Takotsubo Syndrome in a Young Man

Takotsubo syndrome is transient left ventricles dysfunction presenting as apical ballooning or midventricular enlargement with basal hyperkinesia of the left ventricle, while hemodynamically significant coronary artery stenosis is not found. There is considerable evidence that sympathetic catecholamine stimulation is central to takotsubo syndrome pathogenesis and causes coronary arteries constrictions, additional cardiotoxic effect and myocardial stress. First report about takotsubo syndrome was published 30 years ago by japanese H. Sato and al and was called ‘stress cardiomyopathy’. However, not only psychoemotional, but also physical stressors lead to the development of tacocubo syndrome, which increases the pathology significance. Clinical manifestations of takotsubo syndrome are indistinguishable from acute coronary syndrome, but the coronary arteries are not affected by angiography, there is a rapid positive echocardiographic dynamic. Postmenopausal women are predominantly affected (up to 90% patients). This case demonstrates the possible developing of takotsubo syndrome in a young man. The patient, 40 years old was hospitalized with typical clinical symptoms of ST segment elevation acute coronary syndrome after psycho-emotional stress, complicated by acute left ventricle insufficiency. The coronary artery angiography didn’t reveal of any damage and stenosis, there was normal level of troponins, significant increase of N-terminal propeptide of natriuretic hormone. According to echocardiography it was revealed that regional wall motion abnormality extended beyond a single epicardial vascular distribution and circular lesion of the apical and mid segments. After 3-th day from onset of disease we didn’t reveal left ventricle hypokinesia motion abnormalities by echocardiography, left ventricle ejection fraction became normal. This clinical case discuss includes the compliance of the disease manifestations with the diagnostic criteria of takotsubo syndrome, adopted by experts of the European Society of Cardiologists in 2018. Analysis of patient’s electrocardiograms allows to reveal early stage difference between takotsubo syndrome and anterior myocardial infarction.

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