SÍNDROME DE TAKOTSUBO Y ESTRÉS AGUDO.

Abstract

Introduction Takotsubo Syndrome (STk) is characterized by a transient systolic regional dysfunction on the left ventricle, usually diagnosed in 2% of the patients presenting with clinical suspicion of ST elevating myocardial infarction (STAMI). Main etiology is still unclear, correlating with pericardial artery spasm, microvascular alterations, viral myocarditis, heightened catecholamine levels with alteration of sympathetic system, and anatomical variations of the anterior descendent artery. Several emotional and physical triggers are linked to its development, but symptoms can arise in their absence. Most common signs and symptoms include: acute chest pain, dyspnea and syncope, initially indistinct to those of an acute myocardial infarction. Its presence varies according to the trigger: on those with a strong emotional trigger chest pain and palpitations, while on physical stress, underlying disease predominates (stroke, seizure). Case description A 58 year old female, without medical history of cardiovascular disease, was admitted to the hospital because of left sided chest pain, beginning 2 hours ago, most likely caused by emotional distress. On arrival, initial diagnosis was Acute Coronary Disorder (ACD). Coronarography, and anterior oblique right ventriculography confirming the diagnosis. Requiring mainly low-molecular-weight heparin anticoagulation during admission and novel anticoagulants for outpatient care, added to anxiety treatment. Follow-up started October 2019 and went on during 2020. Conclusion STk has similar characteristics to those of ACD on postmenopausal women. The present Clinical Case meets 3 of the 4 Mayo Criteria, and has 61 points on the InterTak score. Acute chest pain, dyspnea and syncope plus several additional studies can confirm STk. EKG showing ST elevation (90%), negative T wave on precordial leads (44%), Q wave present (15-27%). Elevation of the ST segment on V4 to V6 is higher than V1 to V3, with absence of Q anomaly. Heightened troponin levels, but lower than AMI; Heghtened BPN or proBPN could be present. Myocardial stunning could be liked to catecholamine levels 2 to 3 times higher than AMI with Killip III. The recovery does not require treatment, but could require diuretics, beta blockers, ACEs, angiotensin-II receptor blockers, statins and acetylsalicylic acid. Prognosis is favorable with mortality under the 2%.