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      Cardiomiopatía de Takotsubo: disfunción transitoria apical de ventrículo izquierdo Translated title: Takotsubo cardiomyopathy: transient apical dysfunction of the left ventricle

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          Abstract

          El síndrome de disfunción apical transitoria, ballooning o cardiomiopatía de Takotsubo es un síndrome de reciente descripción. Se trata de una entidad de mecanismo parcialmente conocido, caracterizada por la morfología que adopta el ventrículo izquierdo secundaria a la hipocinesia o discinesia de los segmentos apicales e hipercontractilidad de los basales. En la mayoría de los casos publicados se trata de un síndrome con elevación del segmento ST en las derivaciones precordiales, cuya forma de presentación es también el dolor torácico o la disnea, pudiendo existir una moderada elevación de los biomarcadores cardíacos. A diferencia del síndrome coronario agudo, los pacientes con disfunción del ventrículo izquierdo no presentan enfermedad aterotrombótica en las arterias coronarias; además, las alteraciones descritas poseen un carácter reversible. Se han propuesto unos criterios clínicos diagnósticos, existiendo en la actualidad cierta controversia en los mismos, así como en las exploraciones complementarias necesarias para realizar su diagnóstico.

          Translated abstract

          Transient apical dysfunction syndrome, ballooning or Takotsubo cardiomyopathy is a recently described syndrome. It is a disease with a partially known mechanism, characterized by the morphology adopted by the left ventricle secondary to hypokinesis and dyskinesis of the apical segments and hypercontractibility of the basal segments. In most of the cases published, it is a syndrome with ST segment elevation in the precordial leads, whose presentation form is also thoracic pain or dyspnea, with the possible existence of moderate elevation of cardiac biomarkers. On the contrary to the acute coronary syndrome, patients with left ventricle dysfunction do not have atherothrombotic disease in the coronary arteries. Furthermore, the alterations described have a reversible character. Some diagnostic clinical criteria have been proposed and there is presently some controversy on them and on the complementary examination needed to diagnose it.

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          Most cited references103

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          Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction.

          Peculiar asynergy, which consists of hypokinesis or akinesis from the mid portion to the apical area and hyperkinesis of the basal area on contrast left ventriculogram, is rare. Because the end-systolic left ventriculogram looks like a "tako-tsubo," which was used for trapping octopuses in Japan, we proposed the term "tako-tsubo-like left ventricular dysfunction." Our aim was to evaluate its clinical features and causes. We studied 30 patients with tako-tsubo-like left ventricular dysfunction without significant coronary artery disease. We assessed its pathophysiologic mechanisms by coronary spasm provocation test, endomyocardial biopsy, measurement of virus titer, and measurement of circulating catecholamine levels. Patient age ranged from 55 to 83 years. Twenty-eight were women and 2 were men. Tako-tsubo-like left ventricular dysfunction was dramatically resolved on predischarge left ventriculogram at 11.3 +/- 4.3 days. Acute coronary angiography revealed spontaneous multivessel coronary spasm in 3 patients. Among 14 patients, ergonovine or acetylcholine induced epicardial single coronary spasm in 4 patients and multivessel coronary spasm in 6 patients. Spontaneous microvascular spasm occurred at predischarge in 1 patient. An endomyocardial biopsy specimen in 3 patients and measurement of virus titer in 7 patients did not show evidence of acute myocarditis. Circulating norepinephrine was normal or slightly elevated in 6 patients. We showed clinical features of a novel cardiac syndrome with tako-tsubo-like left ventricular dysfunction. Although the precise cause remains unclear, simultaneous multivessel coronary spasm at the epicardial artery or microvascular levels may contribute to the onset of tako-tsubo-like left ventricular dysfunction.
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            Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome.

            The characteristics of 16 women with transient left ventricular (LV) apical ballooning syndrome in a United States population are presented. Additionally, Thrombolysis In Myocardial Infarction (TIMI) frame counts were evaluated during the acute period. Patients generally presented with anterior ST-elevation acute coronary syndrome in the absence of obstructive coronary disease. All patients had LV apical wall motion abnormalities. An acute emotional or physiologic stressor preceded most cases. TIMI frame counts were abnormal in all patients and often abnormal in all 3 major coronary vessels, suggesting that the diffuse impairment of coronary microcirculatory function may play a role in the pathogenesis of the syndrome.
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              Assessment of clinical features in transient left ventricular apical ballooning.

              We sought to assess the clinical features of transient left ventricular (LV) apical ballooning. Although several cases regarding transient LV apical ballooning have been reported, the etiology remains unknown. We investigated 17 patients (14 women, median age 74 years old with a range of 54 to 91 years old) who fulfilled the following criteria: 1) transient LV apical ballooning; 2) ST-T segment change in several leads in electrocardiogram; and 3) no history of old myocardial infarction, valvular heart disease, subarachnoid hemorrhage, or pheochromocytoma. Emotional and physical stress were observed in 16 patients (94%). Technetium-99m tetrofosmin tomographic imaging revealed decreased uptake at the apex of the left ventricle in 11 patients (85%) that later returned to uniform. No significant stenosis or angiographical slow flow in epicardial coronary arteries was observed (n = 9). Provocative focal vasospasm was induced in only one patient (14%) (n = 7). Moreover, no significant abnormality in the coronary microcirculation was detected by Doppler guidewire (n = 3) or contrast echocardiography (n = 1). No patients showed a rise in viral antibody titers. Biopsy specimens revealed interstitial fibrosis in six patients (100%) and slight cell infiltration in three others (50%) (n = 6). These findings suggested that neither abnormalities in the coronary circulation nor acute myocarditis was related to the etiology. Although neurogenic stunned myocardium induced by emotional or physical stress was suggested as the etiology, further investigations are necessary.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                medinte
                Medicina Intensiva
                Med. Intensiva
                Elsevier España, S.L. (, , Spain )
                0210-5691
                April 2007
                : 31
                : 3
                : 146-152
                Affiliations
                [01] Zaragoza orgnameHospital Clínico Universitario orgdiv1Servicio de Medicina Intensiva España
                Article
                S0210-56912007000300006
                10.1016/S0210-5691(07)74793-9
                17439770
                5feda554-cad3-4e97-9cd9-e0deda5ee4bc

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 72, Pages: 7
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                cardiomiopatía de Takotsubo,síndrome de disfunción apical transitoria,síndrome de ballooning,Takotsubo cardiomyopathy,transient apical dysfunction syndrome,ballooning syndrome

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