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Revista Portuguesa de Cardiologia
Article . 2012 . Peer-reviewed
License: CC BY NC ND
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Revista Portuguesa de Cardiologia
Article
License: CC BY NC ND
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Revista Portuguesa de Cardiologia
Article . 2012
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Miocardiopatia Takotsubo: estado da arte

Authors: Sofia Nóbrega; Dulce Brito;

Miocardiopatia Takotsubo: estado da arte

Abstract

Resumo: A miocardiopatia Takotsubo é uma situação reversível, caracterizada por disfunção sistólica transitória do ventrículo esquerdo, a qual mimetiza uma síndrome coronária aguda. Ocorre habitualmente após stress físico ou emocional, com predomínio em mulheres na pós-menopausa, apesar de também poder afetar faixas etárias mais jovens e o género masculino. Apresenta-se frequentemente com dor torácica ou dispneia, alterações eletrocardiográficas sugestivas de enfarte agudo do miocárdio e ligeira elevação das enzimas cardíacas. A angiografia coronária exclui doença arterial obstrutiva, constatando-se, imagiologicamente, acinesia apical ventricular, com hipercontratilidade basal «compensatória».Foram propostos vários mecanismos fisiopatológicos para a síndrome, como doença aterosclerótica oculta, espasmo multivasos ou disfunção microvascular. Contudo, a hipótese mais aceite atualmente é a existência de um excesso de catecolaminas que, por causar uma sobrecarga de cálcio nos miócitos cardíacos, leva a perturbação da contração e função ventriculares. O tratamento é essencialmente de suporte, com reversão espontânea e completa das alterações num intervalo de dias a semanas. Contudo, a ocorrência de complicações e algumas comorbilidades podem predizer um prognóstico menos benigno. Assim, dado que a síndrome Takotsubo ainda é desconhecida em muitos aspetos e face ao crescente número de casos descritos, fez-se uma revisão da literatura do conhecimento atual. Abstract: Takotsubo cardiomyopathy is a reversible condition, characterized by transient left ventricular systolic dysfunction, that mimics an acute coronary syndrome. It usually occurs after physical or emotional stress, predominantly in postmenopausal women, although it also can affect younger age groups and males. It often presents as chest pain or dyspnea with electrocardiographic changes and mild elevation of cardiac enzymes suggesting acute myocardial infarction. Coronary angiography excludes obstructive coronary disease, and imaging reveals ventricular apical akinesia and compensatory hypercontractility of the basal segments.Various pathophysiological mechanisms have been proposed for the syndrome, such as occult atherosclerotic disease, multivessel spasm and/or microvascular dysfunction. However, the most widely accepted hypothesis at present is an excess of catecholamines causing calcium overload in cardiac myocytes, leading to disruption of contraction and ventricular function. Treatment is essentially supportive, with spontaneous and complete reversal of the changes within days or weeks. However, the presence of complications and comorbidities may predict a more adverse prognosis. As much is still unknown about takotsubo cardiomyopathy and the number of reported cases is growing, we present a literature review. Palavras-chave: Miocardiopatia Takotsubo, Síndrome coronária aguda, Disfunção ventricular esquerda, Excesso catecolamínico, Keywords: Takotsubo cardiomyopathy, Acute coronary syndrome, Left ventricular dysfunction, Catecholamine excess

Keywords

RC666-701, Diseases of the circulatory (Cardiovascular) system

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    influence
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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
17
Average
Top 10%
Top 10%
gold