Grytė Ramantauskaitė¹, Neda Daukšaitė¹, Jolanta Laukaitienė²

¹Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

²Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

Abstract

Takotsubo syndrome is acute, reversible cardiomyopathy, widely known as stress induced cardiomyopathy. The prevalence of Takotsubo syndrome is about 2% among patients with clinical manifestations of acute coronary syndrome. Moreover, Takotsubo syndrome is most common in postmenopausal women. Although the exact etiology of the syndrome is not known, the most likely cause of Takotsubo syndrome is the sudden release of stress hormones such as norepinephrine, epinephrine, and dopamine. However, the etiology of about a quarter of patients remains unclear. This syndrome usually presents with angina-type chest pain, shortness of breath, or arrhythmias. The diagnosis of Takotsubo syndrome is based on clinical data, electrocardiographical changes, increased cardiac biomarkers, echocardiography, and coronary angiography. The most common finding on the electrocardiogram in these patients is an elevation of ST segment. Also, newly occurring bundle branch block, T-wave inversion, and significant QT segment elongation are commonly observed. The most important markers of this pathology are increased levels of creatine kinase cardiac isoenzyme (CK-MB) and increased levels of troponins, but their concentrations are significantly lower than in patients with ST segment elevation myocardial infarction. Echocardiography and cardiac magnetic resonance imaging help to determine the morphology and function of the left ventricle, anatomical variant of the syndrome and its complications. Coronary angiography helps to differentiate Takotsubo syndrome from myocardial infarction with ST elevation, with coronary arteries found normal or with minimal non-obstructive changes.

With clinical symptoms and electrocardiographic signs similar to myocardial infarction, it is very important to differentiate between these two pathologies by doing some clinical tests and to provide adequate help in each case. With the help of many clinical researches, there are more and more new findings about pathophysiology, diagnostics and management possibilities of Takotsubo syndrome. In this article, the newest findings about pathophysiology, diagnostics and management of this syndrome are reviewed.

Keywords: Takotsubo syndrome; stress induced cardiopathy; catecholamine storm.