Síndrome de Takotsubo

Abstract

Takotsubo syndrome is characterized by angina and ST elevation simulating acute myocardial infarction and is distinguished by the absence of coronary obstruction in acute, reversible anteroapical dyskinesia with basal hyperkinesia and typical electrocardiographic evolution. This condition was first described in Japan in the nineties. It is a rare close to 1% of all patients with suspected acute coronary syndrome entity. It usually affects postmenopausal women with few cardiovascular risk factors. It is characterized by anginal chest pain, electrocardiographic changes, enzyme elevation myocardial damage, absence of coronary stenosis on angiography and a characteristic anteroapical dyskinesia of left ventricle that normalizes within a few days. Severe emotional stress is the most common trigger. The pathogenesis of this syndrome is still to be defined. It is believed to be due to an exaggerated discharge sympathetic activity, and spasm of the coronary microvascular dysfunction. Although the clinical presentation mimicking acute myocardial infarction, coronary arteriography is no obstructive lesions. Unlike acute coronary syndrome, patients with left ventricular dysfunction do not have atherothrombotic disease in the coronary arteries; in addition, the alterations described have a reversible character. Clinical diagnostic criteria have been proposed, there are at present some controversy in them, as well as complementary examinations necessary for diagnosis.