical, electrocardiographic and enzymatic particularities. Coronary angiography helps to rule out other diagnosis. All patients normalize motility and ventricular function, which is the definitive differential feature respect to ACS.

Miocardiopatía Takotsubo postparto: parto distócico como posible factor desencadenante / Takotsubo cardiomyopathy: dystocic labor as a possible triggering factor

La miocardiopatía Takotsubo, o miocardiopatía por estrés, se define como una disfunción del segmento apical del ventrículo izquierdo, aguda, transitoria y reversible. Normalmente se relaciona con algún tipo de agente estresante, ya sea físico o emocional, pudiendo confundirse este cuadro con un síndrome coronario agudo. Se considera una patología rara, pero que es importante incluir en el diagnóstico diferencial de los trastornos cardiacos, sospechándolo previamente por la sintomatología. Está caracterizado por alteraciones en el electrocardiograma, como elevación del segmento ST en derivaciones precordiales e inversión de la onda T, elevación de las enzimas de necrosis miocárdica o patrones alterados en la ecocardiografía, como la disfunción ventricular apical con hiperquinesia de zonas basales. En cuanto a la fisiopatología, parece que la estimulación simpática juega un papel importante, en el que la disfunción ventricular se desencadena por algún tipo de estrés físico o emocional. Éste provoca una descarga de catecolaminas con un efecto cardiotóxico debido, en su mayor parte, al efecto del adenosín monofosfato cíclico. El tratamiento consiste en las medidas soporte de una miocardiopatía, evitando los fármacos teratogénicos o perjudiciales durante el periodo de lactancia. La evolución es favorable en la mayoría de los casos y el cuadro remite por completo, por lo que el pronóstico en líneas generales se considera bueno. En este trabajo se expone el caso de un parto instrumentado, en el que se manifiesta un cuadro compatible con una miocardiopatía Takotsubo, posiblemente relacionado con un procedimiento invasivo como factor desencadenante.

Takotsubo cardiomyopathy or stress cardiomyopathy is defined as an acute, transient, and reversible dysfunction of the apical segment of the left ventricle. It is usually associated with some sort of stressor, whether physical or emotional, and could be confused with an acute coronary syndrome. It is considered a rare disease, so it is important to include it in the differential diagnosis, previously suspecting the symptoms. It is characterized by alterations in the electrocardiogram such as ST segment elevation and inversion of the T wave in precordial leads, elevation of myocardial necrosis enzymes, or altered patterns on echocardiography such as apical ventricular dysfunction with hyperkinesia of basal areas. Regarding the pathophysiology, it seems that sympathetic stimulation plays an important role, in which ventricular dysfunction is triggered by some kind of physical or emotional stress. This causes a release of catecholamines with cardiotoxic effects due, mostly, to the effect of cyclic AMP. Treatment involves cardiomyopathy supportive care, avoiding teratogenic or harmful drugs during lactation. The evolution is favorable in most cases and the clinical picture abates completely, so the prognosis is generally considered good. In this paper, we expose a case of an instrumental labor in which a clinical picture compatible with Takotsubo cardiomyopathy is presented, triggered by an invasive procedure.

Progress in Stress Cardiomyopathy and Its Forensic Application / 法医学杂志

Stress cardiomyopathy is an atypical myocardial disease induced by emotional or physical stress, with the characteristic of left ventricular systolic dysfunction, transient imaging and electrocardiogram (ECG) changes. Sudden cardiac death can occur in severe cases. Clinical symptoms are likely to appear on acute myocardial infarction, but the exact pathological mechanism is unclear. In the present study, we perform a systematic review of the literature on the clinical manifestations, epidemiological characteristics, ECG, imaging and laboratory tests of stress cardiomyopathy, in order to provide the values for forensic pathology diagnosis.

Doença de Takotsubo (Síndrome do coração partido): uma doença subdiagnosticada? / Takotsubo disease (Broken heart syndrome): an underdiagnosed disease?

Fundamentos: A cardiomiopatia de Takotsubo, maisconhecida como doença de Takotsubo, é umadisfunção do ventrículo esquerdo (VE) reversível naausência de coronariopatia obstrutiva, frequentemente causada por estresse intenso e que apresenta quadroclínico idêntico ao infarto agudo do miocárdio (IAM).A doença de Takotsubo é muitas vezes erroneamente diagnosticada e confundida com o IAM apesar de ter fisiopatologia e tratamento distintos. Objetivos: Avaliar a incidência da doença de Takotsubona Santa Casa de Misericórdia de Ponta Grossa, PR noperíodo de 2007 a 2012, e analisar os fatores de risco, complicações, condições relacionadas à doença e evolução dos pacientes durante a internação hospitalar. Métodos: Estudo descritivo transversal e revisão bibliográfica com análise de dados coletados dos prontuários do Serviço de Hemodinâmica da SantaCasa de Misericórdia de Ponta Grossa, PR no períodode 2007 a 2012. A partir do diagnóstico retrospectivo de doença de Takotsubo, os dados foram expressos em médias e desvios-padrão ou em valores absolutos e porcentagens. As variáveis foram comparadas através do teste t de Student e qui-quadrado. Adotado o nível de significância p<0,05. Resultados: Encontrados 24 pacientes com doença deTakotsubo. Destes, apenas 5 foram diagnosticados na internação hospitalar. Maioria dos pacientes do sexo feminino (71,0%) e prevalência (75,0%) de hipertensão arterial sistêmica (HAS) no total de pacientes Conclusão: A doença de Takotsubo é subdiagnosticada, sendo o diagnóstico realizado durante a internação em apenas um de cada cinco casos admitidos. Houve forte associação da doença com HAS e maior prevalência em mulheres na pós-menopausa.

Background: Takotsubo cardiomyopathy, more commonly known as Takotsubo disease, is a reversible dysfunction of the left ventricle (LV) in the absence of obstructive coronary disease. Often caused by severe stress, its clinical features are similar to those of acute myocardial infarction (AMI), although with diferente pathophysiology and treatment. Objectives: To assess the rate of Takotsubo disease in the Santa Casa de Misericordia hospital, Ponta Grossa,Paraná State, between 2007 and 2012, analyzing risk factors, complications and conditions related to this disease, together with patient outcomes during hospitalization. Methods: Descriptive cross-sectional study and review of the literature with an analysis of data collected from the medical records of the Hemodynamics Unit, Santa Casa de Misericórdia hospital, Ponta Grossa, Paraná State, between 2007and 2012. Drawn from retrospective diagnoses of Takotsubo disease, the data were expressed as means and standard deviations or as absolute values and percentages. Variables were compared using the Student’s t and chi- squared tests, with significance levels of p<0.05.Results: We found 24 patients with Takotsubo disease,of whom only five were diagnosed during hospitalization. Most (71,0%) patients were female, with a prevalence(75,0%) of systemic arterial hypertension (SAH) among all patients. Conclusion: Takotsubo disease is underdiagnosed,with only one in five cases diagnosed during hospitalization. There was a strong association between this disease and SAH, with a higher prevalence among post-menopausal women.

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.

Desfecho de Curto e Longo Prazo na Cardiomiopatia Induzida por Estresse: O que Podemos Esperar? / Short and Long-Term Outcome of Stress-Induced Cardiomyopathy: What Can We Expect?

Fundamento: A cardiomiopatia de estresse/Takotsubo (CT) é uma entidade diagnóstica cada vez mais reconhecida. Objetivo: Este estudo teve como objetivo avaliar a prevalência e os preditores clínicos de complicações de curto e longo prazo de pacientes (pts) com CT. Métodos: Foram incluídos todos os pts consecutivamente admitidos no nosso centro, entre novembro de 2006 e agosto de 2011, que preenchiam os critérios diagnósticos da Clínica Mayo. Resultados: Analisaram-se 37 pts (35 mulheres), com idade média de 63 ± 13 anos. A CT foi precipitada na maioria dos casos por eventos de estresse emocional (57%) e dor torácica foi o sintoma de apresentação mais frequente (89%). O electrocardiograma na admissão mostrou supradesnivelamento do segmento ST em 12 pts (32%) e inversão da onda T em 15 casos (41%). Verificou-se disfunção sistólica ventricular esquerda (VE) grave em 16 pts (45%) e a elevação média de troponina I foi de 2,6 ± 1,8 ng/mL. A taxa de complicações intra-hospitalares foi de 30%, sendo o choque cardiogênico a situação mais comum. O estresse físico, a disfunção sistólica grave do VE e o valor de pico do peptídeo natriurético cerebral (BNP) foram preditores de complicações agudas. Não foi encontrada associação entre o pico de troponina I e a apresentação eletrocardiográfica. Trinta e cinco pacientes foram acompanhados por um tempo médio de 482 ± 512 dias, sem recorrência clínica. Conclusão: Na nossa série de pacientes, a CT foi associada a uma alta taxa de complicações intra-hospitalares. O estresse físico, a disfunção sistólica do VE e o valor de pico do BNP foram preditores de desfechos adversos agudos. .

Background: Stress-induced/Takotsubo cardiomyopathy (TC) is an increasingly recognized diagnostic entity. Objective: This study was aimed to assess the prevalence and clinical predictors of short and long-term outcome of patients (pts) diagnosed with TC. Methods: We included all consecutive pts admitted in our department, from November 2006 to August 2011, who met the Mayo Clinic criteria for TC diagnosis. Results: We evaluated 37 pts (35 women) with a mean age of 63 ±13 years. TC was precipitated by a stressful emotional event in the majority (57%) and chest pain was the most common symptom (89%). Twelve pts (32%) had ST-segment elevation and 15 pts (41%) had T-wave inversion on the electrocardiogram at admission. Severe left ventricular (LV) dysfunction was found in 16 pts (43%) and the mean troponin I level was 2.6±1.8 ng/mL. The in-hospital complication rate was 30%, with cardiogenic shock being the most common situation. Physical stress, severe LV systolic dysfunction and peak brain natriuretic peptide (BNP) were predictors of acute complications. On the other hand, we found no association between peak troponin I and electrocardiographic presentation. Thirty-five pts were followed for a mean time of 482 ± 512 days, without clinic recurrence. Conclusion: In our cohort of pts, TC was associated with a high in-hospital complications rate. Physical stress, LV dysfunction and peak BNP could predict acute adverse outcomes. .

Disfunción apical transitoria o síndrome de Takotsubo: reporte de un caso / Transient apical ballooning or Takotsubo cardiomyopathy: case report

INTRODUCCIÓN: El Síndrome de Takotsubo (STT), balonamiento apical o síndrome del corazón roto es una patología que produce un aturdimiento agudo del miocardio sin encontrarse lesiones obstructivas significativas a la coronariografía. Epidemiologicamente hay mayor incidencia en mujeres postmenopáusicas. Su patogenia es desconocida, con múltiples teorías propuestas. PRESENTACIÓN DEL CASO: Paciente sexo femenino de 41 años, sin antecedentes mórbidos. Encontrándose en reposo, refiere dolor opresivo retroesternal severo irradiado a ambas extremidades superiores con signos y síntomas neurovegetativos intensos, sin presencia de alteraciones emocionales o factores de estrés relacionados. Es trasladada a consultorio de Neltume, zona rural de la región de los Ríos, donde electrocardiograma sugiere infarto agudo al miocardio con supradesnivel del segmento ST de pared inferior y anterior. Es derivada a su hospital base donde por mejoría clínica, se realiza electrocardiograma de control a cinco horas del inicio, mostrando criterios de reperfusión espontánea. Se realiza coronariografía para evaluación, que objetiva arterias coronarias sin lesiones obstructivas y ventriculografía que muestra disquinesia apical compatible con STT. Se deriva a hospital Naval de Talcahuano donde la paciente evoluciona favorablemente, objetivándose por ecocardiografía una restauración de la función cardíaca normal. La paciente es dada de alta tras siete días de tratamiento médico para síndrome coronario agudo. DISCUSIÓN: Como diagnóstico diferencial de síndrome coronario agudo, la sospecha diagnóstica precoz y el acceso a imagenología cardiaca permiten confirmar el síndrome. El manejo de estos pacientes es conservador, con seguimiento imagenológico por posibles complicaciones hasta la recuperación espontánea del funcionamiento ventricular.

INTRODUCTION: TakoTsubo Cardiomyopathy (TCM), transient apical ballooning o broken heart syndrome is a transient cardiac syndrome most commonly presented after severe emotional or physical stress, producing acute myocardial dysfunction, without significant coronary stenosis. Its pathogenesis is unknown, with multiple proposed theories and a higher incidence in postmenopausal women. CASE REPORT: 41-year-old female with no relevant medical history. While resting at home, she presented a severe episode of retrosternal pain, irradiated to both arms and associated with adrenergic symptoms, without related emotional or stressful factors. Twenty minutes after onset, she was brought to a primary care facility in Neltume, Los Rios Region, where electrocardiogram (EKG) showed STsegment elevation on inferior and anterior leads. She was then transferred to the referral center, where after five hours of the beginning of symptoms, follow-up EKG showed spontaneous reperfusion criteria, correlated with spontaneous resolution of symptoms during transferring. Coronary angiography showed no significant stenosis and ventriculography confirmed apical ballooning compatible with TCM. The patient was referred to the Naval Hospital of Talcahuano, where she improved clinically, being discharged seven days later with standard treatment for acute coronary syndrome. DISCUSSION: As part of the differential diagnosis of acute coronary syndrome, early suspicion and access to cardiac catheterization provides the basis for confirming the diagnosis. Treatment is mainly conservative, with imaging follow-up for possible complications until recovery of the ventricular function.

Pseudoinfarto agudo do miocárdio devido à síndrome da disfunção ventricular apical transitória (síndrome de Takotsubo) / Pseudo-acute myocardial infarction due to transient apical ventricular dysfunction syndrome (Takotsubo syndrome)

A síndrome de Takotsubo caracteriza-se por disfunção ventricular esquerda transitória, predominantemente medioapical, desencadeada caracteristicamente por estresse físico ou emocional. Relata-se aqui o caso de uma paciente de 61 anos de idade, admitida com tontura, sudorese profusa e mal-estar súbito, após intenso estresse emocional. Exame físico e eletrocardiograma inicial foram normais, porém havia elevação de troponina I e CKMB massa. Suspeitou-se de infarto agudo do miocárdio sem supradesnivelamento do segmento ST, indicando cineangiocoronariografia de urgência. Foram evidenciados ventrículo esquerdo com hipocinesia difusa grave, balonamento sistólico medioapical e coronárias sem lesões significativas. A paciente foi encaminhada aos cuidados intensivos, evoluindo satisfatoriamente com terapia de suporte. Conforme visto, a cardiomiopatia de Takotsubo pode simular infarto agudo do miocárdio, sendo a cineangiocoronariografia importante para distinção na fase aguda. Neste caso, a paciente evoluiu com resolução espontânea da disfunção ventricular, sem sequelas.

Takotsubo syndrome is characterized by predominantly medial-apical transient left ventricular dysfunction, which is typically triggered by physical or emotional stress. The present article reports the case of a 61-year-old female patient presenting with dizziness, excessive sweating, and sudden state of ill feeling following an episode involving intense emotional stress. The physical examination and electrocardiogram were normal upon admission, but the troponin I and creatine kinase-MB concentrations were increased. Acute myocardial infarction without ST segment elevation was suspected, and coronary angiography was immediately performed, which showed severe diffuse left ventricular hypokinesia, medial-apical systolic ballooning, and a lack of significant coronary injury. The patient was referred to the intensive care unit and was successfully treated with supportive therapy. As this case shows, Takotsubo syndrome might simulate the clinical manifestations of acute myocardial infarction, and coronary angiography is necessary to distinguish between both myocardial infarction and myocardial infarction in the acute stage. The present patient progressed with spontaneous resolution of the ventricular dysfunction without any sequelae.

Síndrome del corazón roto: cardiomiopatía de Tako-Tsubo: [revisión] / Broken heart syndrome: Tako-Tsubo cardiomyopathy: [review]

La cardiomiopatía de Tako-Tsubo se define como una cardiopatía súbita, aguda, caracterizada por alteraciones en la contractilidad de los segmentos apicales del ventrículo izquierdo, lo que lleva de manera rápida e importante a un defecto de bomba a nivel cardíaco, causando sintomatología de diversa gravedad que puede implicar incluso el desarrollo de choque cardiogénico y la muerte. Se caracteriza, entre otros, por una ausencia absoluta de lesiones detectables a la angiografía coronaria. A pesar que no existe a la fecha un consenso al respecto, actualmente se considera que las teorías que mejor explican el síndrome son las alteraciones de la microcirculación coronaria y la toxicidad miocárdica por catecolaminas. Su cuadro clínico se basa principalmente en dolor precordial, asociado a disnea; las enzimas de mionecrosis (principalmente las troponinas) pueden estar aumentadas levemente, aunque es característica la presencia de una coronariografía completamente normal.

Tako-Tsubo cardiomyopathy is defined as a sudden, acute cardiomyopathy, characterized by reversible alterations in left ventricle’s apical segments contractility, resulting in an important decrease in the heart’s ‘pumping’ function. This causes various degrees of symptomatology in the patient, including, in some cases, cardiogenic shock and death. This condition is characterized, specially, by an absolute lack of detectable lesions on coronariography. Although to date there is no consensus on this issue, now considered the theories that best explain the syndrome include abnormalities of the coronary microcirculation and myocardial catecholamine toxicity. The clinical presentation of most patients will include chest pain and dyspnea, with troponins been elevated in some cases, although there will always be the characteristic of a completely normal angiographic study.

Strain bidimensional na cardiopatia de Takotsubo / Two-dimensional strain in Takotsubo cardiomyopathy

Este relato apresenta o seguimento tardio de um caso de cardiomiopatia de Takotsubo com boa evolução clínica e melhora da função sistólica global ventricular esquerda. Contudo, observou-se persistência de significativa disfunção sistólica regional longitudinal que foi avaliada por meio de nova técnica ecocardiográfica (speckle tracking), com as medidas do strain (S) e strain rate (SR) correspondentes. Ressaltamos a importância desse novo método para o acompanhamento dessa cardiopatia, pois permite identificar os pacientes que persistem com disfunção sistólica e que possivelmente serão beneficiados com a manutenção da terapêutica clínica.

This report presents the late follow-up of a case of Takotsubo cardiomyopathy with good clinical outcome and improved left ventricular global systolic function. However, there was persistence of significant regional longitudinal systolic dysfunction evaluated using a new echocardiographic technique (speckle tracking), with corresponding measures of strain (S) and strain rate (SR). We emphasize the importance of this new method to monitoring this cardiomyopathy, since it identifies patients with persistent systolic dysfunction who will possibly benefit from maintenance of clinical therapy.

Cardiomiopatia de takotsubo como causa de disfunção ventricular transitória / Takotsubo cardiomyopathy causing transitory ventricular dysfunction

Relato do caso de mulher de 74 anos, com hipertensão arterial sistêmica e insuficiência vascular periférica, que apresentou sintomas de síndrome coronariana aguda. A angiografia coronariana demonstrou artérias sem obstruções significativas. A ventriculografia e a ecocardiografia demonstraram acinesia dos segmentos médios e apicais, e hipercinesia dos segmentos basais do ventrículo esquerdo. A paciente evoluiu com recuperação completa da função global e motilidade segmentar em ecocardiografia realizada duas semanas após o início dos sintomas. Esse padrão incomum e reversível de disfunção sistólica e comprometimento segmentar dando ao ventrículo esquerdo forma semelhante a um takotsubo é hoje conhecido como cardiomiopatia do estresse.

This is the report of a 74-year-old female patient with a history of systemic hypertension and peripheral vascular disease who presented acute coronary syndrome symptoms. Coronary angiography showed coronary arteries with no significant obstructions. Ventriculography and echocardiography showed akinesia in mid and apical segments; and hyperkinesia of left ventricle basal segments. Two weeks after the onset of symptoms, a new echocardiogram demonstrated normal global and regional systolic function. The uncommon, reversible pattern for systolic dysfunction and segmental compromising that gives left ventricle a takostubo-like shape is known today as stress cardiomyopathy.

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