TAKO-TSUBO KARDİYOMİYOPATİ: LİTERATÜR DERLEME

Tako-tsubo sendromu koroner arterlerinde anlamlı darlık olmayan kişide, sol ventrikül apikal kısmının, geçicibalonlaşması ile karakterize bir sendromdur. Ampulla kardiyomiyopatisi, insan stres kardiyomiyopatisi, kırıkkalp sendromu da denmektedir. Daha çok postmenapozal kadınlarda görülmektedir. Patogenezde stres faktörleri,artmış adrenerjik aktivite, uzamış stunned miyokardiyum, hipertansiyon, kronik obstrüktif akciğer hastalığı(KOAH), azalmış östrojen seviyesi, küçük damar hastalığı, miyokardit, miyokardın yağ asidi metabolizmasınınyetersiz olması öne sürülmüştür. Hastaların öyküsünde semptomlar başlamadan önce genellikle stresli fiziksel,duygusal olaylar mevcuttur. Hastalık klinik olarak nadiren asemptomatik seyredebilir. Göğüs ağrısı, dispne,senkop gibi semptomlar görülebilir. Kalp yetmezliği, supraventriküler ve ventriküler aritmiler oluşabilir. EKGbulguları miyokard enfarktüsü ile benzer.Anteriyor derivasyonlarda ST segment yükselmesi, T dalga negatifliği,QT mesafesi uzaması, nadiren geçici patolojik Q dalgası oluşumu gözlenebilir. Ekokardiyografide tipik olarakantero-apikal akinezi veya diskinezi gözlenir ve günler-haftalar arasında tamamen düzelir. Koroner anjiyografidekoroner arterlerde anlamlı darlıklar gözlenmez. Ventrikülografide anteroapikal balonlaşma ile bazalsegmentlerde kontraktilite artışı saptanır. Manyetik rezonans görüntüleme (MRG), ekokardiyografi gibi bölgeselduvar hareket bozukluğunu göstermede yararlı olabilir. TTK tedavisi ile ilgili kesinleşmiş bir kılavuzbulunmamaktadır. Tedavi az sayıdaki olgu serilerine dayanılarak yapılmaktadır ve destek tedavisi şeklindedir.Koroner anjiyografi yapılamayan merkezlerde akut koroner sendrom tedavisi verilmelidir. Prognozu iyi olansendromun tekrarlama olasılığı mevcuttur. Tekrarı önlemek amacıyla beta bloker ilaçlar verilebilir

Anahtar Kelimeler:

Takotsubo kardiyomiyopati, miyokard enfarktüsü, ekokardiyografi, koroner anjiografi

Tako-Tsubo Cardiomyopathy: Literature Review

Tako tsubo cardiomyopathy is characterized by transient left ventricular apical balooning without significant coronary artery stenosis. It is also referred as Ampulla cardiomyopathy, Human stress cardiomyopathy, Broken heart syndome. It has been described in postmenopausal females with a recent history of physical or emotional stress. In the pathogenesis there are physical stress, stunned myocardium, hypertension, increased adrenergic activity , chronic obstructive pulmonary disease , decreased serum estrogen levels, myocarditis, impairment in fatty ascites metabolizm of myocardium, impairment in multivessel microcirculation. The clinical presentation is usually chest pain, dyspnea , syncope, ,heart failure . supraventricular and ventricular arythmias .In some cases it is asymptomatic . ST segment elevation, T wave inversion, QT interval prolongation, may be detected in electrocardiography which mimics myocardial infarction. Echocardiography shows anteroapical akinezis or diskinesis. Significant coronary artery stenosis is not detected on coronary angiography. Ventriculography demonstrates anteroapical balooning and hypercontractility of basal segments. MRI (Magnetic Resonance Imaging ) shows left ventricular mid and apical diskinezis like echocardiography.MRI is useful in diagnosis of TTC.There is no guideline for the treatment ofTakotsubo cardiomyopathy. The treatment is generally supportive according to few cases. In hospitals which coronary angiography can not be performed, patients should be treated like patients with myocardial infarction . Beta bloker agents should be given in order to prevent recurrences. The prognosis is generally favorable.

Keywords:

Takotsubo cardiomyopathy, myocardial infarction, echocardiography, coronary angiography,

PDF

___

1. Sato H, Tateishi H, Uchida T, Dote K, Ishihara M. Takotsubo-type cardiomyopathy due to multivessel spasm. In: Kodama K, Haze K,Hon M, editors. Clinical aspect of myocardial injury: from ischemia to heart failure. Kagaku Hyoronsha, Tokyo, 1990:56-64.
2. Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med 2004;141:858.
3. Akashi Y, Nakazawa K, Sakakibara M, Miyake F, Koike H, Sasaka K, et al. The clinical features of takotsubo cadiomyopathy. Q J Med 2003:96:563-73.
4. Sadamatsu K, Tashiro H, Maehira N, Yamamoto K. Coronary microvasculer abnormality in the reversible systolic dysfunction observed after non cardiac disease. Jpn Circ J 2000;64:789-92.
5. Shneider B, Stein J. Takotsubo like transient left ventricular disfunction: prevelance and clinical findings in a western population. Circulation 2004:110( Suppl III):697.
6. Akashi YJ, Tejima T,Sakurada H, Matsuda H, Suzuki K, Kawasaski K, et al. Left ventricular rupture associated with takotsubo cardiomyopathy. Mayo Clin proc 2004;79:821-4.
7. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction . Mayo Clinic and Mayo Foundation, Rochester, MN ONLINE 2008.
8. Park JH, Kang SJ, Song JK, Kim HK, Lim CM, Kong DH, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest 2005;128:296-302.
9. Wittstein IS, Thiemann DR, Lima JAC, Baughman KL, Schulman SP, Gerstenblitin G , et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005;352:539- 48.
10. Tsuchihashi K, Ueshima K, Uchida T, Oh- mura N, Kimura K, Owa M, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. JAm Coll Cardiol 2001;38:11-8.
11. Ueyama T. Emotional stress-induced Tako-tsubo cardiomyopathy: animal modeland molecular mechanism.Ann NYAcad Sci 2004;1018:437-44.
12. Hertting K, Krause K, Harle T, Boczor S, Reimers J, Kuck KH, et al. Transient left ventricular apical ballooning in a community hospital in Germany. Int J Cardiol 2006;112:282-8.
13. Stollberger C, Finsterer J, Schneider B. Tako-tsubo-like left ventricular dysfunction: clinical presentation, instrumental findings, additional cardiac and noncardiac diseases and potential pathomechanisms. Minerva Cardioangiol 2005;53:139-45.
14. Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H.Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol 2003;41:737-42.
15. Kurisu S, Inoue I, Kawagoe T, Ishihara M, Schimatani Y, Nishioka K, et al. Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo-like left ventricular dysfunction. J Am Coll Cardiol 2003;41:743-8.
16. Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Musha H, Sasaka K. 123I-MIBG myocardial scintigraphy in patients with ''takotsubo'' cardiomyopathy. J Nucl Med 2004;45:1121-7.
17. Ibanez B, Navarro F, Cordoba M, M-Alberca P, Farre J. Tako-tsubo transient left ventricular apical ballooning: is intravascular ultrasound the key to resolve the enigma? Heart 2005;91:102-4.
18. Libby P. Act local, act global: inflammation and the multiplicity of 'vulnerable'' coronary plaques. J Am Coll Cardiol 2005;45:1600-2.
19. Ueyama T, Hano T, Kasamatsu K,Yamamoto K, Tsuruo Y, Nishio I . Estrogen attenuates the emotional stres inducedcardiac responses in the animal model of takotsubo (Ampulla) cardiomyopathy. J Cardiovasc Pharmacol 2003;42(Suppl 1):117-9.
20. Merli E, Sutcliffe S, Gori M, Sutherland GG. TakoTsubo cardiomyopathy: New insights into the possible underlying pathophysiology. Eur J Echocardiogr 2006;7:53-61.
21. Kardeşoğlu E, Aparcı M, Uz Ö, Özmen N, Çelik T, Cebeci BS. Tako-tsubo kardiyomyopatili bir olgu ve literatürün gözden geçirilmesi. MN Kardiyol 2007;14:392-5.
22. Maden O, Özlü M F, Çelenk M K, Selçuk H, Selçuk MT. Akut stresle gelişebilen muhtemel kardiyak komplikasyon: Tako-tsubo Sendromu. MN Kardiyol 2007;14:396-8
23. Arslan U, Tavil Y, Abacı A, Çengel A. Transient left ventricular apical ballooning syndrome: first series in Turkish patients.Anatol J Cardiol 2007;7:189-90.
24. Kurisu S, Inoue I, Kawagoe T, Ishihara M, Schimatani Y, N a k am u r a S, et al. Tim e c o u r s e o f electrocardiographic changes in patients with takotsubo syndrome: comparison with acute myocardial infarction with minimal enzymatic release. Circ J 2004;68:77-81.
25. Nault M, Baranchuk A, Simpson C, Redfearn D. Takotsubo cardiomyopathy: a novel “proarrhythmic” disease-Case report . Anatol J Cardiol 2007:7(Suppl 1):101-3.
26. Nyui N, Yamanaka O, Nakayama R, Sawano M, Kawai S. 'Tako-tsubo' transient ventricular dysfunction: a case report. Jpn Circ J 2000;64:715-9.
27. Abdulla I, Kay S, Mussap C, Nelson G, Rasmussen H, Hansen P, et al. Apical sparing in tako-tsubo cardiomyopathy. Int Med J 2006;36:414-8.
28. Sharkey S, Lesser J, ZenovichA, Maron M, Lindberg J, Longe TF, et al. Acute and reversible cariomyopathy provoked by sress in women from the United States. Circulation 2005;11:472-9.
29. Joshi SB, Chao T, Herzka DA, Zeman PR, Cooper HA, Lindsay J, Fuisz AR. Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome. Int J Cardiovasc Imaging 2010;26:227-32.
30. Nissen SE. Pathobiology, not angiography, should guide management in acute coronary syndrome/nonST-segment elevation myocardial infarction. JAm Coll Cardiol 2003;41:03S-12S.
31. Desmet W, Adriaenssens B, Dens J. Apikal balooning of the left ventricle: first series in white patients. Heart 2003;89:1027-31.
32. Akashi Y, Musha H, Nakazawa K, Miyake F. Plasma brain natriuretic peptide in takotsubo cardiyomyopathy. Q J Med 2004;97:599-607.
33. Yoshida T, Hibino T, Fujimaki T, Oguri M, Kato K, Yajima K, Ohte N, Yokoi K, Kimura G. Tako-tsubo cardiomyopathy complicated by apical thrombus formation: a case report. Int J Cardiol 2009;132(3):e120-2.
34. Akashi YJ, Tejima T, Sakurada H. Left ventricular rupture associated with Takotsubo cardiomyopathy. Mayo Clin Proc 2004;79(6):821-4.
35. Figueredo VM, Gupta S. Embolic complication of Tako-Tsubo cardiomyopathy QJM 2009;102(11):820- 2.
36. Kodama S, Miyoshi K, Shiga Y, Maruyama S, Sumi S, Tojou H, Yamanouchi Y, Urata H. Takotsubo cardiomyopathy complicated by high-grade atrioventricular block: A report of two cases . Exp Clin Cardiol 2009;14(2):e35-8.
37. Tibrewala AV, Moss BN, Cooper HA. A rare case of tako-tsubo cardiomyopathy complicated by a left ventricular thrombus. South Med J 2006;99:2-3.
38. Yasuga Y, Inoue M, Takeda Y, Kitazume R, Hayashi N, Nakagawa Y, et al. Tako-tsubo-like transient left ventricular dysfunction with apical thrombus formation: a case report. J Cardiol 2004;43:75-80.
39. Sasaki N, Kinugawa T, Yamawaki M, Furuse Y, Shimoyama M, Ogino K, et al. Transient left ventricular apical ballooning in a patient with bicuspid aortic valve created a left ventricular thrombus leading to acute renal infarction. Circ J 2004;68:1081-3.
40. Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K, et al. Left ventricular apical thrombus formation in a patient with suspected tako-tsubo-like left ventricular dysfunction. Circ J 2003;67:556-8.
41. Desmet W, Adriaenssens B, Dens J. Apikal balooning of the left ventricle: first series in white patients. Heart 2003;89(9):1027-31.
42. Lipiecki J, Durel N, Decalf V, Soubeyrand P, Moisa A, Citron B, et al. Transient left ventricular apical ballooning or the tako-tsubo syndrome. Arch Mal Coeru Vaiss 2005;98:275-80.
43. Dib C, Asirvatham S, Elesber A, Rihal C, Friedman P, Prasad A. Clinical correlates and prognostic significance of electrocardiographic abnormalities in apical ballooning syndrome (Takotsubo/stress-induced cardiomyopathy).Am Heart J 2009;157(5):933-8