Patientenversorgung in der akuten Phase der stressinduzierten Kardiomyopathie (Tako-Tsubo-Kardiomyopathie) – und danach?

Abstract

The prognosis of patients presenting with Tako-Tsubo cardiomyopathy (TTC) is generally considered to be favorable. However, in the acute phase of the disorder complications are not infrequent and, therefore, continuous monitoring and consistent therapy in an intensive care unit is essential. Typical complications in patients with TTC are cardiogenic shock, obstruction of the left ventricular outflow tract (LVOT), occasionally accompanied by acute mitral regurgitation, arrhythmias, predominantly torsade de pointes tachycardias due to QT prolongation, left ventricular (LV) thrombus formation with or without consecutive thromboembolic events, and LV rupture. After confirmation of TTC by coronary angiography, repeat echocardiography should be performed. A standardized therapy for patients with TTC has so far not been established. Recommendations for the acute phase include the administration of anxiolytic agents for patients who present with preceding emotional stress, consistent therapy of physical stressors (such as pain or asthma) and avoidance of catecholamine therapy. Shock due to LVOT obstruction is treated by administration of volume and β-blockers. With respect to the occurrence of torsade de pointes tachycardias, drugs which might cause QT prolongation should not be given. The notable incidence of LV thrombus formation justifies therapeutic anticoagulation. Systematic studies and treatment recommendations for the prophylaxis of recurrent TTC do not exist. The recently reported association between TTC and malignant disorders should prompt tumor screening and subsequent preventive medical checkups in patients affected by TTC.

Takotsubo cardiomyopathy: how much do we know of this syndrome in children and young adults?

“…59 Owing to the occurrence of torsades de pointes, drugs that might cause QTc prolongation should be avoided. 60 Intraventricular thrombosis is one of the known complications of this self-resolving cardiomyopathy, as observed in one of our patients (Fig 8). It can occur at any time of the disease, and unfortunately may develop despite full dose of anticoagulation.…”

“…In cases of left ventricular outflow tract obstruction and hypotension, short acting β-blockers like propranolol and fluids is recommended 59 . Owing to the occurrence of torsades de pointes, drugs that might cause QTc prolongation should be avoided 60 …”

Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome

“…Despite TTS often-perceived benign nature, with functional recovery within a few weeks in almost 96% of cases, life threatening complications and even fatalities can be expected in the early course of the disease [ 14 ]. Therefore, observation on an intensive care unit is common clinical practice in the acute setting of TTS [ 15 ].…”

The Value of Fetuin-A as a Predictor to Identify Takotsubo Patients at Risk of Cardiovascular Events

“…Despite a good general prognosis and an often-attributed benign pathology to its self-limiting course, life threatening complications and even fatal incidents may worsen clinical prognosis [29]. Therefore, monitoring on an intermediate care unit is standard clinical practice in the acute phase of TTC [30]. Fluid retention, hemodynamic compromising arrhythmias or even cardiogenic shock may require a transfer to an intensive care ward for a ventilation therapy or even extracorporeal circulation therapy.…”