Takotsubo Syndrome (Takotsubo) (Clinical Case with the Analysis of Modern Diagnostic and Therapeutic Algorithms for the Management of Patients)

Abstract

Introduction. Takotsubo syndrome is a transient stress-induced condition that simulates acute coronary syndrome. The disease is rare and difficult for verifying due to necessity of using invasive techniques. At present, there are following main pathophysiological hypotheses of Takotsubo syndrome: vascular – acute multi-vessel coronary spasm, «aborted» myocardial infarction with spontaneous reсanalization; myocardial – acute increasing of post-load of left ventricle, acute obstruction of the output tract of left ventricle and direct catecholamine myocardial stunning. The aim of the study. Analysis of modern approaches for diagnostics and treatment of patients with Takotsubo syndrome and analysis of our own clinical case. Materials and methods. Systemic analysis, bibliosemantics and analysis of case of a specific patient with Takotsubo syndrome. The searching of sources was carried out using scientific – statistical database of medical information: PubMed – NCBI. Totally, 9 sources in English and Russian languages were analyzed. Results. Takotsubo syndrome is one of the clinical variants of acute coronary syndrome. At present, the classic model of the syndrome is a regional violation of the movement of the walls of the left ventricle: circular hypokinesia of the apex and middle segments with hyperkinesia of the distal segments which is diagnosed by transthoracic echocardiography. The criteria for diagnosis of Takotsubo syndrome are: transient, inverse violations of regional contractility of the left or right ventricle, which often, but not always, preceded by a stress trigger (emotional or physical); regional violations are usually larger than the blood supply pool of one coronary artery and are often manifested by circular dysfunction of the involved segment of the left ventricle; the absence of causative changes in the coronary arteries (acute damage to the plaque, the formation of intracoronary thrombus, dissection of the coronary arteries) or other pathological processes that could explain transient left ventricle dysfunction (for example – hypertrophic cardiomyopathy, viral myocarditis); new, transient changes in the electrocardiogram (ST segment elevation, ST segment depression, blockade of the left leg of a bunch of Gis, inversion of the T wave and/or long QT interval); diagnostic increasing of natriuretic peptides; a relatively small increasing of troponins, which does not correspond to the area of lesions of the left ventricle; restoration of left ventricular function based on results of visualization methods in dynamic observation (3-6 months). However, to diagnose the Takotsubo syndrome, it is extremely important to exclude acute coronary occlusion by performing an early coronarography and determining the level of cardiac biomarkers. The clinical course of the pathology, the results of clinical and laboratory diagnostic methods (troponin test), visualization methods of diagnostics (echocardioscopy) and interventional examination of coronary vessels (coronaro-and ventriculography) gave us reasons to suspect the presence of Takotsubo syndrome and to choose the right therapeutic tactics. However, to diagnose Takotsubo syndrome it is extremely important to exclude an acute coronary occlusion by perfoming of early coronarography and ventriculography and determining the level of cardiac biomarkers. It have not been performed the randomized clinical trials of specific treatment for such patients. Conclusions. Modern invasive methods for diagnosing of heart diseases (echocardiography, coronarography and determining of biomarkers of myocardial necrosis) allow us to reliably verify the Takotsubo syndrome. To develop the optimal tactic for the management of patients with Takotsubo syndrome it is expedient to conduct the randomized trials.

Keywords

• diagnostic-treatment algorithm
• Takotsubo syndrome