Takotsubo cardiomyopathy , also known as stress cardiomyopathy , is a type of non-ischemic cardiomyopathy in which temporary temporary weakening of the heart muscle is present. This attenuation can be triggered by emotional distress, such as the death of a loved one, breaking up, rejection of a constant partner or anxiety. This leads to one of the common names, broken heart syndrome . Stress cardiomyopathy is now a leading cause of acute heart failure, lethal ventricular arrhythmias, and ventricular rupture.
The name "takotsubo syndrome" comes from the Japanese word takotsubo "octopus trap," because the left ventricle takes a shape that resembles a fishing rod.
Video Takotsubo cardiomyopathy
Signs and symptoms
The typical feature of takotubo cardiomyopathy is chest pain associated with ECG changes that mimic myocardial infarction of the anterior wall. During patient evaluation, protruding out of the left ventricular apex with the hypercontract base from the left ventricle is often noted. This is a prominent feature of the peak of the heart with a preserved function of the base that makes this syndrome its name takotsubo "octopus trap", in Japan, where it was first described.
Stress is a major factor in takotubo cardiomyopathy, with over 85% of cases being driven by events that are physically or emotionally suppressing that initiate the onset of symptoms. Examples of emotional stressors include the sadness of the death of a loved one, fear of public speaking, arguing with spouses, disagreement, betrayal, and financial problems. Acute asthma, surgery, chemotherapy, and stroke are examples of physical stressors. In some cases, stress can be a fun event, such as marriage, winning a jackpot, sports triumph, or birthday.
Takotsubo cardiomyopathy is more commonly seen in postmenopausal women. Often there is a history of severe emotional or physical stress (usually negative, sometimes happy).
Maps Takotsubo cardiomyopathy
Cause
The cause of takotsubo cardiomyopathy is not fully understood, but several mechanisms have been proposed.
It is likely that there are several contributing factors that may include some amount of vasospasm and failure of the microvasculature. A series of cases looking at a large group of patients reported that some patients developed a takotubo cardiomyopathy after emotional stress, while others had previous clinical stressors. (such as asthma attacks or sudden illness). About one-third of patients do not experience any previous stressful events. A series of major 2009 cases from Europe found that takotubo cardiomyopathy was slightly more frequent during the winter. This may be related to two possible causes of pathophysiology: coronary spasm of microvessels, which are more common in cold weather, and viral infections - such as Parvovirus B19 - which is more common during winter.
Diagnosis
Transient apical ballooning syndrome or takotsubo cardiomyopathy is found in 1.7 to 2.2% of patients with acute coronary syndromes. While the original case study was reported in individuals in Japan, takotubo cardiomyopathy has been noted recently in the United States and Western Europe. It is likely that this syndrome was previously undiagnosed before it is described in detail in the Japanese literature. Individual evaluation with a takotsubo cardiomyopathy usually includes a coronary angiogram to rule out the occlusion of the left anterior descending artery, which will not reveal significant blockages that will cause left ventricular dysfunction. Provided that individuals survive their initial presentation, left ventricular function improves within two months.
The diagnosis of takotubo cardiomyopathy may be difficult at presentation. The ECG findings are often confusing with those found during acute myocardial infarction of the anterior wall. This classic mimics the elevation of the myocardial ST-segment elevation, and is characterized by acute onset of apical ventricular apical wall disorder (balloon) with chest pain, shortness of breath, ST-segment elevation, T-wave inversion or QT interval extension on ECG. Cardiac enzymes are usually negative and are worst, and cardiac catheterization usually indicates no significant coronary artery disease.
Diagnosis is made by a pathognomonic motion abnormality, in which the left ventricular base contracts normally or hiperkinetik while left ventricular residual is akinetik or diskinetik. This is accompanied by a significant lack of coronary artery disease that will explain the abnormalities of wall movement. Although the apical balloon has been classically described as an angiographic manifestation of takotubo, it has been shown that left ventricular dysfunction in this syndrome includes not only classical apical balloons, but also different angiographic morphologies such as ventricular air balloons and, rarely, other local balloon segments.
Balloon patterns are classified by Shimizu et al. as takotsubo type for apical akinesia and basal hyperkinesia, reverse takotsubo for basal akinesia and apical hyperkinesia, mid-ventricular type for central ventricular bal- vo accompanied by basal and apical hyperkinesia, and local types for any other segmental left ventricular balloon with clinical characteristics of left ventricular dysfunction similar to takotubo.
In summary, the main criteria for the diagnosis of takotubo cardiomyopathy are: the patient should experience a stressor before symptoms begin to appear; patient ECG readings should show abnormalities of the normal liver; patients should not show signs of coronary blockage or other common causes of heart problems; cardiac enzyme levels in the heart must be increased or irregular; and the patient must recover complete contractions and function normally within a short period of time.
Treatment
The treatment of takotubo cardiomyopathy generally supports naturally, as it is considered a temporary disturbance. Treatment depends on whether the patient has heart failure or acute hypotension and shock. In many individuals, the function of the left ventricle normalizes within two months. Aspirin and other heart medications also appear to aid in the treatment of this disease, even in extreme cases. Once the patient is diagnosed, and myocardial infarction (heart attack) excludes, aspirin regimens can be discontinued, and treatment becomes supportive of the patient.
While medical care is important to overcome the acute symptoms of takotubo cardiomyopathy, further treatment includes lifestyle changes. It is important that the individual remains physically fit while learning and maintaining a method for managing stress, and to cope with difficult situations in the future.
Although the symptoms of takotubo cardiomyopathy usually disappear by itself and this condition heals completely within a few weeks, some serious complications may occur that must be treated. These most commonly include congestive heart failure and very low blood pressure, and less commonly include blood clots in the left ventricular apex, irregular heartbeat, and tearing of the heart wall.
Heart failure
For patients with acute heart failure, ACE inhibitors, angiotensin receptor blockers, and beta blockers, are considered to be the mainstay of the treatment of heart failure. But the use of specialized beta blockers for takotubo cardiomyopathy is controversial, as they may not benefit.
Low blood pressure
For people with cardiogenic shock, medical care is based on whether there is left ventricular outflow (LVOT) obstruction. Therefore, early echocardiography is needed to determine the appropriate management. For those with inotropic agents LVOTs should not be used, but should be managed as patients with hypertrophic cardiomyopathy, (eg phenylephrine and fluid resuscitation). For cases where LVOT is not blocked, inotropic therapy (eg dobutamine and dopamine) may be used, but with consideration that takotsubo is caused by an excess of catecholamines.
Furthermore, mechanical support with an intra-aortic balloon pump (IABP) has been established as supportive care.
Prognosis
Despite the initial presentation of the tomb in some patients, most patients survived the initial acute event, with a very low mortality rate or complications in the hospital. After a patient recovers from the acute stage of the syndrome, they can expect good results and a very long-term prognosis. Even when the ventricular systolic function is severely impaired in presentation, it usually increases within the first few days and is normal within the first few months. Although rare, recurrence of the syndrome has been reported and appears to be related to the nature of the trigger.
Epidemiology
Takotsubo cardiomyopathy is rare, affecting between 1.2% and 2.2% of people in Japan and 2% to 3% in western countries with myocardial infarction. It also affects more women than men with 90% of cases are women, mostly postmenopausal. Scientists believe one reason is that estrogen causes the release of catecholamines and glucocorticoids in response to mental stress. It is impossible for patients who recover syndrome twice, although it has occurred in rare cases. The average age at onset is between 58 and 75 years. Less than 3% of cases occur in patients under 50 years of age.
History
Although the first scientific description of the takotsubo's cardiomyopathy was not until the 1990s, Cebelin and Hirsch wrote of human stress stress cardiomyopathy in 1980. Both saw suicide attacks that occurred in Cuyahoga County, Ohio last 30 years, especially those with autopsies who had no internal injuries , but died of physical attacks. They found that 11 out of 15 had myofibrillar degeneration similar to that of stressful studies in animals. In the end, they conclude their data support the "catecholamine mediation theory of myocardial changes in humans and the lethal potential of stress through its effect on the heart".
The first case studied the takotsubo cardiomyopathy in Japan in 1991 by Sato et al. More cases of syndrome appeared in Japan within the next decade, although western medicine has not been recognized. This syndrome finally occurred in 1997 when Pavin et al. wrote about two cases of "reversible LV dysfunction precipitated by acute emotional stress." The western world had never heard of such a thing at the time, as it is very rare and often misdiagnosed. The Japanese finally reported about the syndrome to the west in 2001 under the name of "temporary circular balloons LV" although at this point the west has heard many cases. The syndrome reached the international audience through media in 2005 when the New England Journal of Medicine wrote about the syndrome.
Cultural reference
A case of what is proved by the Takotsubo syndrome is the central motif of the end of the Blossom Autumn novel (Slovenian: Cvetje v jeseni : 1917) by Slovenian writer Ivan Tav? ar and the movie Blossoms in Autumn (1973) takes a picture afterwards. A village girl named Meta suddenly died after she was asked by Janez, a lawyer from Ljubljana who had spent the summer with her, to marry him. At his funeral, his father stated that he was never very healthy, and that he had a heart defect. His mother stated: "He died of happiness."
References
External links
- Takotsubo site
Source of the article : Wikipedia
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