Takotsubo syndrome

Takotsubo syndrome receives this name because the heart adopts a sharper and narrower shape at its lower end that is reminiscent of amphorae that are used in Japan - the place where this syndrome was described for the first time - to hunt octopuses and that they receive precisely the name of takotsubo, which literally means "octopus trap". WHAT YOU SHOULD KNOW

• The symptoms of Takotsubo syndrome resemble angina pectoris or acute myocardial infarction.
• The trigger is usually related to both physical and emotional stress: unusual physical activity, surgery, an accident ...
• Recovery is effective and rarely reappears.

Similarity to angina pectoris

The heart is responsible for pumping blood through blood vessels to the entire body, including itself through the coronary arteries. If, for various reasons, there is an obstruction of the blood supply to the coronary arteries, the heart suffers and cannot perform its function, producing one or one.

On some occasions, patients have been seen with pain similar to that of an acute myocardial infarction with analytical and electrocardiographic alterations typical of this pathology but in whom, when subjected to angiography to assess the obstruction of the coronary arteries, it has been seen that these are intact.

When this occurs, it refers to a possible syndrome of transient apical dyskinesia, transient apical dysfunction, stress cardiomyopathy, broken heart syndrome or, more commonly, Takotsubo syndrome.

How it is produced

Takotsubo syndrome affects women more often than men. Usually to women of middle or advanced age, over fifty years. The cause that can produce this alteration is not known, but the possibility of a viral infection has been postulated.

Usually there is a clear trigger related to it, be it physical or emotional, such as an unusual physical activity, surgery, an accident or acute and severe emotional stress.

These are generally patients without alterations in the coronary arteries, as would be expected in an acute myocardial infarction, but this is not the case.

Various mechanisms have been proposed that partially explain the alterations that occur, such as a transient vasospasm that compromises circulation, a microvascular alteration that is not visualized at the level of angiography, and an excessive response to the release of catecholamines such as adrenaline and norepinephrine. , substances that are massively produced in stressful or distressing situations.

Symptoms and diagnosis

The symptoms of Takotsubo syndrome are those of a person suffering from angina pectoris or acute myocardial infarction. The patient reports oppressive central chest pain, which does not change with movement or rest, which may radiate to the upper extremities (especially the left), neck, back, or upper abdomen.

The pain may be accompanied by a vegetative picture, with dizziness, cold sweats, nausea or vomiting. Sometimes there may also be a sensation of dyspnea, shortness of breath, as well as general malaise and a sensation of imminent death. Complications of a Takotsubo syndrome can be ventricular arrhythmias, severe bradycardia or heart failure.

The initial diagnosis of pain with anginal characteristics should always be treated as pain of ischemic causes. When performing one, alterations typical of an acute ischemic coronary condition with elevation of the ST segment of the electrocardiogram will be seen in the apical and anterior area of ​​the heart.

When carrying out one to assess cardiac enzymes that are usually elevated in the case of an acute coronary syndrome, such as troponins and CPKs, these will be elevated in the vast majority of cases, the percentage in the case of troponins being close to 100%.

Thus, the pain pattern will be unrecognizable from that of a true acute myocardial infarction and initial complementary tests will not rule it out. It will not be until an angiography is performed that it will be observed that there is no obstruction at the level of the coronary arteries that can explain the patient's anginal pain.

When performing a ventriculography to assess the mobility of the heart, it will be observed that the upper part of the left ventricle contracts normally while the apical part, the most extreme, moves irregularly or does not even move, giving the characteristic image that recalls to the traps of hunting octopuses that give the syndrome its name.

Treatment

Before an initial picture of pain suggestive of angina pectoris, it should be treated as such, with nitrates and antiaggregants. When the diagnosis of Takotsubo syndrome has been established and since it is caused by a release of catecholamines, drugs that counteract its effects, such as beta-blockers or calcium antagonists, will be administered.

Despite the severity of the condition in its initial presentation, the vast majority of patients recover completely after the acute episode, normalizing the changes in the electrocardiogram and echocardiogram over several weeks. It is a syndrome that rarely reappears.

Precautionary measures

There are no specific preventive measures for Takotsubo syndrome. If you have suffered from it, it is advisable to follow up by a cardiologist and avoid stressful situations as far as possible.