La cardiomiopatía de Takotsubo es una rara falla cardiaca aguda que puede manifestarse en situaciones de estrés. Es de importancia vital conocer este síndrome para establecer su diagnóstico y manejo oportunos, en especial en los casos relacionados con la anestesia. Se envían 7 interesantes artículos sobre este tema.
Takotsubo cardiomyopathy is a rare acute heart failure that can occur in stressful situations. It is very important to know this syndrome to establish diagnosis and timely management, especially in cases related to anesthesia. We e-mail seven interesting articles on this topic.
Takotsubo cardiomiopatia é uma insuficiência cardíaca aguda rara pode ocorrer em situações estressantes. É vital saber desta síndrome para estabelecer o diagnóstico e tratamento oportuno, especialmente em casos relacionados com a anestesia. Eles enviaram sete artigos interessantes sobre este tema.
Cardiomiopatía inducida por estres (Síndrome de Tako-Tsubo) en Austria
Stress-induced cardiomyopathy (Tako-Tsubo syndrome) in Austria
Valerie Weihs, Daniela Szücs, Barbara Fellner, Bernd Eber, Wolfgang Weihs, Thomas Lambert, Bernhard Metzler, et als
European Heart Journal: Acute Cardiovascular Care 2013;2:137 DOI:10.1177/2048872613483592
Abstract
Background: Tako-Tsubo syndrome (TS) is a still rarely diagnosed clinical syndrome, which is characterized by acute onset of chest pain, transient cardiac dysfunction with (frequently) reversible wall motion abnormalities (WMAs), but with no relevant obstructive coronary artery disease. Methods and results: Among 179 consecutive patients with proven diagnosis of TS that were retrospectively analysed in this multicentre registry, women represented the majority of patients (94%) while only 11 men (6%) developed TS. Mean age was 69.1±11.5 years (range 35-88 years). Cardinal symptoms of TS, which led to admission, were acute chest pain (82%) and dyspnoea (32%), respectively. All patients demonstrated typical WMAs, whereby four different types of WMAs could be defined: (1) a more common apical type of TS (n=89; 50%); (2) a combined apical and midventricular form of TS (n=23; 13%); (3) the midventricular TS (n=6; 3%); and (4) an unusual type of basal WMAs of the left ventricle (n=3). Only in 101 patients (57%), a clear causative trigger for onset of symptoms could be identified. In-hospital cardiovascular complications occurred in 25 patients (14%) and consisted of cardiac arrhythmias in 10 patients (40%), cardiogenic shock in six patients (24%), cardiac decompensation in eight patients (32%) and cardiovascular death in one patient, respectively. Echocardiographic control of left ventricular function after the initial measurement was available in almost 70% of the patients: complete recovery of WMAs was found in 73 patients (58.87%); 49 patients (39.52%) showed persistent WMAs. Recurrences of TS were only seen in four patients. During the follow-up period, 13 patients died: three of cardiovascular causes and 10 of non-cardiac causes. In-hospital mortality was 0.6%, 30-day mortality was 1.3% and 2-year mortality was 6.7%. Conclusions: This study represents to date the largest series of patients suffering from TS in Austria and worldwide. Similar to others, in our series the prevalence of TS was significantly higher in women than in men, while in contrast to other studies, the apical type of TS was detected most frequently. The similar clinical presentation of TS patients to the clinical picture of acute myocardial infarction demonstrates the importance of immediate coronary angiography for adequate differential diagnosis of TS. TS is not necessarily a benign disease due to cardiovascular complications as well as persistent WMAs with delayed recovery.
http://acc.sagepub.com/content/2/2/137.full.pdf
Reactividad microvascular coronaria dañada en mujeres con síndrome de abalonamiento apical (Takotsubo/cardiomiopatía por estrés)
Impaired coronary microvascular reactivity in women with apical ballooning syndrome (Takotsubo/stress cardiomyopathy)
Sandeep M Patel, Amir Lerman, Ryan J Lennon, Abhiram Prasad
European Heart Journal: Acute Cardiovascular Care 2013;2:147-152
Abstract
Aims: The pathophysiology of apical ballooning syndrome (ABS) remains to be elucidated. The aim of this study was to evaluate the coronary vascular reactivity of patients who were previously diagnosed with ABS. Methods and results: A total of 228 cases of ABS were prospectively identified, and of these, 10 patients (median age 61 years (IQR 48-75); all females) who underwent coronary vasomotion testing were included in the study. Coronary epicardial and microvascular responses to intracoronary acetylcholine (ACH; % change in diameter and % change in blood flow at doses of 10−6-10−4 mol/l), nitroglycerin (200-300 mg), and adenosine (36-60 µg) were evaluated. The median change in diameter with ACH was -9.3% (IQR -36.4, 3.2) with six patients (60%) demonstrating epicardial coronary constriction. The median increase in peak coronary blood flow in response to ACH was 13.1% (IQR -18.6, 55.0). This was markedly lower than the blood flow response seen in a reference group of 211 women from our laboratory (mean age 60 years) with normal microvascular responses to ACH: 103% (IQR 75, 149). Seven (70%) patients had <50% increase in coronary blood flow indicating abnormal microvascular response to ACH. 70% had either abnormal epicardial or microvascular response to ACH. Median coronary flow reserve was abnormal at 2.2% (IQR 2.0, 3.4; normal
>2.5), and 90% had at least one abnormal measure of microvascular vasomotion. Conclusion: The novel observation is that coronary microvascular dysfunction is highly prevalent in patients with ABS. Thus, chronically impaired coronary vascular reactivity, especially involving the microcirculation, may be a central feature of the pathophysiology of ABS.
Keywords: Apical ballooning syndrome, endothelium, microcirculation, stress cardiomyopathy, Tako-Tsubo cardiomyopathy.
http://acc.sagepub.com/content/2/2/147.full.pdf
http://acc.sagepub.com/content/2/2/147.full.pdf+html
Más sobre Takotsubo - More on Takotsubo
Presentación clínica inicial de cardiomiopatía de Takotsubo con atención especial en los cambios electrocardiográficos: una revisión de casos de la literatura
Initial clinical presentation of Takotsubo cardiomyopathy with-a focus on electrocardiographic changes: A literature review of cases.
Sanchez-Jimenez EF.
World J Cardiol. 2013 Jul 26;5(7):228-41. doi: 10.4330/wjc.v5.i7.228
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722420/pdf/WJC-5-228.pdf
Cardiomiopatía biventricular de takotsubo: estudio de un caso y revisión de la literatura
Biventricular takotsubo cardiomyopathy: case study and review of literature.
Daoko J, Rajachandran M, Savarese R, Orme J.
Department of Cardiology, Memorial Hospital, 325 S. Belmont St., York, Pennsylvania 17405.
Tex Heart Inst J. 2013;40(3):305-11.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709233/pdf/20130600s00024p305.pdf
Cardiomiopatía de Takotsubo simulando infarto miocárdico postoperatorio en un paciente joven sanoTakotsubo cardiomyopathy mimicking postoperative myocardial infarction in a young healthy patient.
Mallick PN, Upadhaya SP, Das AK, Singh RK.
Department of Anaesthesiology and Critical Care, Al Jahra Hospital, Ministry of Health, Kuwait.
Indian J Anaesth. 2013 Mar;57(2):193-5. doi: 10.4103/0019-5049.111856.
http://www.ijaweb.org/text.asp?2013/57/2/193/111856
Características clínicas de la cardiomiopatía de Takotsubo en América del Norte
Clinical characteristics of Takotsubo cardiomyopathy in North America
Ahmed S, Ungprasert P, Ratanapo S, Hussain T, Riesenfeld EP.
North Am J Med Sci [serial online] 2013 [cited 2013 Aug 25];5:77-81.
http://www.najms.org/text.asp?2013/5/2/77/107520
http://www.najms.org/temp/NorthAmJMedSci5277-3511936_094519.pdf
Emergencia cardiaca no usual perioperatoria en una mujer joven sana
Unusual perioperative cardiac emergency in a healthy young woman.
Ganjoo P, Pandey VK, Singh H, Tandon MS, Singh D.
Department of Anaesthesiology and Intensive Care, GB Pant Hospital, Maulana Azad Medical College, New Delhi 110002, India.
Case Rep Anesthesiol. 2012;2012:103051. doi: 10.1155/2012/103051. Epub 2012 Aug 16.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431067/pdf/CRIM.ANESTHESIOLOGY2012-103051.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Takotsubo cardiomyopathy is a rare acute heart failure that can occur in stressful situations. It is very important to know this syndrome to establish diagnosis and timely management, especially in cases related to anesthesia. We e-mail seven interesting articles on this topic.
Takotsubo cardiomiopatia é uma insuficiência cardíaca aguda rara pode ocorrer em situações estressantes. É vital saber desta síndrome para estabelecer o diagnóstico e tratamento oportuno, especialmente em casos relacionados com a anestesia. Eles enviaram sete artigos interessantes sobre este tema.
Cardiomiopatía inducida por estres (Síndrome de Tako-Tsubo) en Austria
Stress-induced cardiomyopathy (Tako-Tsubo syndrome) in Austria
Valerie Weihs, Daniela Szücs, Barbara Fellner, Bernd Eber, Wolfgang Weihs, Thomas Lambert, Bernhard Metzler, et als
European Heart Journal: Acute Cardiovascular Care 2013;2:137 DOI:10.1177/2048872613483592
Abstract
Background: Tako-Tsubo syndrome (TS) is a still rarely diagnosed clinical syndrome, which is characterized by acute onset of chest pain, transient cardiac dysfunction with (frequently) reversible wall motion abnormalities (WMAs), but with no relevant obstructive coronary artery disease. Methods and results: Among 179 consecutive patients with proven diagnosis of TS that were retrospectively analysed in this multicentre registry, women represented the majority of patients (94%) while only 11 men (6%) developed TS. Mean age was 69.1±11.5 years (range 35-88 years). Cardinal symptoms of TS, which led to admission, were acute chest pain (82%) and dyspnoea (32%), respectively. All patients demonstrated typical WMAs, whereby four different types of WMAs could be defined: (1) a more common apical type of TS (n=89; 50%); (2) a combined apical and midventricular form of TS (n=23; 13%); (3) the midventricular TS (n=6; 3%); and (4) an unusual type of basal WMAs of the left ventricle (n=3). Only in 101 patients (57%), a clear causative trigger for onset of symptoms could be identified. In-hospital cardiovascular complications occurred in 25 patients (14%) and consisted of cardiac arrhythmias in 10 patients (40%), cardiogenic shock in six patients (24%), cardiac decompensation in eight patients (32%) and cardiovascular death in one patient, respectively. Echocardiographic control of left ventricular function after the initial measurement was available in almost 70% of the patients: complete recovery of WMAs was found in 73 patients (58.87%); 49 patients (39.52%) showed persistent WMAs. Recurrences of TS were only seen in four patients. During the follow-up period, 13 patients died: three of cardiovascular causes and 10 of non-cardiac causes. In-hospital mortality was 0.6%, 30-day mortality was 1.3% and 2-year mortality was 6.7%. Conclusions: This study represents to date the largest series of patients suffering from TS in Austria and worldwide. Similar to others, in our series the prevalence of TS was significantly higher in women than in men, while in contrast to other studies, the apical type of TS was detected most frequently. The similar clinical presentation of TS patients to the clinical picture of acute myocardial infarction demonstrates the importance of immediate coronary angiography for adequate differential diagnosis of TS. TS is not necessarily a benign disease due to cardiovascular complications as well as persistent WMAs with delayed recovery.
http://acc.sagepub.com/content/2/2/137.full.pdf
Reactividad microvascular coronaria dañada en mujeres con síndrome de abalonamiento apical (Takotsubo/cardiomiopatía por estrés)
Impaired coronary microvascular reactivity in women with apical ballooning syndrome (Takotsubo/stress cardiomyopathy)
Sandeep M Patel, Amir Lerman, Ryan J Lennon, Abhiram Prasad
European Heart Journal: Acute Cardiovascular Care 2013;2:147-152
Abstract
Aims: The pathophysiology of apical ballooning syndrome (ABS) remains to be elucidated. The aim of this study was to evaluate the coronary vascular reactivity of patients who were previously diagnosed with ABS. Methods and results: A total of 228 cases of ABS were prospectively identified, and of these, 10 patients (median age 61 years (IQR 48-75); all females) who underwent coronary vasomotion testing were included in the study. Coronary epicardial and microvascular responses to intracoronary acetylcholine (ACH; % change in diameter and % change in blood flow at doses of 10−6-10−4 mol/l), nitroglycerin (200-300 mg), and adenosine (36-60 µg) were evaluated. The median change in diameter with ACH was -9.3% (IQR -36.4, 3.2) with six patients (60%) demonstrating epicardial coronary constriction. The median increase in peak coronary blood flow in response to ACH was 13.1% (IQR -18.6, 55.0). This was markedly lower than the blood flow response seen in a reference group of 211 women from our laboratory (mean age 60 years) with normal microvascular responses to ACH: 103% (IQR 75, 149). Seven (70%) patients had <50% increase in coronary blood flow indicating abnormal microvascular response to ACH. 70% had either abnormal epicardial or microvascular response to ACH. Median coronary flow reserve was abnormal at 2.2% (IQR 2.0, 3.4; normal
>2.5), and 90% had at least one abnormal measure of microvascular vasomotion. Conclusion: The novel observation is that coronary microvascular dysfunction is highly prevalent in patients with ABS. Thus, chronically impaired coronary vascular reactivity, especially involving the microcirculation, may be a central feature of the pathophysiology of ABS.
Keywords: Apical ballooning syndrome, endothelium, microcirculation, stress cardiomyopathy, Tako-Tsubo cardiomyopathy.
http://acc.sagepub.com/content/2/2/147.full.pdf
http://acc.sagepub.com/content/2/2/147.full.pdf+html
Más sobre Takotsubo - More on Takotsubo
Presentación clínica inicial de cardiomiopatía de Takotsubo con atención especial en los cambios electrocardiográficos: una revisión de casos de la literatura
Initial clinical presentation of Takotsubo cardiomyopathy with-a focus on electrocardiographic changes: A literature review of cases.
Sanchez-Jimenez EF.
World J Cardiol. 2013 Jul 26;5(7):228-41. doi: 10.4330/wjc.v5.i7.228
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722420/pdf/WJC-5-228.pdf
Cardiomiopatía biventricular de takotsubo: estudio de un caso y revisión de la literatura
Biventricular takotsubo cardiomyopathy: case study and review of literature.
Daoko J, Rajachandran M, Savarese R, Orme J.
Department of Cardiology, Memorial Hospital, 325 S. Belmont St., York, Pennsylvania 17405.
Tex Heart Inst J. 2013;40(3):305-11.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709233/pdf/20130600s00024p305.pdf
Cardiomiopatía de Takotsubo simulando infarto miocárdico postoperatorio en un paciente joven sanoTakotsubo cardiomyopathy mimicking postoperative myocardial infarction in a young healthy patient.
Mallick PN, Upadhaya SP, Das AK, Singh RK.
Department of Anaesthesiology and Critical Care, Al Jahra Hospital, Ministry of Health, Kuwait.
Indian J Anaesth. 2013 Mar;57(2):193-5. doi: 10.4103/0019-5049.111856.
http://www.ijaweb.org/text.asp?2013/57/2/193/111856
Características clínicas de la cardiomiopatía de Takotsubo en América del Norte
Clinical characteristics of Takotsubo cardiomyopathy in North America
Ahmed S, Ungprasert P, Ratanapo S, Hussain T, Riesenfeld EP.
North Am J Med Sci [serial online] 2013 [cited 2013 Aug 25];5:77-81.
http://www.najms.org/text.asp?2013/5/2/77/107520
http://www.najms.org/temp/NorthAmJMedSci5277-3511936_094519.pdf
Emergencia cardiaca no usual perioperatoria en una mujer joven sana
Unusual perioperative cardiac emergency in a healthy young woman.
Ganjoo P, Pandey VK, Singh H, Tandon MS, Singh D.
Department of Anaesthesiology and Intensive Care, GB Pant Hospital, Maulana Azad Medical College, New Delhi 110002, India.
Case Rep Anesthesiol. 2012;2012:103051. doi: 10.1155/2012/103051. Epub 2012 Aug 16.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431067/pdf/CRIM.ANESTHESIOLOGY2012-103051.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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