A CURRENT OVERVIEW OF TAKOTSUBO SYNDROME

Yıl 2024, Cilt: 25 Sayı: 4, 540 - 549, 21.10.2024

Ibrahim Kılıccalan , Sedat Gül

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

Öz

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.

Anahtar Kelimeler

Takotsubo syndrome, Intensive care, Stress, Acute Disease.

TAKOTSUBO SENDROMUNA GÜNCEL BİR BAKIŞ

Öz

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.

Anahtar Kelimeler

Takotsubo Sendromu, Yoğun Bakım, Stres, Akut Hastalık.

Kaynakça

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