Le syndrome de « Tako-Tsubo » : à propos de deux cas

Abstract

The "tako-tsubo" syndrome, initially described by Japanese authors is an apical akinesis of the left ventricule without significant coronary artery disease, with a moderate elevation of troponine I. We report 2 cases of women (with an average age of 68 years). They were refered for suspected acute coronary syndrome including on admission chest pain and ST segment elevation. Cardiac ultrasonography shew an apical akinesis. Coronary angiography didn't show significant coronary lesion. A moderate elevation of troponine was noted but no significant elevation of CPK. The prognosis has been excellent for these 2 patients. We observed a ventricular tachycardia due to QT lengthening in 1 case treated anteriorly by Flecaïn which spontaneously resolved. The first month, the electrocardiogram and cardiac ultrasonography anomalies disappeared totally. The treatment is based on β-blockers, aspirin, statines, ACE. In the two cases, we didn't find arguments for myocarditis, recanalized thrombosis, coronary spasm, pheochromocytomas, but a risk factor is inboth: emotional stress. Maybe the diagnosis could be easier with the sub-millimeter cardiac computed tomography.