Petrov Ivo S, Tokmakova Mariya P, Marchov Daniel N, Kichukov Kostadin N
Clinic of Cardiology and Angiology, Tokuda Hospital Sofia, Bulgaria.
Folia Med (Plovdiv). 2011 Apr-Jun;53(2):5-12. doi: 10.2478/v10153-010-0031-0.
Tako-tsubo syndrome is a novel cardio-vascular disease affecting predominantly postmenopausal women exposed to unexpected strong emotional or physical stress, in the absence of significant coronary heart disease. It is characterized by acute onset of severe chest pain and/or acute left ventricular failure, ECG-changes, typical left ventricular angiographic findings, good prognosis and positive resolution of the morphological and clinical manifestations. First described in 1990 in Japan by Sato, Tako-tsubo cardiomyopathy is characterized by transient contractile abnormalities of the left ventricle, causing typical left ventricular apical ballooning at end-systole with concomitant compensatory basal hyperkinesia. There are also atypical forms, presenting with left ventricular systolic dysfunction which affects the mid-portions of the left ventricle. The etiology of the disease still remains unclear. Many theories have been put forward about the potential underlying pathophysiological mechanisms that may trigger this syndrome among which are the theory of catecholamine excess, the theory of multivessel coronary vasospasm, the ischemic theory, and the theory of microvascular dysfunction and dynamic left ventricular gradient induced by elevated circulating catecholamine levels. Adequate management of Tako-tsubo syndrome demands immediate preparation for coronary angiography. Once the diagnosis is made, treatment is primarily symptomatic and includes monitoring for complications. Patients with Tako-tsubo syndrome most frequently develop acute LV failure, pulmonary edema, rhythm and conductive disturbances and apical thrombosis. Treatment is symptomatic and includes administration of diuretics, vasodilators and mechanical support of circulation with intra-aortic balloon counterpulsation.
应激性心肌病是一种新型心血管疾病，主要影响绝经后女性，这些女性在无明显冠心病的情况下遭受意外的强烈情绪或身体应激。其特征为急性发作的严重胸痛和/或急性左心室衰竭、心电图改变、典型的左心室血管造影表现、预后良好以及形态和临床表现的积极缓解。1990年由佐藤在日本首次描述，应激性心肌病的特征是左心室短暂收缩异常，导致收缩末期典型的左心室心尖部气球样变，并伴有代偿性基底节运动亢进。也有非典型形式，表现为影响左心室中部的左心室收缩功能障碍。该疾病的病因仍不清楚。关于可能引发该综合征的潜在病理生理机制，已经提出了许多理论，其中包括儿茶酚胺过量理论、多支冠状动脉痉挛理论、缺血理论以及循环儿茶酚胺水平升高引起的微血管功能障碍和动态左心室梯度理论。应激性心肌病的适当管理需要立即准备进行冠状动脉造影。一旦做出诊断，治疗主要是对症治疗，包括监测并发症。应激性心肌病患者最常发生急性左心室衰竭、肺水肿、心律失常和传导障碍以及心尖部血栓形成。治疗是对症的，包括使用利尿剂、血管扩张剂以及通过主动脉内球囊反搏进行循环的机械支持。
