Kardiomiopatia wywołana stresem w diagnostyce bólu w klatce piersiowej

Joanna Mazurkiewicz¹, Krzysztof Pabisiak¹, Joanna Zielonka²

Summary
Stress cardiomiopathy (SC), also known as takotsubo syndrome, broken heart disease or apical ballooning syndrome, is an increasing reported syndrome caused by reversible systolic dysfunction of the left ventricle. In more than 60% of cases the onset of symptoms is preceded by emotional or physical stress with most cases described in post-menopausal women. The incidence of stress cardiomiopathy is estimated to be approximately 2% of patients presenting with clinical and ecg symptoms an acute myocardial infarction. Angiography of SC patients demonstrates intact coronary arteries, while echocardiography or ventriculography show systolic dysfunction of the myocardium extending beyond the territory of a single coronary artery. The pathogenesis of this disorder is not well understood. Postulated mechanisms include catecholamine mediated myocardial stunning, coronary artery spasm, direct myocardial toxicity of catecholamines, genetic background and others. The treatment of this transient disorder managed with supportive therapy based upon the patient’s overall clinical condition. The prognosis is good. Nearly all patients can make a full recovery within 4 weeks of onset. Stress cardiomiopathy should be included in the differential diagnosis of patients with an apparent acute coronary syndrome, especially in the setting of a stressful trigger.

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