An Emerging Cardiovascular Disease: Takotsubo Syndrome

Abstract

Takotsubo syndrome (TTS) is a recently identified cardiac disease, which is far from being completely known. The aims of this narrative review are to provide a better understanding of the pathophysiological features of TTS and to update clinical findings in order to improve the management of subjects affected by this syndrome (according to the most recent consensus papers issued by the international scientific societies). We based our search on the material obtained via PubMed up to April 2019. The terms used were “Takotsubo Syndrome and Takotsubo cardiomyopathy” in combination with “heart failure, pathophysiology, complications, diagnosis, and treatment.” TTS is a reversible form of ventricular dysfunction usually characterized by akinesia of the apex in the absence of obstructive coronary artery disease. In its initial phase, TTS may be indistinguishable from AMI and is usually triggered by a sudden emotional/physical stressor which abruptly increases catecholamine levels. However, the mechanisms by which catecholamines or other unidentified molecules can cause myocardial dysfunction is unknown. In-hospital stay may be hampered by various life-threatening complications, while data on long-term survival remain scarce and unclear. Furthermore, TTS may sometimes recur. We believe that TTS is clearly a much more complex condition than previously thought. Much remains to be discovered about its pathophysiologic mechanisms, the role of the link between the heart and brain and that of triggering factors and gender, and the reasons why this syndrome displays different phenotypes and sometimes recurs. Undoubtedly, preliminary evidence from pathophysiological studies (mainly genetic studies) has shown promising advances. However, prospective randomized clinical trials are still needed in order to identify and to tailor the best medical treatments for TTS patients.

Síndrome de Takotsubo: Fisiopatología, manifestaciones clínicas y diagnóstico

“…La presentación clínica de esta afección, que se encuentra en pacientes con hemorragia subaracnoidea relacionada con un aneurisma, se parece mucho a la del STT y se caracteriza por una forma completamente reversible de disfunción aguda del VI. En consecuencia, el trabajo experimental ha demostrado que la actividad elevada del sistema nervioso simpático en la fase aguda de la hemorragia subaracnoidea induce daño miocárdico y contribuye al desarrollo de disfunción cardíaca (11,13).…”

“…En una pequeña serie de pacientes en la fase aguda de STT, Moscatelli et al (11) midieron el flujo sanguíneo cerebral regional, un índice bien establecido de actividad cerebral y demostraron un aumento significativo del flujo sanguíneo cerebral en el hipocampo, el tronco encefálico y los ganglios basales en paralelo con una disminución en la corteza prefrontal. Aunque estos cambios disminuyeron gradualmente, todavía estaban presentes en la fase crónica del STT incluso después de que desaparecieron las anomalías típicas del movimiento de la pared cardíaca.…”

“…Las anomalías del movimiento de la pared suelen extenderse al territorio de las arterias coronarias afectadas (9). La angiografía coronaria por TC se emplea como imagen alternativa para excluir la estenosis coronaria cuando la presentación se retrasa o el paciente está libre de dolor y estable al ingreso (11,12).…”

Broken Heart Syndrome Secondary To Liver Abscess

“…Diabetes mellitus, cannabis use, and underlying panic/anxiety disorder are well-known risk factors for TTCM. There are several accepted criteria for diagnosing TTCM [14][15][16]. However, the revised Mayo Clinic criteria are the most widely accepted one ( Table 1).…”

“…In patients with LV thrombus, anticoagulation is recommended for at least 3 months [15]. Studies have failed to show a decrease in the recurrence of TTCM with chronic use of beta-blockers and hence is not recommended [14].…”