Abstract
Takotsubo syndrome (TTS) is a reversible left ventricular dysfunction characterized by local apical hypokinesia usually triggered by a physical or emotional stress. According to the last available data TTS may represent 2% of all admissions for acute coronary syndromes. Despite the reliable prevalence, diagnosis of TTS remains difficult. The initial presentation, both clinically and electrocardiographically, is similar to an acute myocardial infarction (AMI). The biomarker profile is also similar, although the peaks of troponin and creatinine kinase levels are lower, and brain natriuretic peptide levels are higher in patients with TTS compared with ST-segment elevation AMI. Modified Mayo diagnostic criteria are the most common for the diagnosis. Pathogenesis of TTS currently is not well understood. Catecholamines appear to play a central role in the pathophysiology of TTS. However, it is conceivable that some people have a genetic predisposition to stress-induced TTS. A genetic predisposition has been suggested based on the few familial TTS cases described. Despite reversible myocardial dysfunction, acute heart failure is the most common complication in the acute phase of TTS. In-hospital mortality rate is comparable to that of ST-segment elevation AMI. There are no randomized clinical trials to support specific treatment recommendations in TTS. It is believed that the tactics of managing patients with TTS hospitalized with suspicion of acute coronary syndrome should comply with the protocol of management of patients with AMI while acute coronary pathology is not excluded.
Highlights
Takotsubo syndrome (TTS) is a reversible left ventricular dysfunction characterized by local apical hypokinesia usually triggered by a physical or emotional stress
The biomarker profile is similar, the peaks of troponin and creatinine kinase levels are lower, and brain natriuretic peptide levels are higher in patients with TTS compared with ST-segment elevation acute myocardial infarction (AMI)
Catecholamines appear to play a central role in the pathophysiology of TTS
Summary
Кардиомиопатия такоцубо – это остро развивающаяся дисфункция миокарда левого желудочка (ЛЖ), впервые описанная в 1990 г. Sato и соавт., характеризующаяся уникальным паттерном регионального, циркулярного снижения сократимости миокарда ЛЖ, приводящим к транзиторному баллонированию ЛЖ во время систолы. В основе заболевания лежит остро развивающаяся гибернация миокарда, зона которой выходит за пределы территории кровоснабжения одной коронарной артерии [1]. В литературе можно встретить множество синонимов для описания этой патологии, в том числе: синдром такоцубо, синдром «разбитого сердца», стресс-индуцированная кардиомиопатия. Клиническая картина заболевания в остром периоде мало отличается от острого инфаркта миокарда [4,5]. И включавшего 6523 пациента с синдромом такоцубо, распространенность заболевания составляет около 2% от всех госпитализаций с подозрением на острый коронарный синдром (ОКС) [6]. До 90% пациентов с синдромом такоцубо составляют женщины в постменопаузальном периоде. По данным Wedekind и соавт. от 2006 г. доля синдрома такоцубо среди женщин, госпитализированных по поводу ОКС, достигает 710%
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