Novel insights into the pathogenesis and management of patients with Takotsubo syndrome
DOI:
https://doi.org/10.6016/ZdravVestn.3451Keywords:
heart failure, stress, catecholamines, microvascular dysfunction, treatmentAbstract
Since its first description in 1990, Takotsubo syndrome has been recognized as a well-known medical condition. Both the prevalence and recurrence rate of Takotsubo syndrome are estimated to be 1-3% of patients mimicking ST-elevation myocardial infarction and 4% of Takotsubo patients, respectively. The syndrome presents with a transient non-ischemic acute heart failure and relatively fast recovery of myocardial contractility. Frequently, Takotsubo syndrome is precipitated by a previous trigger, such as physical or emotional stress. However, in approximately one-third of Takotsubo patients, the trigger remains unidentified. In terms of acute clinical presentation, Takotsubo patients with and without acute coronary syndrome-related symptoms have been recognized. Early recognition of the latter group is challenging due to the lack of clear indication for transthoracic echocardiography and coronary angiography with left ventriculography in this patient cohort, representing the gold standard in diagnostics of Takotsubo patients. Therefore, the prevalence of Takotsubo patients without acute coronary syndrome-related symptoms appears to be underestimated. In addition, novel data reveal that both short- and long-term prognoses in Takotsubo patients are comparable to the prognosis in acute coronary syndrome patients. Furthermore, chronic heart failure has been recognized in a subgroup of Takotsubo patients. Takotsubo syndrome thus represents a heterogeneous medical condition, with a potential for adverse outcomes. Therefore, novel approaches to the diagnostics and treatment of this patient population are required. This article presents novel insights into the pathogenesis and management of Takotsubo patients. In addition, we also provide an outline of our experience in the management of these patients.
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