BackgroundTakotsubo cardiomyopathy (TTC) is characterised by transient contractility disturbances of the apex of the left ventricle.MethodsWe enrolled 101 patients from the northern-eastern part of Poland in the years 2008–2012 who were hospitalised for TCC. The control group consisted of female patients diagnosed with anterior myocardial infarction with ST-segment elevation (anterior STEMI) (n = 101).Results89 % of the study group were women. Patients with TTC had diabetes (12.6 % vs 29.7 %; p = 0.002) and hyperlipidaemia (36.8 % vs 64.4 %; p = 0.0001) significantly less frequently, and better kidney function assessed by estimated glomerular filtration rate versus patients with anterior STEMI (74.52 % vs 64.30 %; p = 0.004). In the TTC group there were more patients with chronic obstructive pulmonary disease (11.6 % vs 1.0 %; p = 0.002) and thyroid disturbances, especially hyperthyroidism (23.4 % vs 11.0 %; p = 0.021). In patients with TTC sudden cardiac arrest, pulmonary oedema and cardiogenic shock were observed less frequently than in the control group (14.7 % vs 30.7 %; p = 0.0078). Hospitalisations in TTC patients were less frequently complicated by pneumonia (20.0 % vs 35.6 %; p = 0.0148) and urinary infection (4.2 % vs 21.8 %; p = 0.0003). Cardiac rupture occurred in 3 patients with TTC and in 1 with anterior STEMI. In-hospital mortality was significantly lower in the group with TTC. Also, mortality at 30 days, 3 months, 1 year and 2.5 years was significantly lower in patients with TTC than in patients with MI (p = 0.035; p = 0.0226; p = 0.0075; p = 0.009).ConclusionsPreviously considered to be a benign syndrome, TTC should be reconsidered as a clinical condition at risk for serious complications such as cardiac arrest, cardiogenic shock, pulmonary oedema and cardiac rupture leading to death and causing substantial early hazard. The prognosis in TTC is significantly better than in patients with anterior STEMI.

No abstract

A b s t r a c tThe early period of myocardial infarction may be a dramatic step in coronary heart disease due to the risk of sudden death or acute heart failure less often. It is known that a quick opening coronary artery responsible for the creation of a myocardial infarction, is the best method of treatment in the prevention of these complications. We describe a case of a 75-year-old patient with myocardial infarction complicated by pulmonary edema and cardiogenic shock, treated with primary coronary angioplasty with the left transradial approach.Key words: myocardial infarction, cardiogenic shock, transradial approach S t r e s z c z e n i e Wczesny okres ostrego zawału serca może być dramatycznym etapem choroby wieńcowej ze względu na ryzyko nagłego zgonu lub rzadziej -ostrej niewydolności krążenia. Wiadomo, że szybkie udrożnienie zamkniętej tętnicy wieńcowej odpowiedzialnej za powstanie zawału serca jest najlepszą metodą leczniczą w profilaktyce wspomnianych powikłań. Opisujemy przypadek 75-letniego pacjenta z zawałem serca powikłanym obrzękiem płuc i wstrząsem kardiogennym, leczonego metodą pierwotnej angioplastyki wień-cowej z wkłucia promieniowego lewego.Słowa kluczowe: zawał serca, wstrząs kardiogenny, wkłucie promieniowe

A b s t r a c tSevere functional mitral regurgitation in acute myocardial infarction may be one of the main reasons for cardiogenic shock. According to data from the SHOCK registry, this happens in 6.9% of cases of acute myocardial infarction complicated by heart failure. The only way to significantly improve the prognosis is the use of intra-aortic balloon pump (IABP) and urgent coronary revascularization. We describe a patient with acute myocardial infarction without ST-segment elevation, complicated by severe mitral regurgitation, successfully treated with IABP and percutaneous coronary intervention of the infarct-related coronary artery.K Ke ey y w wo or rd ds s: : myocardial infarction, cardiogenic shock, mitral regurgitation S t r e s z c z e n i e Duża czynnościowa niedomykalność zastawki mitralnej (mitral regurgitation -MR) w świeżym zawale serca (myocardial infarction -MI) może być jednym z zasadniczych powodów wstrząsu kardiogennego (cardiogenic shock -CS). Według danych rejestru SHOCK zdarza się to w około 7% przypadków zawału powikłanego ostrą niewydolnością serca. Podobnie jak w każdej innej przyczynie CS wikłającego MI, jedynie zastosowanie balonu kontrapulsacyjnego (intra-aortic balloon pump -IABP) i wczesna rewaskularyzacja wieńcowa przynoszą największą korzyść choremu, gdyż zwiększają szanse przeżycia. Przedstawiono przypadek pacjenta z zawałem serca bez uniesienia odcinka ST powikłanym ciężką MR, skutecznie leczonego IABP i plastyką tętnicy wieńcowej odpowiedzialnej za zawał serca. S Sł ło ow wa a k kl lu uc cz zo ow we e: : zawał serca, wstrząs kardiogenny, niedomykalność mitralna Corresponding author/Adres do korespondencji: Romuald Krynicki MD, PhD, Department of Cardiology, Hospital, 11 Piłsudski St, 18-400 Lomza, Poland, tel./fax: +48 86 47 33 265, e-mail: a.s@kardiologia-lomza.pl P Pr ra ac ca a w wp pł ły yn nę ęł ła a: : 28.07.2012, p pr rz zy yj ję ęt ta a d do o d dr ru uk ku u: : 13.09.2012. Case report/Opis przypadku IntroductionSevere functional mitral regurgitation (MR) complicating myocardial infarction (MI) may be one of the leading causes of cardiogenic shock (CS). According to data from the SHOCK registry it occurs in approximately 7% of cases of MI complicated by acute heart failure [1]. As in other causes of CS complicating acute myocardial infarction, intra-aortic balloon pump (IABP) and early percutaneous coronary intervention (PCI) are the sole strategies bringing significant benefits to the patient and increasing the chance of survival [2].We describe a case of a patient with non-ST-segment elevation MI complicated by severe MR successfully treated with IABP and PCI of the right coronary artery, which was the infarct-related artery. Case report