A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME

Ibrahim Kılıccalan; Sedat Gül

doi:10.18229/kocatepetip.1122741

Review

A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME

Year 2024, , 540 - 549, 21.10.2024

Ibrahim Kılıccalan , Sedat Gül

https://doi.org/10.18229/kocatepetip.1122741

Abstract

Takotsubo syndrome is an acute, reversible disease characterized by transient dysfunction of the left ventricle of the heart. The pathogenesis of Takotsubo syndrome is not known precisely. However, various hypotheses regarding pathogenesis have been put forward. These hypotheses; coronary microvascular dysfunction, coronary artery spasm, catecholamine-induced myocardial stunning, reperfusion injury after acute coronary syndrome, myocardial microinfarction, endothelial dysfunction and estrogen deficiency, and abnormalities in cardiac fatty acid metabolism. Among these hypotheses and theories, catecholamine-induced cardiotoxicity and coronary microvascular dysfunction are most frequently emphasized. Takotsubo syndrome manifests itself with some clinical symptoms and signs. In Takotsubo syndrome, symptoms seen at presentation are chest pain, shortness of breath, and syncope, from the most common to the least. Clinically, it can be confused with acute myocardial infarction or acute coronary syndrome because it causes complaints such as acute chest pain and shortness of breath. Therefore, it is important to differentiate from these diseases. Anamnesis, physical examination, cardiac troponin, creatine kinase, troponin, electrocardiography (ECG), coronary angiography are used in the differential diagnosis. The presence of physical or emotional stress plays an important role in the differential diagnosis of Takotsubo syndrome. There is no specific treatment for Takotsubo syndrome. However, treatment can be divided into two parts as acute and chronic phases. While treatments for complications arising due to Takotsubo syndrome are applied in the acute phase, drugs such as beta blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers are used in the chronic phase. Takotsubo syndrome can also be seen in intensive care patients. In intensive care patients, it often manifests itself with hemodynamic disturbances and respiratory failure. Therefore, Takotsubo syndrome should be considered in intensive care patients when hemodynamic and respiratory changes are observed and patients should be followed up in this direction.

Keywords

Takotsubo syndrome, Intensive care, Stress, Acute Disease.

References

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TAKOTSUBO SENDROMUNA GÜNCEL BİR BAKIŞ

Year 2024, , 540 - 549, 21.10.2024

Ibrahim Kılıccalan , Sedat Gül

https://doi.org/10.18229/kocatepetip.1122741

Abstract

Takotsubo sendromu, kalbin sol ventrikülünün geçici işlev bozukluğu ile karakterize akut, geri dönüşümlü bir hastalıktır. Takotsubo sendromunun patogenezi tam olarak bilinmemektedir. Ancak Takotsubo sendromununpatogenezi ile ilgili çeşitli hipotezler ileri sürülmüştür. Takotsubo sendromunun patogenezi ile ilgili hipotezler; koroner mikrovasküler disfonksiyon, koroner arter spazmı, katekolamin kaynaklı miyokardiyal sersemleme, akut koroner sendromdan sonrası reperfüzyon hasarı, miyokardiyal mikroinfarktüs, endotel disfonksiyonu ve östrojen eksikliği ve kardiyak yağ asidi metabolizmasındaki anormallikler şeklinde adlandırılabilir. Takotsubo sendromu ile ilgili hipotez ve teoriler arasında en sık olarak katekolamin kaynaklı kardiyotoksisite ve koroner mikrovasküler disfonksiyon üzerinde durulmaktadır. Takotsubo sendromu bazı klinik semptom ve bulgularla kendini gösterir. Takotsubo sendromunda, başvuru sırasında görülen semptomlar, en yaygından en aza doğru göğüs ağrısı, nefes darlığı ve senkoptur. Klinik olarak akut göğüs ağrısı ve nefes darlığı gibi şikayetlere neden olduğu için akut miyokard enfarktüsü veya akut koroner sendrom ile karıştırılabilir. Bu nedenle bu hastalıklardan ayırt edilmesi önemlidir. Ayırıcı tanıda anamnez, fizik muayene, kardiyak troponin, kreatin kinaz, troponin, elektrokardiyografi (EKG), koroner anjiyografi kullanılır. Takotsubo sendromunun ayırıcı tanısında fiziksel veya duygusal stresin varlığı önemli bir rol oynar. Takotsubo sendromu için spesifik bir tedavi yoktur. Ancak tedavi akut ve kronik dönemler olarak ikiye ayrılabilir. Akut dönemde Takotsubo sendromuna bağlı gelişen komplikasyonlara yönelik tedaviler uygulanırken, kronik dönemde beta blokerler, anjiyotensin dönüştürücü enzim (ACE) inhibitörleri, anjiyotensin II reseptör blokerleri gibi ilaçlar kullanılmaktadır. Takotsubo sendromu yoğun bakım hastalarında da görülebilmektedir. Yoğun bakım hastalarında sıklıkla hemodinamik bozukluklar ve solunum yetmezliği ile kendini gösterir. Bu nedenle yoğun bakım hastalarında hemodinamik ve solunumsal değişiklikler gözlendiğinde Takotsubo sendromu düşünülmeli ve hastalar bu yönde takip edilmelidir.

Keywords

Takotsubo Sendromu, Yoğun Bakım, Stres, Akut Hastalık.

References

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2. Pelliccia F, Kaski JC, Crea F, et al. Pathophysiology of Takotsubo Syndrome. Circulation. 2017;135(24):2426– 41.
3. Hurst RT, Prasad A, Askew JW, et al. Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology. JACC Cardiovasc Imaging. 2010;3(6):641–9.
4. Medeiros K, O’Connor MJ, Baicu CF, et al. Systolic and diastolic mechanics in stress cardiomyopathy. Circulation. 2014;22(16):1659–67.
5. Prasad A. Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction. Circulation. 2007;115(5):56-9.
6. Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807–16.
7. Haghi D, Athanasiadis A, Papavassiliu T, et al. Right ventricular involvement in Takotsubo cardiomyopathy. Eur Heart J. 2006;27(20):2433–9.
8. Kurowski V, Kaiser A, von Hof K, et al. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest. 2007;132(3):809–16.
9. Ennezat PV, Rossi DP, Aubert JM, et al. Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo). Echocardiography. 2005;22(7):599–602.
10. Van de Walle SOA, Gevaert SA, Gheeraert PJ, et al. Transient stress-induced cardiomyopathy with an ‘inverted takotsubo’ contractile pattern. Mayo Clin Proc. 2006;81(11):1499–502.
11. Cacciotti L, Camastra GS, Beni S, et al. A new variant of Tako-tsubo cardiomyopathy: transient mid- ventricular ballooning. J Cardiovasc Med (Hagerstown). 2007;8(12):1052–4.
12. Veillet-Chowdhury M, Hassan SF, Stergiopoulos K. Takotsubo cardiomyopathy: A review. Acute Cardiac Care. 2014;16(1):15–22.
13. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. American Heart Journal. 2008;155(3):408–17.
14. Doyen D, Moschietto S, Squara F, et al. Incidence, clinical features and outcome of Takotsubo syndrome in the intensive care unit. Archives of Cardiovascular Diseases. 2020;113(3):176–88.
15. Sharkey SW, Maron BJ. Epidemiology and Clinical Profile of Takotsubo Cardiomyopathy. Circ J. 2014;78(9):2119–28.
16. Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015;373(10):929–38.
17. Minhas AS, Hughey AB, Kolias TJ. Nationwide Trends in Reported Incidence of Takotsubo Cardiomyopathy from 2006 to 2012. The American Journal of Cardiology. 2015;116(7):1128–31.
18. Akashi YJ, Nef HM, Lyon AR. Epidemiology and pathophysiology of Takotsubo syndrome. Nat Rev Cardiol. 2015;12(7):387–97.
19. Y-Hassan S. Clinical Features and Outcome of Pheochromocytoma-Induced Takotsubo Syndrome: Analysis of 80 Published Cases. The American Journal of Cardiology. 2016;117(11):1836–44.
20. De Angelis F, Savino K, Oliva V, et al. Over the exceptions: Psychiatric disorder, medical stress, and takotsubo cardiomyopathy. J Cardiovasc Echography. 2017;27(2):66.
21. Ashfaq A, Ullah W, Khanal S, et al. Takotsubo cardiomyopathy: a rare complication of acute viral gastroenteritis. Journal of Community Hospital Internal Medicine Perspectives. 2020;10(3):258–61.
22. Muratsu A, Muroya T, Kuwagata Y. Takotsubo cardiomyopathy in the intensive care unit. Acute Med Surg. 2019;6(2):152–7.
23. Park J-H, Kang S-J, Song J-K, et al. Left Ventricular Apical Ballooning Due to Severe Physical Stress in Patients Admitted to the Medical ICU. Chest. 2005;128(1):296–302.
24. Rowell AC, Stedman WG, Janin PF, et al. Silent left ventricular apical ballooning and Takotsubo cardiomyopathy in an Australian intensive care unit. ESC Heart Failure. 2019;6(6):1262–5.
25. Oras J, Lundgren J, Redfors B, et al. Takotsubo syndrome in hemodynamically unstable patients admitted to the intensive care unit - a retrospective study. Acta Anaesthesiol Scand. 2017;61(8):914–24.
26. Salah HM, Mehta JL. Takotsubo cardiomyopathy and COVID-19 infection. European Heart Journal - Cardiovascular Imaging. 2020;21(11):1299–300.
27. Shah RM, Shah M, Shah S, et al. Takotsubo Syndrome and COVID-19: Associations and Implications. Current Problems in Cardiology. 2021;46(3):100763.
28. Dweck MR, Bularga A, Hahn RT, et al. Global evaluation of echocardiography in patients with COVID-19. European Heart Journal - Cardiovascular Imaging. 2020;21(9):949–58.
29. Giustino G, Croft LB, Oates CP, et al. Takotsubo Cardiomyopathy in COVID-19. Journal of the American College of Cardiology. 2020;76(5):628–9.
30. Bathina J, Weiss S, Weintraub WS. Understanding the pathophysiology of apical ballooning syndrome: a step closer. Expert Rev Cardiovasc Ther. 2015;13(1):5–8.
31. Komamura K, Fukui M, Iwasaku T, et al. Takotsubo cardiomyopathy: Pathophysiology, diagnosis and treatment. World J Cardiol. 2014;6(7):602–9.
32. Tsuchihashi K, Ueshima K, Uchida T, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. J Am Coll Cardiol. 2001;38(1):11–8.
33. Lyon AR, Rees PSC, Prasad S, et al. Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5(1):22–9.
34. Abe Y, Kondo M, Matsuoka R, et al. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol. 2003;41(5):737–42.
35. Abe Y, Kondo M. Apical ballooning of the left ventricle: a distinct entity? Heart. 2003;89(9):974–6.
36. Akashi YJ, Nakazawa K, Sakakibara M, et al. 123I-MIBG myocardial scintigraphy in patients with ‘takotsubo’ cardiomyopathy. J Nucl Med. 2004;45(7):1121–7.
37. Wittstein IS, Thiemann DR, Lima JAC, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352(6):539–48.
38. Abraham J, Mudd JO, Kapur NK, et al. Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists. J Am Coll Cardiol. 2009;53(15):1320–5.
39. Marcovitz PA, Czako P, Rosenblatt S, et al. Pheochromocytoma presenting with Takotsubo syndrome. J Interv Cardiol. 2010;23(5):437–42.
40. Vitale C, Rosano GMC, Kaski JC. Role of Coronary Microvascular Dysfunction in Takotsubo Cardiomyopathy. Circ J. 2016;80(2):299–305.
41. Camici PG, Crea F. Microvascular angina: a women’s affair? Circ Cardiovasc Imaging. 2015;8(4):e003252.
42. Vitale C, Mendelsohn ME, Rosano GMC. Gender differences in the cardiovascular effect of sex hormones. Nat Rev Cardiol. 2009;6(8):532–42.
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Details

Primary Language	English
Subjects	Clinical Sciences
Journal Section	Review
Authors	Ibrahim Kılıccalan 0000-0001-7086-4988 Sedat Gül 0000-0001-6634-7849
Publication Date	October 21, 2024
Acceptance Date	September 5, 2022
Published in Issue	Year 2024

Cite

APA	Kılıccalan, I., & Gül, S. (2024). A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME. Kocatepe Tıp Dergisi, 25(4), 540-549. https://doi.org/10.18229/kocatepetip.1122741
AMA	Kılıccalan I, Gül S. A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME. KTD. October 2024;25(4):540-549. doi:10.18229/kocatepetip.1122741
Chicago	Kılıccalan, Ibrahim, and Sedat Gül. “A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME”. Kocatepe Tıp Dergisi 25, no. 4 (October 2024): 540-49. https://doi.org/10.18229/kocatepetip.1122741.
EndNote	Kılıccalan I, Gül S (October 1, 2024) A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME. Kocatepe Tıp Dergisi 25 4 540–549.
IEEE	I. Kılıccalan and S. Gül, “A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME”, KTD, vol. 25, no. 4, pp. 540–549, 2024, doi: 10.18229/kocatepetip.1122741.
ISNAD	Kılıccalan, Ibrahim - Gül, Sedat. “A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME”. Kocatepe Tıp Dergisi 25/4 (October 2024), 540-549. https://doi.org/10.18229/kocatepetip.1122741.
JAMA	Kılıccalan I, Gül S. A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME. KTD. 2024;25:540–549.
MLA	Kılıccalan, Ibrahim and Sedat Gül. “A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME”. Kocatepe Tıp Dergisi, vol. 25, no. 4, 2024, pp. 540-9, doi:10.18229/kocatepetip.1122741.
Vancouver	Kılıccalan I, Gül S. A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME. KTD. 2024;25(4):540-9.

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