Pillitteri Marta, Brogi Etrusca, Piagnani Chiara, Bozzetti Giuseppe, Forfori Francesco
Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy.
Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
J Anesth Analg Crit Care. 2024 Jul 15;4(1):45. doi: 10.1186/s44158-024-00178-y.
Resembling the morphology of Japanese polyp vessels, the classic form of Takotsubo cardiomyopathy is characterized by the presence of systolic dysfunction of the mid-apical portion of the left ventricle associated with basal hyperkinesia. It is believed that this may be due to a higher density of β-adrenergic receptors in the context of the apical myocardium, which could explain the greater sensitivity of the apex to fluctuations in catecholamine levels.The syndrome is precipitated by significant emotional stress or acute severe pathologies, and it is increasingly diagnosed during the perioperative period. Indeed, surgery, induction of general anaesthesia and critical illness represent potential harmful trigger of stress cardiomyopathy. No universally accepted guidelines are currently available, and, generally, the treatment of TTS relies on health care personal experience and/or local practice. In our daily practice, anaesthesiologists can be asked to manage patients with the diagnosis of new-onset Takotsubo before elective surgery or an emergent surgery in a patient with a concomitant stress cardiomyopathy. Even more, stress cardiomyopathy can arise as a complication during the operation.In this paper, we aim to provide an overview of Takotsubo syndrome and to discuss how to manage Takotsubo during surgery and in anaesthesiologic special settings.
应激性心肌病的经典形式类似于日本息肉样血管的形态，其特征是左心室心尖中部存在收缩功能障碍并伴有基底节运动亢进。据信，这可能是由于心尖部心肌中β-肾上腺素能受体密度较高，这可以解释心尖对儿茶酚胺水平波动的更高敏感性。该综合征由重大情绪应激或急性严重疾病引发，且在围手术期的诊断越来越多。实际上，手术、全身麻醉诱导和危重病是应激性心肌病的潜在有害触发因素。目前尚无普遍接受的指南，一般来说，应激性心肌病的治疗依赖于医疗保健人员的个人经验和/或当地做法。在我们的日常实践中，麻醉医生可能会被要求在择期手术前或在患有应激性心肌病的患者进行急诊手术时管理新诊断为应激性心肌病的患者。甚至，应激性心肌病可能在手术期间作为并发症出现。在本文中，我们旨在概述应激性心肌病综合征，并讨论如何在手术期间和麻醉特殊情况下处理应激性心肌病。
