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Tako-tsubo kardiyomiyopati: literatür derleme

Authors: Ceyhan, Ceyhun; Turgut, Hülya;

Tako-tsubo kardiyomiyopati: literatür derleme

Abstract

Tako-tsubo sendromu koroner arterlerinde anlamlı darlık olmayan kiside, sol ventrikül apikal kısmının, geçici balonlasması ile karakterize bir sendromdur. Ampulla kardiyomiyopatisi, insan stres kardiyomiyopatisi, kırık kalp sendromu da denmektedir. Daha çok postmenapozal kadınlarda görülmektedir. Patogenezde stres faktörleri, artmıs adrenerjik aktivite, uzamıs stunned miyokardiyum, hipertansiyon, kronik obstrüktif akciger hastalıgı (KOAH), azalmıs östrojen seviyesi, küçük damar hastalıgı, miyokardit, miyokardın yag asidi metabolizmasının yetersiz olması öne sürülmüstür. Hastaların öyküsünde semptomlar baslamadan önce genellikle stresli fiziksel, duygusal olaylar mevcuttur. Hastalık klinik olarak nadiren asemptomatik seyredebilir. Gögüs agrısı, dispne, senkop gibi semptomlar görülebilir. Kalp yetmezligi, supraventriküler ve ventriküler aritmiler olusabilir. EKG bulguları miyokard enfarktüsü ile benzer. Anteriyor derivasyonlarda ST segment yükselmesi,Tdalga negatifligi, QT mesafesi uzaması, nadiren geçici patolojik Q dalgası olusumu gözlenebilir. Ekokardiyografide tipik olarak antero-apikal akinezi veya diskinezi gözlenir ve günler-haftalar arasında tamamen düzelir. Koroner anjiyografide koroner arterlerde anlamlı darlıklar gözlenmez. Ventrikülografide anteroapikal balonlasma ile bazal segmentlerde kontraktilite artısı saptanır. Manyetik rezonans görüntüleme (MRG), ekokardiyografi gibi bölgesel duvar hareket bozuklugunu göstermede yararlı olabilir. TTK tedavisi ile ilgili kesinlesmis bir kılavuz bulunmamaktadır. Tedavi az sayıdaki olgu serilerine dayanılarak yapılmaktadır ve destek tedavisi seklindedir. Koroner anjiyografi yapılamayan merkezlerde akut koroner sendrom tedavisi verilmelidir. Prognozu iyi olan sendromun tekrarlama olasılıgı mevcuttur.Tekrarı önlemek amacıyla beta bloker ilaçlar verilebilir.

Tako tsubo cardiomyopathy is characterized by transient left ventricular apical balooning without significant coronary artery stenosis. It is also referred as Ampulla cardiomyopathy, Human stress cardiomyopathy, Broken heart syndome. It has been described in postmenopausal females with a recent history of physical or emotional stress. In the pathogenesis there are physical stress, stunned myocardium, hypertension, increased adrenergic activity , chronic obstructive pulmonary disease , decreased serum estrogen levels, myocarditis, impairment in fatty ascites metabolizm of myocardium, impairment in multivessel microcirculation. The clinical presentation is usually chest pain, dyspnea , syncope, ,heart failure . supraventricular and ventricular arythmias .In some cases it is asymptomatic . ST segment elevation, T wave inversion, QT interval prolongation, may be detected in electrocardiography which mimics myocardial infarction. Echocardiography shows anteroapical akinezis or diskinesis. Significant coronary artery stenosis is not detected on coronary angiography. Ventriculography demonstrates anteroapical balooning and hypercontractility of basal segments. MRI (Magnetic Resonance Imaging ) shows left ventricular mid and apical diskinezis like echocardiography.MRI is useful in diagnosis of TTC.There is no guideline for the treatment ofTakotsubo cardiomyopathy. The treatment is generally supportive according to few cases. In hospitals which coronary angiography can not be performed, patients should be treated like patients with myocardial infarction . Beta bloker agents should be given in order to prevent recurrences. The prognosis is generally favorable.

Country
Turkey
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Keywords

Ekokardiyografi, Takotsubo Cardiomyopathy, Echocardiography, Takotsubo Kardiyomiyopati, Miyokard Enfarktüsü, Myocardial Infarction, 610, Takotsubo cardiomyopathy;myocardial infarction;echocardiography;coronary angiography, Takotsubo kardiyomiyopati;miyokard enfarktüsü;ekokardiyografi;koroner anjiografi, Coronary Angiography, Koroner Anjiografi

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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!
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