Takotsubo syndrome (stress-induced cardiomyopathy): case report

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Abstract

Takotsubo syndrome (CТ) is an acutely developing reversible myocardial dysfunction, leading to left ventricular balloning during systole and the development of acute heart failure in 15–45% of cases. There are primary and secondary CT. The article reflects the issues of pathogenesis, clinical manifestations and modern criteria for the diagnosis of this disease. A clinical case of the primary variant of CT, resembling acute coronary syndrome, is given.

About the authors

Anna G. Evdokimova

Yevdokimov Moscow State University of Medicine and Dentistry

Email: Aevdokimova@rambler.ru
ORCID iD: 0000-0003-3310-0959

D. Sci. (Med.)

Russian Federation, Moscow

Raisa I. Struk

Yevdokimov Moscow State University of Medicine and Dentistry

Email: rstruk@list.ru

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Vladimir V. Evdokimov

Yevdokimov Moscow State University of Medicine and Dentistry

Email: vvevdokimov@rambler.ru
ORCID iD: 0000-0003-3910-2488

D. Sci. (Med.)

Russian Federation, Moscow

Galina V. Voronina

Yevdokimov Moscow State University of Medicine and Dentistry

Email: teleckv@gmail.ru
ORCID iD: 0000-0001-6558-4498

Department Head

Russian Federation, Moscow

Irina S. Mikhailova

Yevdokimov Moscow State University of Medicine and Dentistry

Email: teleckv@gmail.ru

Cand. Sci. (Med.)

Russian Federation, Moscow

Anna A. Golikova

Yevdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: golikova.Anna.1954@mail.ru
ORCID iD: 0000-0001-8118-9615

D. Sci. (Med.)

Russian Federation, Moscow

References

  1. Sato H, Tateishi H, Uhida T. Takotsubo-type cardiomyopathy due to multivessel spasm. In: Kodama K, Haze R, Hon M, et al, editors. Clinical aspect of myocardial injury: from ischemia to heart failure. Tokyo: Kagakuhyournsha, 1990.
  2. Шилова А.С., Шмоткина А.О., Яфарова А.А., Гиляров М.Ю. Синдром такоцубо: современные представления о патогенезе, распространенности и прогнозе. Рациональная Фармакотерапия в Кардиологии. 2018;14(4):598-604 [Schilova AS, Schmotkina AO, Jafarova AA, Gilarov MYu. Takotsubo Syndrome: Contemporary Views on the Pathogenesis, Prevalence and Prognosis. Rational Pharmacotherapy in Cardiology. 2018;14(4):598-604 (in Russian)]. doi: 10.20996/1819-6446-2018-14-4-598-604
  3. Новиков В.И., Новикова Т.Н. Кардиомиопатии. М.: МЕДпресс-информ, 2021 [Novikov VI, Novikova TN. Kardiomiopatii. Moscow: MEDpress-inform, 2021 (in Russian)].
  4. Алехин М.Н. Синдром такоцубо: значение эхокардиографии. Кардиология. 2017;57(7):80-7 [Alekhin MN. Syndrome takotsubo: of Value of Echocardiography. Kardiologiia. 2017;57(7):80-7 (in Russian)]. doi: 10.18087/cardio.2017.7.10009
  5. Ghadri J-R, Wittstein IS, Prasad A, et al. International Expert Consensus Documenton Tacotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J. 2018;39(22):2032-46. doi: 10.1093/eurheartj/ehy076
  6. Lyon AR, Bossone E, Schneider B, et al. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2016;18(1):8-27. doi: 10.1002/ejhf.424
  7. Ghadri J-R, Wittstein IS, Prasad A, et al. International Expert Consensus Documenton Tacotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management. Eur Heart J. 2018;39(22):2047-62. doi: 10.1093/eurheartj/ehy077

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2. Fig. 1. Results of ventriculography. Dimensions of left ventricle in diastol (left). Symptoms of systolic (Middle Fig.) ballooning of the top of the left ventricle in takotsubo cardiomyopathy. Octopus pot (right).

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3. Fig. 2. Echo results. A – punctuation of the apex in the acute period of takotsubo cardiomyopathy, B – elimination of pathological changes during observation.

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4. Fig. 3. Ekg results. Infarction-like changes: nodular rhythm, 2 blocked atrial extrasistols at withdrawal II, heart rate 43 per minute. Deflection of the heart’s electrical axis to the right. Complex QRS – 0,16', interval Q–T – 0,44', Q V1–4, rise of segment ST in leads II, III, V2–6, regress – in RV4–6. Complete blockade of the right foot of the Gis beam.

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5. Fig. 4. Algorithm of diagnostics of takotsubo syndrome InterTAK (2018). Adapted from [7].

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6. Fig. 5. The circuit of application of the device Impella - endovascular implantation in the left ventricle of the system for auxiliary circulation.

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7. Fig. 6. Patient K’s EKG results. Conclusion: sinus rhythm, correct, heart rate 75 per minute. Rise of ST in leads I, aVL, V2–4, depression ST in leads III, aVF, rSV2, qRV3. Signs of early repolarization in leads V4–6. RV5>RV4. Hypertrophy LJ, left atrium.

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8. Fig. 7. On the KAG series of patients K. from 14.05.2019. all coronary arteries are passable, atherosclerotic changes are not defined.

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9. Fig. 8. Systolic perforation of patient’s К. left ventricular apex clot at the top of the left ventricle.

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