Takotsubo syndrome secondary to adaptative emotional disorder
Keywords:
takotsubo, troponin, angiography, electrocardiogram.Abstract
Introduction: Takotsubo syndrome or stress cardiomyopathy is characterized by a transient regional systolic dysfunction, mainly of the left ventricle that simulates an acute myocardial infarction, but in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. It is the cause of 1-2 % of all acute coronary syndromes, which requires a timely diagnosis and an adequate treatment to avoid morbidity and mortality from this pathology.
Objective: to highlight the importance of taking into account takotsubo syndrome or stress cardiomyopathy as a differential diagnosis in patients with chest pain according to the clinical history and pain triggers.
Case presentation: Fifty-year-old patient with typical chest pain after an emotional episode; the initial electrocardiogram reported anterolateral ischemia with positive troponin and systolic heart failure, and the angiography showed no alteration in the coronary vessels, concluding with the diagnosis of Takotsubo syndrome.
Conclusion: It is important to consider takotsubo syndrome in the differential diagnosis of patients with chest pain, evaluating the circumstances by which the pain originates since it requires multidisciplinary medical management.
Downloads
References
1. Stawiarski K, Ramakrishna H. Redefining Takotsubo Syndrome and Its Implications. J Cardiothorac Vasc Anesth [Internet]. 2019;33:[Aprox. 2 p.]. Disiponible en: https://doi.org/10.1053/j.jvca.2019.08.010
2. Summers MR, Prasad A. Takotsubo Cardiomyopathy. Heart Fail Clin [Internet]. 2013;9(2):111–22. Disiponible en: https://doi.org/10.1016/j.hfc.2012.12.007
3. Kurowski V, Kaiser A, Von Hof K, Killermann DP, Mayer B, Hartmann F, et al. Apical and midventricular transient left ventricular dysfunction syndrome (Tako-Tsubo cardiomyopathy): Frequency, mechanisms, and prognosis. Chest [Internet]. 2007;132(3):809–16. Disiponible en: https://doi.org/10.1378/chest.07-0608
4. Ono R, Falcão LM. Takotsubo cardiomyopathy systematic review: Pathophysiologic process, clinical presentation and diagnostic approach to Takotsubo cardiomyopathy. Int J Cardiol [Internet]. 2016; 209:196–205. Disiponible en: https://doi.org/10.1016/j.ijcard.2016.02.012
5. Campos FAD, Ritt LEF, Costa JPS, Cruz CM, Feitosa Filho GS, Oliveira QB de, et al. Factors Associated with Recurrence in Takotsubo Syndrome: A Systematic Review. Arq Bras Cardiol [Internet]. 2020;115:[Aprox. 2 p.]. Disiponible en: https://doi.org/10.36660/abc.20180377
6. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med [Internet]. 2015; 373(10):929–38. Disiponible en: https://doi.org/10.1056/NEJMoa1406761
7. Ugalde Prieto H, Yubini MC, Sanhueza MI, Ayala F, Chaigneau E, Dussaillant G, et al. Síndrome de tako-tsubo, caracterización clínica y evolución a un año plazo. Rev Med Chil [Internet]. 2017; 145(10):1268–75. Disiponible en: https://doi.org/10.4067/S0034-98872017001001268
8. Di Filippo C, Bacchi B, Di Mario C. Novel Aspects of Classification, Prognosis and Therapy in Takotsubo Syndrome. Eur Cardiol [Internet]. 2019; 14(3):191–6. Disiponible en: https://doi.org/10.15420/ecr.2019.27.3
9. Sattar Y, Siew KSW, Connerney M, Ullah W, Alraies MC. Management of Takotsubo Syndrome: A Comprehensive Review. Cureus [Internet]. 2020; 12(1):e6556. Disiponible en: https://doi.org/10.7759/cureus.6556.
10. Aparisi Á, Uribarri A. Takotsubo syndrome. Med Clin (Barc) [Internet]. 2020; 155(8):347–55. Disiponible en: https://doi.org/10.1016/j.medcli.2020.04.023
11. Sato H, Tateishi H, Uchida T, Dote K, Ishihara M, Kodama K, et al. Takotsubo-type cardiomyopathy due to multivessel spasm. En: Kodama K, Haze K, Hon M, eds. Clinical aspect of myocardial injury: from ischemia to heart failure. Tokio: Kagakuhyoronsha; 1990. Pp. 55–64.
12. Y-Hassan S, Yamasaki K. History of takotsubo syndrome: is the syndrome really described as a disease entity first in 1990? Some inaccuracies. International journal of cardiology [Internet]. 2013; 166: 736–7. Disiponible en: https://doi.org/10.1016/j.ijcard.2012.09.183
13. Consenso ESC 2018 sobre la cuarta definición universal del infarto. Rev Española Cardiol [Internet]. 2019; 72(1):72.e1-72.e27. Disiponible en: https://doi.org/10.1016/J.RECESP.2018.11.011
14. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J [Internet]. 2006; 27(13):1523–9. Disiponible en: https://doi.org/10.1093/eurheartj/ehl032
15. Y-Hassan S, Tornvall P. Epidemiology, pathogenesis, and management of takotsubo syndrome. Clinical Autonomic Research [Internet]. 2018; 28: 53–65. Disiponible en: https://doi.org/10.1007/s10286-017-0465-z
16. Verschure DO, Somsen GA, van Eck-Smit BLF, Knol RJJ, Booij J, Verberne HJ. Tako-tsubo cardiomyopathy: how to understand possible pathophysiological mechanism and the role of (123) I-MIBG imaging. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol [Internet]. 2014; 21(4):730–8. Disiponible en: https://doi.org/10.1007/s12350-014-9855-y
17. Kato K, Lyon AR, Ghadri JR, Templin C. Takotsubo syndrome: aetiology, presentation and treatment. Heart [Internet]. 2017; 103(18):1461–9. Disiponible en: https://doi.org/10.1136/heartjnl-2016-309783
18. Agdamag AC, Patel H, Chandra S, Rao A, Suboc TM, Marinescu K, et al. Sex Differences in Takotsubo Syndrome: A Narrative Review. J Women’s Heal [Internet]. 2020; 29(8):1122–30. Disiponible en: https://doi.org/10.1089/jwh.2019.7741
19. Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, et al. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail [Internet]. 2016; 18(1):8–27. Disiponible en: https://doi.org/10.1002/ejhf.424
20. Núñez Gil IJ, Almendro Delia M, Andrés M, Sionis A, Martin A, Bastante T, et al. Secondary forms of Takotsubo cardiomyopathy: A whole different prognosis. Eur Hear journal Acute Cardiovasc care [Internet]. 2016; 5(4):308–16. Disiponible en: https://doi.org/10.1177/2048872615589512
21. Nyman E, Mattsson E, Tornvall P. Trigger factors in takotsubo syndrome – A systematic review of case reports. Eur J Intern Med [Internet]. 2019; 63:62–8. Disiponible en: https://doi.org/10.1016/j.ejim.2019.02.017
22. Ghadri JR, Cammann VL, Jurisic S, Seifert B, Napp LC, Diekmann J, et al. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. Eur J Heart Fail [Internet]. 2017; 19(8):1036–42. Disiponible en: https://doi.org/10.1002/ejhf.683
23. Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, et al. Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol [Internet]. 2010; 55(4):333–41. Disiponible en: https://doi.org/10.1016/j.jacc.2009.08.057
24. Mitsuma W, Kodama M, Ito M, Tanaka K, Yanagawa T, Ikarashi N, et al. Serial electrocardiographic findings in women with Takotsubo cardiomyopathy. Am J Cardiol [Internet]. 2007; 100(1):106–9. Disiponible en: https://doi.org/10.1016/j.amjcard.2007.02.062
25. Moscatelli S, Montecucco F, Carbone F, Valbusa A, Massobrio L, Porto I, et al. An Emerging Cardiovascular Disease: Takotsubo Syndrome. Biomed Res Int [Internet]. 2019; 10:[Aprox. 2 p.]. Disiponible en: https://doi.org/10.1155/2019/6571045
Download PDF
