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TAKOTSUBO SYNDROME AS ACUTE FORM OF MICROVASCULAR ANGINA. CLINICAL CASE

https://doi.org/10.20996/1819-6446-2017-13-4-489-494

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Abstract

The mechanisms of stress-induced cardiomyopathy (takotsubo syndrome) have not been fully determined. A clinical case of the development of stressinduced cardio-myopathy in a patient with microvascular angina is presented. A 73-year-old woman was hospitalized to the cardiology clinic with a diagnosis of acute circular myocardial infarction (elevation ST II, III, aVF, V2-6, positive troponin test). According to coronary angiography stenosis of coronary arteries were not identified. According to echocardiography the following abnormalities were revealed: decrease in global contractility of the myocardium, hyperkinesia of the basal parts of the left ventricle and at the same time akinesia of the apex and hypokinesia of the middle segments of the left ventricle. After 1 month a contractility of the myocardium was normal, there were no zones of violation of contractility. It was suggested that the patient had takotsubo syndrome. Anginal pain due to physical and emotional stress with unchanged coronary arteries suggested primary microvascular angina. It was confirmed by the presence of endothelium-dependent vasodilation disorders that were revealed by positron emission tomography of myocardium with cold pressor test and peripheral arterial tonometry. This clinical case demonstrates one of the discussed pathogenetic mechanisms of the takotsubo syndrome – generalized microvascular spasm. As the patient suffered previously from chronic microvascular angina, it seems logical in this case to regard stress-induced cardiomyopathy as an acute form of microvascular angina.

About the Authors

S. A. Boldueva
North-Western State Medical University named after I.I. Mechnikov
Russian Federation

MD, PhD, Professor, Head of Chair of Faculty Therapy,

Kirochnaya ul. 41, St-Petersburg, 191015



M. V. Ryzhikova
North-Western State Medical University named after I.I. Mechnikov
Russian Federation

MD, Cardiologist, Department of Cardiology for Treatment of Patients with myocardial infraction, Clinic named after Peter the Great,

Kirochnaya ul. 41, St-Petersburg, 191015



N. S. Shvets
North-Western State Medical University named after I.I. Mechnikov
Russian Federation

MD, Head of Department of Cardiology for Treatment of Patients with myocardial infraction, Clinic named after Peter the Great,

Kirochnaya ul. 41, St-Petersburg, 191015



I. A. Leonova
North-Western State Medical University named after I.I. Mechnikov
Russian Federation

MD, PhD, Associate Professor, Chair of Faculty Therapy,

Kirochnaya ul. 41, St-Petersburg, 191015



I. Yu. Titova
North-Western State Medical University named after I.I. Mechnikov
Russian Federation

MD, Department of Functional Diagnostics, Clinic named after Peter the Great,

Kirochnaya ul. 41, St-Petersburg, 191015



I. N. Kochanov
North-Western State Medical University named after I.I. Mechnikov
Russian Federation

MD, Head of Interventional Radiology Department, Clinic named after Peter the Great,

Kirochnaya ul. 41, St-Petersburg, 191015



References

1. Lyon Alexander R., Bossone E, Birke ,Schneider B et al. Сurrent state of knowledge on Takotsubo syndrome: a position statement from the task force on Takotsubo syndrome of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2016;18:8-27.

2. ACC/AHA/ACP-ACIM. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J. 2013;34:2949-3003.

3. Martin B.J., Gurtu V., Chan S., Anderson T.J. The relationship between peripheral arterial tonometry and classic measures of endothelial function. Vasc Med. 2013;18(1):13-8.

4. Ryzhkova D.V., Kolesnichenko M.G., Boldueva S.A. et al. The study of the state of coronary hemodynamics by the method of positron emission tomography in patients with cardiac syndrome X. Sibirskiy Meditsinskiy Zhurnal. 2012;27(2):48-54. (In Russ.) [РыжковаД.В., М.Г. Колесниченко, Болдуева С.А. и др. Изучение состояния коронарной гемодинамики методом позитронной эмиссионной томографии у пациентов с кардиальным синдромом Х. Сибирский Медицинский Журнал. 2012;27(2):48-54].

5. Kothawade K., Merz N.B. Microvascular Coronary Dysfunction in Women Pathophysiology, Diagnosis, and Management. Current Problems in Cardiology. 2011;36(8):291-318.

6. Boldueva S.A., Leonova I.A. Primary microvascular angina pectoris (cardiac syndrome X). Controversial and unresolved issues:terminology, definitions, pathogenetic mechanisms. Serdtse. 2016;15(4):223-34. (In Russ.) [Болдуева С.А., Леонова И.А. Первичная микроваскулярная стенокардия (кардиальный синдром Х).Спорные и нерешенные вопросы: терминология, дефиниции, патогенетические механизмы. Сердце. 2016;15(4):223-34].

7. Lanza G.A., Crea F. Primary Coronary Microvascular Dysfunction: Clinical Presentation, Pathophysiology and Management. Circulation Journal. 2010;121:2317-25.

8. Wittstein I.S., David R., Thiemann, M.D., et AL. Neurohumoral features of myocardial stunning due to sudden emotional stress. The New England Journal of Medicine. 2005;352(6):539-48.

9. Vitale C., Rosano G, KaskiJ.C. Role of Coronary MicrovascularDysfunction in Takotsubo Cardiomyopathy. Circulation Journal. 2016;80:299-305.

10. Kaski J.C., Hermann, J A. Lerman A. Coronary microvascular dysfunction in the clinical setting: from mystery to reality. Eur Heart J. 2012;33(22):2771-82.

11. Cotrim C., Almeida A.G., Carrageta M. Cardiac syndrom X, intraventricular gradients and, beta-blockers. Revista Portuguesa de Cardiologia. 2010;29(2):193-203.


For citation:


Boldueva S.A., Ryzhikova M.V., Shvets N.S., Leonova I.A., Titova I.Y., Kochanov I.N. TAKOTSUBO SYNDROME AS ACUTE FORM OF MICROVASCULAR ANGINA. CLINICAL CASE. Rational Pharmacotherapy in Cardiology. 2017;13(4):489-494. (In Russ.) https://doi.org/10.20996/1819-6446-2017-13-4-489-494

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ISSN 1819-6446 (Print)
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