Abstract
Takotsubo cardiomyopathy was first described in Japan in the 1980s. The pathology was described as acute but usually reversible left ventricular dysfunction in response to psychological and physical stress. The reversible form of Takotsubo cardiomyopathy is characterized by basal left ventricular akinesis or hypokinesis associated with apical hyperkinesis, which is resolved independently.
About 2% of Takotsubo cardiomyopathy cases are considered troponin-positive with suspected acute coronary syndrome. The reversible form of Takotsubo cardiomyopathy varies from 1 per cent to 23 per cent of all Takotsubo cardiomyopathy cases and is associated with young age, a less pronounced decline in the left ventricle fraction and a more pronounced neurological pathology as compared to the irreversible form of Takotsubo.
The exact mechanism of Takotsubo cardiomyopathy development is not known; it is assumed to be related to catecholamine cardiotonic exposure, coronary spasm, coronary microvascular disorders and estrogen deficiency. Intracranial hemorrhage, general anaesthesia or neurological pathologies may be a trigger for reversible cardiomyopathy.
The diagnosis of Takotsubo reversible cardiomyopathy is based on the following data: first-time electrocardiography changes, rise of cardiac-specific troponins, basal akinesia or left ventricular hypokinesia according to echocardiography, absence of obstructive coronary pathology according to coronarography, pheochromocytoma or myocarditis. Treatment of Takotsubo cardiomyopathy is mainly aimed at maintenance therapy and treatment of complications, the most frequent complications of this type of cardiomyopathy include myocarditis, pleural or pericardial effusion, formation of thrombuses in the left ventricle. The recurrence of Takotsubo reversible cardiomyopathy is as high as 10%. Left ventricular ejection fraction reduction, atrial fibrillation and neurological diseases are the predictors of increased mortality.
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About the authors
- Leo A. Bockeria, Academician of Russian Academy of Sciences and Russian Academy of Medical Sciences, President, ORCID
- Ol'ga L. Bockeria, Dr. Med. Sc., Professor, Corresponding Member of Russian Academy of Sciences, ORCID
- Shamil' M. Abdulkerimov, Cardiovascular Surgeon, ORCID
- Gyulsuna A. Yurkulieva, Cardiologist, ORCID
- Margarita I. Gurina, Resident, ORCID
