Department of Cardiology and Cardiovascular Surgery, San Giuseppe Moscati Hospital, Avellino, Italy.
Eur Rev Med Pharmacol Sci. 2013 Jan;17(1):105-11.
"Takotsubo" cardiomyopathy (TTC) is a clinical disorder usually triggered by intense emotional and/or physical stress, characterized by reversible severe localized left ventricular wall dyskinesia, transient changes of ST segment, without significant coronary artery stenoses, that can mimic acute myocardial infarction.
Although TTC is well known to have a good mid- and long-term prognosis, arrhythmic risk is increasingly recognized and we could provide, in view of the available literature, a mean for a prognostic stratification and some practical suggestions for management of these "vulnerable" patients.
Further studies with randomized trials will be needed to prove the optimal treatment of TTC.
TTC, generally considered a benign syndrome, should be reconsidered as a clinical condition at high risk for lethal arrhythmias in a subpopulation with QTc > 500 msec in acute phase. The studies about arrhythmias and TTC are based on case reports. TTC may present with sudden cardiac death: this results in a probable underestimate of the real arrhythmic risk. TTC is one of the causes of acquired long QT syndrome and could be a trigger able to unmask latent silent or inapparent congenital long QT syndrome. All factors that can exacerbate QT prolongation should be promptly removed. In the case of marked bradycardia and/or TdP should be implant a temporary pacemaker. In most cases, due to the transient nature of the syndrome, it is reasonable to recommend only beta-blocker therapy at discharge, despite the absence of randomized trials. If there are high-risk factor for long QT syndrome (QTc post-TCM > 500 ms, prior syncope, previous cardiac arrests) thought should be given an indication to ICD implant.
“心尖球囊样综合征”（TTC）是一种临床疾病，通常由强烈的情绪和/或身体应激引起，其特征为可逆性严重局部左心室壁运动障碍、ST 段一过性改变，不存在明显的冠状动脉狭窄，可模拟急性心肌梗死。
尽管 TTC 具有良好的中期和长期预后，但心律失常风险日益受到关注，我们可以根据现有文献提供一种预后分层方法，并为这些“脆弱”患者的管理提供一些实用建议。
需要进一步开展随机试验研究以证明 TTC 的最佳治疗方法。
TTC 通常被认为是一种良性综合征，但在急性 QTc > 500 msec 的亚组患者中，应重新将其视为发生致死性心律失常的高危临床情况。关于心律失常和 TTC 的研究基于病例报告。TTC 可能导致心源性猝死：这可能导致对真实心律失常风险的低估。TTC 是获得性长 QT 综合征的原因之一，并且可能是能够揭示潜在的隐性或无症状先天性长 QT 综合征的触发因素。应立即去除可加重 QT 延长的所有因素。如果存在明显的心动过缓和/或尖端扭转型室性心动过速，应植入临时起搏器。在大多数情况下，由于该综合征具有短暂性，尽管缺乏随机试验，建议在出院时仅给予β受体阻滞剂治疗是合理的。如果存在长 QT 综合征的高危因素（经 TCM 后 QTc > 500 ms、既往晕厥、既往心脏骤停），应考虑植入 ICD。
