Takotsubo Syndrome: Contemporary Views on the Pathogenesis, Prevalence and Prognosis
https://doi.org/10.20996/1819-6446-2018-14-4-598-604
Abstract
Takotsubo syndrome (TTS) is a reversible left ventricular dysfunction characterized by local apical hypokinesia usually triggered by a physical or emotional stress. According to the last available data TTS may represent 2% of all admissions for acute coronary syndromes. Despite the reliable prevalence, diagnosis of TTS remains difficult. The initial presentation, both clinically and electrocardiographically, is similar to an acute myocardial infarction (AMI). The biomarker profile is also similar, although the peaks of troponin and creatinine kinase levels are lower, and brain natriuretic peptide levels are higher in patients with TTS compared with ST-segment elevation AMI. Modified Mayo diagnostic criteria are the most common for the diagnosis. Pathogenesis of TTS currently is not well understood. Catecholamines appear to play a central role in the pathophysiology of TTS. However, it is conceivable that some people have a genetic predisposition to stress-induced TTS. A genetic predisposition has been suggested based on the few familial TTS cases described. Despite reversible myocardial dysfunction, acute heart failure is the most common complication in the acute phase of TTS. In-hospital mortality rate is comparable to that of ST-segment elevation AMI. There are no randomized clinical trials to support specific treatment recommendations in TTS. It is believed that the tactics of managing patients with TTS hospitalized with suspicion of acute coronary syndrome should comply with the protocol of management of patients with AMI while acute coronary pathology is not excluded.
About the Authors
A. S. Shilova
City Clinical Hospital №1 named after N.I. Pirogov;
Pirogov Russian National Research Medical University Ostrovitianova
Russian Federation
Russian Federation
Alexandra S. Shilova – MD, PhD, Doctor, Intensive Care Unit for Patients with Myocardial Infarction, City Clinical Hospital №1 named after N.I. Pirogov; Assistant, Chair of Faculty Therapy named after A.I. Nesterov, Pirogov Russian National Research Medical University
Leninsky prospect 8, Moscow, 119049; Ostrovitianova ul. 1, Moscow, 117997
A. O. Shmotkina
City Clinical Hospital №1 named after N.I. Pirogov;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Alexandra O. Shmotkina – MD, Doctor, Intensive Care Unit for Patients with Myocardial Infarction, City Clinical Hospital №1 named after N.I. Pirogov; Post-Graduate Student, Chair of Preventive and Emergency Cardiology, Sechenov University
Leninsky prospect 8, Moscow, 119049; Trubetskaya ul. 8-2, Moscow, 119991
A. A. Yafarova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Adel A. Yafarova – Student
Trubetskaya ul. 8-2, Moscow, 119991
M. Yu. Gilyarov
City Clinical Hospital №1 named after N.I. Pirogov;
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Mikhail Yu. Gilyarov – MD, PhD, Deputy Chief Physician for Therapeutic Care, City Clinical Hospital №1 named after N.I. Pirogov; Professor, Chair of Preventive and Emergency Cardiology, Sechenov University
Leninsky prospect 8, Moscow, 119049; Trubetskaya ul. 8-2, Moscow, 119991
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Review
For citations:
Shilova A.S., Shmotkina A.O., Yafarova A.A., Gilyarov M.Yu. Takotsubo Syndrome: Contemporary Views on the Pathogenesis, Prevalence and Prognosis. Rational Pharmacotherapy in Cardiology. 2018;14(4):598-604. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-4-598-604
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