Dissertations / Theses on the topic 'Takotsubo'

Introduction: Takotsubo cardiomyopathy or stress cardiomyopathy is a syndrome of transient left ventricular (LV) dysfunction mimicking myocardial infarction, but lacking obstruction of coronary artery disease (CAD) or acute plaque rupture. A characteristic differentiation from CAD is that regional motional abnormality extends beyond a territory perfused with a single epicardial coronary artery. Clinically, it is characterized by apical ballooning of the LV due to due to depression of mid and apical segments, with hyperkinesis of cardiac basal walls. Women are affected more than men, predominantly in the postmenopausal age. Case Report: A 54-year-old Caucasian female with a history of COPD, hypertension, uncontrolled diabetes mellitus, hyperlipidemia, depression and ongoing tobacco use presented with complaints of worsening shortness of breath two days prior to admission. She denied chest pain, worsened cough, palpitations, nausea or vomiting. On examination, she was in distress and anxious, with labored breathing. Upon examining the chest, decreased air entry was present in both lung fields with bibasilar wheezing. Initial lab tests showed mild respiratory acidosis, with pH of 7.24, pCO2 of 47.4 and pO2 of 65. Troponins on the day of admission was Soon after admission, she started complaining of severe right neck pain. Repeat EKG revealed localized lateral J point, anteroseptal q waves and 4mm ST-segment elevation in leads V3 and V4 reciprocal changes and without chest pain. Repeat troponins were slightly elevated to 0.42 ng/ml and CK-MB was elevated to 20.2 ng/ml. A transthoracic echocardiogram showed regional abnormalities in left ventricle with the apex, mid to distal septum and the anterior part of septum was akinetic. Discussion: Takotsubo cardiomyopathy presents in 1 to 2 percent of troponin-positive acute coronary syndrome (ACS) with various clinical manifestations and various outcomes. Some patients have favorable outcomes based on their clinical performance and extent of cardiac muscle involvement. As in the case we presented, this syndrome can be entirely idiopathic, without a definitive underlying cause. Supportive management while hospitalized and early identification of complications improve the prognosis.

Introduction: Takotsubo cardiomyopathy is an apical ballooning syndrome, which can be triggeredby stress. Only few case reports describe the onset of Takotsubo as a complication of neurosurgery procedures. Clinical presentation: A case of a 53 year-old female with a spinal neurinoma and surgery-associated Takotsubo cardiomyopathy is demonstrated. The patient developed typical signs of a myocardial infarction with circulation depression and ST elevation, but normal cardiac enzymes at the end of surgery. Cardiac catheterization and levocardiography confirmed the absence of any critical coronary disease but the presence of a typical apical ballooning and midventricular hypokinesis. The patient recovered completely under supportive conservative and cardiological therapy, showing regular left ventricular pumpfunction. Conclusion: Interventions in neurosurgery and perioperative care should be kept as stress free as possible. Due to the possibility of neurogenic mechanisms related to cardiomyopathy, Takotsubo cardiomyopathy as an entity of stress-induced complications should be taken into consideration.

Bakgrund: Takotsubo kardiomyopati är ett akut tillstånd för vårdsökande personer som symtommässigt liknar hjärtinfarkt men i själva verket är en reversibel hjärtsvikt. I det akuta skedet har sjuksköterskan en viktig roll i att inhämta anamnes, vilket är avgörande för att kunna vidta adekvata omvårdnadsåtgärder. Syfte: Att beskriva vårdsökande personers erfarenheter av att drabbas av takotsubo kardiomyopati. Metod: Integrativ litteraturöversikt vilken sammanfattar 13 vetenskapliga artiklar. Resultat: Litteraturöversikten visar tre huvudkategorier: Utlösande faktorer, Akuta skedet och Dagligt liv. De som drabbas av takotsubo kardiomyopati främst är kvinnor samt personer med liknande personlighetsdrag, där oro, ångest och stress är en stor del av vardagen. Emotionella eller fysiska stressorer är de främsta bakomliggande orsakerna till att drabbas av takotsubo kardiomyopati. Symtomen är främst dyspné och bröstsmärta som flera av de drabbade till en början ignorerar. Slutsats: Takotsubo kardiomyopati medför existentiella frågor och oro för framtiden där stresshantering och sjuksköterskans personcentrerade förhållningssätt är avgörande för att återfå god hälsa. Det krävs ytterligare forskning för att utforma strategier för väl anpassad personcentrerad omvårdnad för de drabbade.
Background: Takotsubo cardiomyopathy is a critical condition for the care recipient that is symptomatically similar to myocardial infarction but in fact is a reversible form of heart failure. In the critical stage, the nurse has an important role in acquiring anamnesis, which is crucial in order to be able to perform adequate nursing actions.Aim: To describe care recipients experience of suffering from takotsubo cardiomyopathy.Method: Integrative literature review of 13 scientific articles.Result: Common findings lead to three main categories: Triggering factors, Critical stage and Everyday life. Those affected by takotsubo cardiomyopathy are mainly women and have similar personality traits, where uneasiness, anxiety and stress are major parts of the everyday life. An emotional or physical stressor are often the underlying cause of the person being affected by takotsubo. The symptoms are mainly dyspnoea and chest pain, symptoms that several of the affected initially ignore. Conclusion: Takotsubo cardiomyopathy brings up existential concerns and questions about the future where stress management and the nurse’s person centered approach are crucial for regaining good health. Further research is needed to obtain strategies to form well-adjusted person centered care for those affected.

Takotsubo cardiomyopathy (TTC) is a disease characterized by transient left ventricular (LV) dysfunction and typical wall motion abnormalities in apical parts, without obvious signs of coronary influence. Due to its elusive natural cause and the lack of clarified pathology, further studies are needed. Thirteen patients presented with an episode of TTC, and referred to Örebro University Hospital (USÖ), were prospectively included and investigated by comparisons made at onset (acute phase) against at follow-up three months later (recovery phase). Including echocardiographic measurements, focused on biventricular systolic long-axis function and conventional diastolic function (DF) variables. Systolic improvement was shown, while most DF data were unchanged, suggesting that TTC is mainly a systolic disease affecting both ventricles. Diagnosis should include multidisciplinary engagement, as TTC associates both with emotional stress and pathological markers of physiological stress. In this thesis, such approach was offered to the aforementioned patients; to see if a common denominator could be found, thus, contributing to better handling. Emotional state was assessed, along with an array of cardiac investigations in addition to echocardiography. Acutely, imbalance in the autonomic cardiac control was shown, as well as a trend toward posttraumatic stress, but specific findings allowing conclusions on differential diagnosis could not be demonstrated. By adding another 15 TTC patients (i.e. 28 in total), through collaboration with observers from USA, a retrospective echocardiographic analysis could be done to further study DF; concluding that TTC associates with impairment of conventional DF variables which tends to parallel the systolic recovery, in contrary to the initial result but in line with other causesof LV dysfunction. Magnetic resonance imaging (MRI) is another method of choice at TTC. The USÖ patients had cardiac MRI, thus, a retrospective analysis was done to investigate the effect on LV geometry, both echocardiographic and by MRI; suggesting that TTC is consistently associated with increased LV mass, due to a local impact that seems to follow the change in LVconcentric wall motion.

Det är cirka två procent av de patienter som insjuknar med symtom förenliga med akut kranskärlssjukdom (AKS) som istället drabbas av takotsubo syndrom (TS). TS anses vara kraftigt underdiagnostiserat och även ofta felaktigt diagnostiserat. Brister i rekommendationer och avsaknad av riktlinjer, i kombination med att patienterna inte är särskilt vanligt förekommande, kan påverka förutsättningarna för sjuksköterskor att erbjuda dessa patienter evidensbaserad och personcentrerad omvårdnad.   Syftet med studien var att beskriva sjuksköterskors erfarenheter av omvårdnad vid takotsubo syndrom.   Metoden var en kvalitativ, deskriptiv intervjustudie med induktiv ansats. Semistrukturerade intervjuer genomfördes med tio sjuksköterskor verksamma inom hjärtsjukvård. Insamlade data transkriberades och analyserades med inspiration från Graneheim och Lundmans kvalitativa innehållsanalys.   Resultatet genererade i de fem kategorierna: sjuksköterskornas erfarenheter av insjuknandet i TS, sjuksköterskornas erfarenheter av omvårdnadsbehovet vid TS, sjuksköterskornas erfarenheter av omvårdnadsåtgärder vid TS, kunskap och evidens i omvårdnadsarbetet vid TS och sjuksköterskans copingstrategier vid bristande evidens och kunskap. Sjuksköterskorna hade varierande erfarenheter av omvårdnaden och de flesta tyckte att omvårdnadsarbetet vid TS var svårt. Många av sjuksköterskorna upplevde svårigheter att besvara patienternas frågor och att detta påverkades av begränsad kunskap inom området och av att det inte fanns några riktlinjer att följa för omvårdnadsarbetet. Detta gjorde att sjuksköterskorna inte visste om det fanns några särskilda restriktioner och rekommendationer för dessa patienter. Sjuksköterskorna upplevde även att patienterna var i stort behov av samtal och information och att en stor del av omvårdnadsarbetet bestod av att försöka tillgodose detta behov.   Slutsatsen i denna studie är att sjuksköterskorna upplevde att det saknades kunskap om specifik omvårdnad vid TS. De ville erbjuda patienterna bästa möjliga omvårdnad och de efterfrågade mer kunskap och stöd för att kunna åstadkomma detta. Sjuksköterskorna upplevde frustration eftersom de inte kunde erbjuda evidensbaserad omvårdnad till dessa patienter på samma sätt de vanligtvis kunde erbjuda till andra patienter. Den omvårdnad som erbjöds till patienterna varierade mellan sjuksköterskorna och nedprioriterades ofta, bland annat till fördel för det medicinska arbetet och för andra patienter i större behov av omvårdnad.
About two percent of the patients who suffer from symptoms consistent with acute coronary syndrome (ACS) have instead been affected by takotsubo syndrome (TS). TS is considered to be severely under-diagnosed and also often incorrectly diagnosed. Deficiencies in recommendations and lack of guidelines, in combination with the fact that patients are not particularly common, can affect the prerequisites nurses have to offer these patients evidence-based and person-centered care.   The purpose of the study was to describe nurses' experiences of nursing care in takotsubo syndrome.   The method was a qualitative, descriptive interview study with inductive approach. Semi-structured interviews were conducted with ten practicing nurses in heart care. The collected data was transcribed and analyzed with inspiration from Graneheim and Lundman's qualitative content analysis.   The results generated five categories: nurses´ experiences of suffering from TS, nurses’ experiences of nursing care, nurses’ experiences of nursing actions, knowledge and evidence in nursing care and nurses´ coping strategies in case of lack of evidence and knowledge. The nurses had different experiences with the nursing care, and a majority expressed difficulties nursing patients with TS. Many nurses experienced difficulties in answering the patients' questions and that this was affected by limited knowledge as well as there were no specific guidelines for the appropriate nursing care. This meant that the nurses did not know if there were any particular restrictions and recommendations for these patients. Furthermore, the nurses expressed the need for patients being given proper support and information.   The conclusion of this study is that the nurses experienced lack of knowledge in specific nursing care of patients with TS. The nurses wanted to offer the best possible care and they asked for more knowledge and support in order to achieve this. Due to lack of support and information the nurses felt frustrated as they were unable to offer evidence-based nursing equal to that of any other patient. The results also showed that the nursing care offered to the patients varied between the nurses and that the nursing care of the patients with TS to a large extent was given less priority. This down-prioritization was to the benefit of the medical work and other patients who were deemed to be in greater need of nursing care. The discrimination of TS patients was largely to prioritize other patients in greater need of nursing care.   About two percent of the patients who suffer from symptoms consistent with acute coronary syndrome (ACS) have instead been affected by takotsubo syndrome (TS). TS is considered to be severely under-diagnosed and also often incorrectly diagnosed. Deficiencies in recommendations and lack of guidelines, in combination with the fact that patients are not particularly common, can affect the prerequisites nurses have to offer these patients evidence-based and person-centered care.   The purpose of the study was to describe nurses' experiences of nursing care in takotsubo syndrome.   The method was a qualitative, descriptive interview study with inductive approach. Semi-structured interviews were conducted with ten practicing nurses in heart care. The collected data was transcribed and analyzed with inspiration from Graneheim and Lundman's qualitative content analysis.   The results generated five categories: nurses´ experiences of suffering from TS, nurses’ experiences of nursing care, nurses’ experiences of nursing actions, knowledge and evidence in nursing care and nurses´ coping strategies in case of lack of evidence and knowledge. The nurses had different experiences with the nursing care, and a majority expressed difficulties nursing patients with TS. Many nurses experienced difficulties in answering the patients' questions and that this was affected by limited knowledge as well as there were no specific guidelines for the appropriate nursing care. This meant that the nurses did not know if there were any particular restrictions and recommendations for these patients. Furthermore, the nurses expressed the need for patients being given proper support and information.   The conclusion of this study is that the nurses experienced lack of knowledge in specific nursing care of patients with TS. The nurses wanted to offer the best possible care and they asked for more knowledge and support in order to achieve this. Due to lack of support and information the nurses felt frustrated as they were unable to offer evidence-based nursing equal to that of any other patient. The results also showed that the nursing care offered to the patients varied between the nurses and that the nursing care of the patients with TS to a large extent was given less priority. This down-prioritization was to the benefit of the medical work and other patients who were deemed to be in greater need of nursing care. The discrimination of TS patients was largely to prioritize other patients in greater need of nursing care.

Takotsubo syndrome, also known as Takotsubo cardiomyopathy, broken heart syndrome and stress cardiomyopathy, is a form of acquired cardiac failure that typically occurs after a period of intense emotional or physical stress. Patients typically present with symptoms indicative of acute coronary syndrome, but angiography shows no culprit pathology. Ventricular imaging shows a hypokinetic apical, and often mid-LV, myocardium coupled with a hyperkinetic basal myocardium, although inverted Takotsubo variants with or without mid-LV sparing have also been described. The majority of reported Takotsubo syndrome cases are in post-menopausal females, although it can occur in both males and females across a wide range of ages. Using a previously-described method of inducing transient apical dysfunction in male rats by administering IV high-dose adrenaline, ovariectomised females showed a far greater sensitivity to the same adrenaline dose than non-ovariectomised females, showing a higher mortality rate. 2-week estrogen replacement did ameliorate this increase in mortality, although vehicle-only minipumps also had some effect in reducing mortality in ovariectomised female rats. 2-week estrogen administration to male rats did not result in a significantly-different mortality rate. Attempts to recapitulate another Takotsubo syndrome model by administering IP high-dose isoprenaline demonstrated that choice of anaesthetic was crucial in allowing a necessary condition, hyperthermia, to occur, as maintenance of anaesthesia with isoflurane rather than ketamine-midazolam prevented this rise in body temperature caused by the administration of isoprenaline. Hyperthermia was found to be an essential condition for the induction of apical dysfunction in this model, although the removal of hyperthermia after the initiation of contractile dysfunction did not reverse the Takotsubo-like contractility pattern. Attempts to recreate the contractile dysfunction in the isolated heart were unsuccessful. However, imaging studies showed that adrenaline can induce a mitochondrial dysfunction in the isolated rat heart, with hyperthermia augmenting this effect.

Takotsubo kardiomyopati (TK) är ett syndrom som uppvisar liknande symtom som vid en akut hjärtinfarkt. EKG-bild och hjärtskademarkörer i serum kan också tala för en akut hjärtinfarkt men vid kranskärlsröntgen påvisas normala kranskärl. I Sverige diagnostiseras cirka 600 personer årligen med TK och företrädelsevis är det postmenopausala kvinnor som drabbas. Forskning om syndromet pågår men avsaknad av tydliga evidensbaserade behandlingsstrategier både inom den akuta och sekundärpreventiva vården kan leda till ett icke optimalt omhändertagande av denna grupp patienter. Sekundärprevention syftar till att personen drabbad av sjukdom skall ges förutsättningar att förhindra och/eller skjuta upp återinsjuknande. Sjuksköterskor som träffar dessa personer i hjärtrehabilitering efter diagnos TK är en viktig del för framtida livssituation för den drabbade och att belysa erfarenheter hos dessa sjuksköterskor kan vara av intresse för vidare sekundärpreventiv omvårdnad av patienter med TK. Syftet var att belysa sjuksköterskors erfarenhet och upplevelser av sekundärpreventiv omvårdnad vid Takotsubo kardiomyopati. Metoden var en kvalitativ intervjustudie där data samlades in genom att intervjua sju sjuksköterskor arbetande på hjärtmottagning dit patienter med TK blev kallade för återbesök. Intervjuerna genomfördes med stöd av en semistrukturerad intervjuguide utformad av författarna. Den insamlade datan transkriberades och analyserades sedan med kvalitativ innehållsanalys. Resultatet av sjuksköterskornas erfarenhet trädde fram i tre kategorier, ”Behov av kunskap och kompetens för att kunna tillgodose behov av information”, ”Önskan om individanpassad sekundärprevention” och ”Brist på evidensbaserad omvårdnad”. Sjuksköterskornas upplevelser var att det främst var kvinnor som drabbades av TK och att livssituationen för dessa innan insjuknandet var fyllt av stress. Sjuksköterskorna upplevde även att patienterna hade det tufft i efterförloppet med kvarvarande besvär med trötthet, andfåddhet och stor oro. Sjuksköterskorna kände att de inte hade tillräckligt med kunskap om TK, dess behandling och dess naturalförlopp Detta skulle kunna härledas till otydliga riktlinjer och att det saknades evidensbaserade strategier för ett optimalt omhändertagande. Tankar och önskemål om förbättringsarbete kring denna patientkategoris sekundärpreventiva omvårdnad framkom. Denna studies slutsats blev att sjuksköterskornas erfarenheter av sekundärpreventiv omvårdnad vid TK är att det behövs utvecklas evidensbaserade riktlinjer för omvårdnaden. Sjuksköterskorna upplevde patientgruppen som en skör grupp med stort behov av stöd i eftervården och de kunde känna en viss otillfredsställelse av att inte kunna möta patientens behov beroende på avsaknad av tydliga riktlinjer. Sjuksköterskorna var engagerade och intresserade av patientgruppen och såg potential för förbättringsarbete och förordade ett multidisciplinärt samarbete för att samla största möjliga erfarenheter kring dessa patienter.

Bakgrund: När någon drabbas av en allvarlig sjukdom som kan vara livshotande blir det i regel en förändring i livet. Upplevelsen av hjärtinfarkt eller takotsubo kan bli både skrämmande och främmande inte bara för den drabbade, utan även för deras närstående. Hjärtinfarkt är en sjukdom som drabbar många och är ett av vår tids mest förekommande sjukdomstillstånd. Takotsubo är en nytillkommen diagnos som kan misstolkas som hjärtinfarkt. Det är värdefullt att ha förståelse och kunnande om insjuknandet och livet efter för de personer som drabbats av sjukdomen, även för deras närstående och sjukvårdspersonal. Syfte: Syftet var att beskriva kvinnors upplevelser av att ha drabbats av hjärtinfarkt eller takotsubo. Metod: En beskrivande litteraturstudie baserat på åtta vetenskapliga artiklar med kvalitativ ansats och en studie med mixad ansats. Sammanlagt nio artiklar. Artiklarna söktes via CINAHL och PubMed via Medline. Huvudresultat: Kvinnornas vanligaste upplevelser var förnekelse av symtomen och de såg sig inte vara i riskgruppen att drabbas av hjärtsjukdom. En rädsla att bli betraktad som hypokondriker och dålig erfarenhet av vården ledde till fördröjning av att söka vård. Kvinnorna upplevde skillnader på vårdens kompetens, mellan olika vårdinrättningar. Kvinnorna upplevde en tacksamhet över att ha överlevt och insåg behovet av livsstilsförändringar. Merparten av kvinnorna upplevde oro och ångest över att drabbas av hjärtinfarkt igen. Slutsats: Kvinnorna förväntades inte att drabbas av hjärtinfarkt eller takotsubo. Kvinnorna samt vårdpersonal uppfattade inte symtomen som en hjärtinfarkt eller takotsubo, vilket leder till fördröjd vård. Kvinnorna upplever också ojämn kvalitet på vård. Kvinnorna upplever en stor förändring av livet samt att dess rädsla och oro alltid kommer att vara närvarande. Nyckelord: Myocardial infarkt, Takotsubo kardiomyopati, Upplevelser, Kvinnor.
Background: When someone suffers a serious illness that can be life-threatening, there is usually a change in life. The experience of a myocardial infarction or takotsubo can be both frightening and foreign not only to the affected, but also to their loved ones. Myocardial infarction is a disease that affects many people and is one of the most common conditions of our time. Takotsubo is a recent diagnosis that can be misinterpreted as a myocardial infarction. It is valuable to have an understanding and knowledge of the illness and life of the people affected by illnesses, including those of their relatives and health care professionals. Aim: The purpose was to describe women's experiences of having suffered from myocardial infarction and takotsubo. Method: A descriptive literature study based on eight scientific articles with a qualitative approach and one study with a mixed approach. A total of nine articles. The articles were searched via CINAHL and PubMed through Medline. Results: The most common experiences among the women were denial of the symptoms and they did not see themselves in the risk group of suffering from heart disease. Fear of being considered hypochondriacs and poor experience of care led to a delay in seeking care. The women experienced differences in care skills, between different healthcare institutions. The women felt gratitude for surviving and realized the need for lifestyle changes. Most of the women experienced anxiety about being affected by a heart attack again. Conclusion: The women were not expected to suffer a myocardial infarction or takotsubo. The women as well as health care workers did not perceive the symptoms as a myocardial infarction or takotsubo, which led to delayed care. The women also experience uneven quality of care. The women experience a great change in life and that their fears and anxieties will always be present. Keywords: Myocardial infarction, Takotsubo cardiomyopathy, Experiences, Women.

Bakgrund:Takotsubo syndrom har länge behandlats som ett metaforiskt tillstånd. Det harbevisats att det sker en fysisk förändring i hjärtat och att det förorsakas avemotionell och fysisk stress. Av alla dem som blir diagnostiserade med Takotsubosyndrom är det 97% som är kvinnor.Syfte:Syftet med litteraturstudien var att beskriva kvinnors upplevelser av diagnosenTakotsubo syndrom. Metod:En systematisk litteraturstudie med en induktiv ansats. Datainsamlingen bestod aven systematisk litteratursökning i databaserna Cinahl, PubMed och PsycInfo. Tioartiklar av god kvalité inkluderades i resultatet via en integrerad analys enligtKristensson (2014). Resultat:I resultatet framkom det tre kategorier; Upplevelser innan sjukdomsdebut,upplevelser vid sjukdomsdebut och upplevelser efter sjukdomsdebut. Resultatetvisade att kvinnorna hade varit utsatta för flertalet stressrelaterade livshändelserunder sitt liv, samt att symtom har ignorerats fram till sjukdomsdebut. Debuten avsjukdomen har utlösts av emotionella och fysiska faktorer. Kvinnorna har upplevtliknande symtom som en hjärtinfarkt vilket gjorde att diagnosen av Takotsubosyndrom upplevdes chockerande. Efter sjukdomsdebuten beskrivs upplevelsen avatt drabbas av sjukdomen och hur kvinnornas dagliga liv förändrades, samt vad somorsakade den stress relaterande sjukdomen. Slutsats:Tillståndet utlöses av emotionella och fysiska faktorer. Huvudsymtomen varbröstsmärta, andnöd, yrsel, illamående samt oro och ångest. Vårdpersonalen har enriktigt roll i bemötandet av patienterna med Takotsubo syndrom genom att biståmed rätt diagnos oh behandling. Det kan uppnås genom utbildning och ökadkunskap hos vårdpersonalen.

Stress (Takotsubo) cardiomyopathy is a severe form of acute heart failure (HF) with rapid onset, characterized by hypocontraction of the heart from the mid-left ventricle to apex. It is precipitated by extreme stress and plasma levels of the catecholamines adrenaline and noradrenaline are significantly elevated. This thesis describes the development of a new model of Takotsubo cardiomyopathy through rapid intravenous injection of a supraphysiological dose of adrenaline into anaesthetised male Sprague- Dawley (SD) rats and real-time imaging of the heart using either 2D-echocardiography or cardiac magnetic resonance (CMR). This in vivo rat model was used, in conjunction with in vitro IonOptix video-edge detection of cardiomyocyte contractility, to firstly demonstrate that this syndrome results from an adrenaline-induced trafficking-switch of the coupling of the pleiotropic β2-adrenceptor (AR) from Gs-adenylyl cyclase (AC)-cyclic adenosine monophosphate (cAMP) cardiostimulant to Gi-activated cardiodepressant pathways. Cardiomyocyte β2AR:β1AR population ratios, determined by radioligand binding, suggested that an apical-basal gradient in β2AR expression accounted for the in vivo apical hypokinesis. Certain β-blockers can act as biased agonists of a Gi-coupled isoform of the β2AR in animal and human cardiomyocytes via a pathway that involves p38 MAPK. Administration of the clinical β-blockers propranolol and carvedilol 15 minutes after adrenaline either enhanced or failed to reverse apical hypocontractility. In vitro analysis demonstrated that β2AR-Gi signalling involves p38 MAPK activation. However, pre-treatment with either the p38 MAPK inhibitor SB203580 or the β2AR blocker ICI-118,551 prior to adrenaline resulted in significant mortality, which suggested that the β2AR-Gs/Gi coupling switch is a cardioprotective strategy. Gi-protein is upregulated in chronic HF, while β1ARs are down-regulated. In contractility studies of chronically failing human/rat cardiomyocytes, β2AR-Gs responses were present with minimal active Gi-protein component. This suggested that while in acute HF β2AR-Gs positively inotropic responses are impaired and β1ARs are preserved, the opposite may be true in chronic HF.

Bakgrund: Takotsubo syndrom är en akut och reversibel hjärtsvikt som vanligen orsakas av psykisk eller fysisk påfrestning. Det är främst kvinnor i postmenopausal ålder som drabbas, men förekommer hos båda könen och i alla åldrar. Patofysiologin vid Takotsubo syndrom är fortfarande inte klarlagd och det råder brist på forskning vad gäller patienternas erfarenheter av att drabbas av sjukdomen. Syfte: Att beskriva patienters erfarenheter av att ha drabbats av Takotsubo syndrom. Metod: En kvalitativ explorativ studie med 11 semistrukturerade intervjuer som analyserades med innehållsanalys. Resultat: Resultatet visade att patienter upplever en process från insjuknande till återhämtning som innefattar att söka svar och förståelse för bakomliggande orsaker, att drabbas av känslomässiga reaktioner och ett behov av stöd. Resultatet visade också att sjukdomen ledde till förändring i tillvaron. Slutsats: Fynden i resultatet visar att patienter som drabbats av Takotsubo syndrom upplever en process av att anpassa sig till en ny livssituation genom vägledning för att uppnå välbefinnande. Detta kan uppnås genom personcentrerad vård.   Nyckelord: Kvalitativ metod, Patienterfarenheter, Personcentrerad vård, Takotsubo syndrom
Background: Takotsubo syndrome is an acute and reversible type of heart failure syndrome that is usually caused by psychological or physical stress. Postmenopausal women are primarily affected, but the syndrome occur in both genders and in all ages. The pathophysiology of Takotsubo syndrome is still unclear and there is a lack of research regarding patients' experience of the disease. Purpose: To describe patients' experience of being affected by Takotsubo syndrome. Method: A qualitative interview study with 11 semi-structured interviews was undertaken and analyzed with content analysis. Result: The results showed that patients experienced a process from onset to recovery that involves seeking answers and understanding of underlying causes, that they suffered from emotional reactions and needed support. The result also showed that the disease led to a change in the participants' daily lives. Conclusion: The findings in the results show that patients described a process of adapting to a new life situation through guidance to achieve well-being which could be done by person centered care. Keywords: Patient experience, Person-centered care, Takotsubo syndrome, Qualitative method

Echocardiography is a well established technique when evaluating the size and function of the heart. One of the most common ways to measure the size of the right ventricle (RV) is to measure the RV outflow tract 1(RVOT1). Several ways to measure RVOT1 are described in the literature.These ways were compared with echocardiography on 27 healthy subjects.The result showed significant differences in RVOT1, depending on the way it was measured, concluding that the same site, method and body positionshould be used when comparing RVOT1 in the same subject over time.One parameter to evaluate the RV diastolic function (RVDF) is to measure the RV isovolumetric relaxation time (RV-IVRT), a sensitive marker ofRV dysfunction. There are different ways to measure this. In this thesis two ways of measuring RV-IVRT and their time intervals were compared in 20 patients examined with echocardiography. There was a significant difference between the two methods indicating that they are not measuring the same interval.Another way to assess the RVDF is to measure the maximal early diastolicvelocity (MDV) in the long-axis direction. MDV can be measured bydifferent methods, hence 29 patients were examined and MDV was measured according to two methods. There was a good correlation but a poor agreement between the two methods meaning that reference values cannot be used interchangeably.Takotsubo cardiomyopathy is characterized by apical wall motion abnormalities without coronary stenosis. The pathology of this condition remains unclear. To evaluate biventricular changes in systolic long-axisfunction and diastolic parameters in the acute phase and after recovery, 13 patients were included and examined with echocardiography at admission and after recovery. The results showed significant biventricular improvementof systolic long-axis function while most diastolic parameters remainedunchanged.

Nos últimos 25 anos, a Síndrome de Takotsubo emergiu como uma apresentação relevante de lesão miocárdica aguda, caracterizada por uma falha distinta regional na contracção ventricular, normalmente acompanhada por uma significativa redução na fracção de ejecção ventricular esquerda, sendo tipicamente reversível. Identificada primariamente por cientistas Japoneses em 1991, esta patologia foi designada Takotsubo devido à sua apresentação característica no ecocardiograma, semelhante ao vaso usado para pescar polvos. Takotsubo é uma síndrome que mimetiza o enfarte agudo do miocárdio, na ausência de doença arterial obstrutiva coronária epicárdica, de forma a explicar o grau de anormalidade na motilidade da parede ventricular. Usualmente, mais comum nas mulheres idosas, esta condição é, geralmente, desencadeada por situações inesperadas de stress emocional ou físico, estando associada a alterações no eletrocardiograma e ligeira elevação nos biomarcadores cardíacos. O mecanismo fisiopatológico ainda não está claro, mas acredita-se que uma alta concentração circulante de catecolaminas provoca uma disfunção aguda da microcirculação coronária e do metabolismo dos cardiomiócitos, levando a um atordoamento transitório do miocárdio. As recorrências são raras e julga-se que o prognóstico a longo prazo é bom. O tratamento durante a fase aguda é principalmente sintomático. Não há consenso quanto à terapêutica a longo prazo para a Síndrome de Takotsubo.
In the last 25 years, the Takotsubo Syndrome has emerged as an important form of acute myocardial injury characterized by distinctive regional left ventricular contraction failure, often with marked reduction of left Ventricular ejection fraction, and is typically completely reversible. First identified by Japanese scientists in 1991, this disorder was named for the distinctive echocardiogram’s resemblance to traditional takotsubo, or octopus fishing pots. Takotsubo is a syndrome that mimics an acute myocardial infarction in absence of obstructive epicardial coronary artery disease to explain the degree of the wall motion abnormalities. Typically more common in the elderly women, this condition is usually triggered by unexpected emotional or physical stress situations, and is associated with electrocardiogram abnormalities and slight elevation of cardiac biomarkers. The pathophysiological mechanism is not clear yet, but it is believed that a high circulating concentration of catecholamines causes an acute dysfunction of the coronary microcirculation and metabolism of cardiomyocytes, leading to a transient myocardial stunning. Recurrences are rare and it is thought that the long-term prognosis is good. Treatment during the acute phase is mainly symptomatic treatment. There is no consensus regarding long-term management of Takotsubo Syndrome.

Takotsubo cardiomyopathy is a reversible condition, characterized by transient left ventricular systolic dysfunction, that mimics an acute coronary syndrome. It usually occurs after physical or emotional stress, predominantly in postmenopausal women, although it also can affect younger age groups and males. It often presents as chest pain or dyspnea with electrocardiographic changes and mild elevation of cardiac enzymes suggesting acute myocardial infarction. Coronary angiography excludes obstructive coronary disease, and imaging reveals ventricular apical akinesia and compensatory hypercontractility of the basal segments. Various pathophysiological mechanisms have been proposed for the syndrome, such as occult atherosclerotic disease, multivessel spasm and/or microvascular dysfunction. However, the most widely accepted hypothesis at present is an excess of catecholamines causing calcium overload in cardiac myocytes, leading to disruption of contraction and ventricular function. Treatment is essentially supportive, with spontaneous and complete reversal of the changes within days or weeks. However, the presence of complications and comorbidities may predict a more adverse prognosis. As much is still unknown about takotsubo cardiomyopathy and the number of reported cases is growing, we present a literature review.

碩士
中臺科技大學
醫學影像暨放射科學系暨研究所
105
Takotsubo cardiomyopathy (or heart break syndrome) is a rare case, usually typically triggered by an acute emotional or physical stress events. Cardiomyopathy is usually in apex from the coronary angiography. It’s appearance look likes a octopus pot. In 1990, the Japanese. Dr. Sato named it for the first time. It is also named transient left ventricle apical ballooning and clinical characterized by temporary left ventricular dysfunction. It shows no significant coronary artery disease.Most cases present intense chest pain or shock by emotional triggering events,such as death, accidental or constant anxiety. Some cardiomyopathy has acute myocardial infarction with symptoms. Coronary spasm, microcirculation dysfunction and catecholamine overload have been proposed as the possible causes of this syndrome. We evaluated eight patients who presented with left ventricular dysfunction after sudden emotional stress with apical ballooning syndrome in this study. The clinical patients underwent echocardiography and cardiac catheterization .The results of Takotsubo cardiomyopathy were analyzed. Statistical analysis were used to identify whether acute stenosis risk factors were associated with cardiomyopathy. The patient was discharged and remained well without chest pain or dyspnea and left ventricular dysfunction recovered completely in 2 to 3 weeks after discharge. Female are more than male .The median age of patients was 66.8 years,and no significant coronary artery disease present. (p <0.01). Key words: Takotsubo , Cardiomyopathy, Chest pain ,Stress

A prevalência de Miocardiopatia de Takotsubo é estimada em 1-3% de todos os pacientes com suspeita de síndrome coronário agudo. Enquanto o processo fisiopatológico permanece ainda uma incerteza, pacientes com Miocardiopatia de Takotsubo e pacientes com síndroma coronário agudo partilham os mesmos factores de risco cardiovascular, embora os achados angiográfios mostrem que ruptura de placas de ateroma coronárias não explica a fisiopatologia de Miocardiopatia de Takotsubo. A maioria dos estudos aponta a hipótese de disfunção miocárdica mediada por catecolaminas como a via final na patogénese de Miocardiopatia de Takotsubo. Este mecanismo sugere que um papel importante é desempenhado pela activação do sistema nervoso simpático, a qual seria desencadeada por um evento stressante. Não obstante, embora uma situação de stresse intenso esteja na origem de Miocardiopatia de Takotsubo, existe escassa evidência sobre os factores que a originam. É conhecida a associação entre sintomas depressivos e o aumento do risco cardiovascular. Estudos retrospectivos recentes têm sugerido que a existência de doença psiquiátrica e características pré-morbidas pode ser um importante factor predisponente de Miocardiopatia de Takotsubo. Estas evidências sugerem a influência de factores psicossociais na incidência de Miocardiopatia de Takotsubo. Esta revisão de literatura tem como objectivo reunir a evidência científica disponível que permita responder, pelo menos em parte, à questão de quais os aspectos psicossociais e qual o seu papel na patogénese, prevalência e prognóstico de Miocardiopatia de Takotsubo.
The prevalence of Takotsubo Cardiomyopathy accounts for 1-3% of all patiens suspected to have acute coronary syndrome. Whereas the pathophysiology remains uncertain, both pacients with Takotsubo Cardiomyopathy and acute coronary sindrome share commun cardiovascular risk factors. Although, angiographic findings depict that atheroma embolic causes do not explain its pathophysiologic mechanisms. Most cientific evidence singles out the chatecholamine-mediated hypothesis as the primal mean of myocardial stunning in Takotsubo Cardiomyopathy. This mechanism points sympathetic nervous system activation as a key factor, which would be triggered by sudden stress. Neverthless, as much as a stressful event is frequently the precipitator of Takotsubo Cardiomyopathy, little is know about the factors preceding it. Although, i tis known the association between depressive symptoms and incrise of cardiovascular mortality risk. Recent retrospective studies have suggested that psychiatric disease and pré-morbid characteristcs could play an important role in predisposing risk factors for Takotsubo Cardiomyopathy. This findings suggests plausible influence of psychossocial factors on Takotsubo Cardiomyopathy. This literature review has the purpose to gather the cientific available evidence that would allow to answer, at least partially, to the question of which psychossocial factors and the role they play in pathophysiology, prevalence and prognosis of Takotsubo Cardiomyopathy.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Introdução: A Síndrome de Takotsubo caracteriza-se por disfunção sistólica aguda e reversível do ventrículo esquerdo, usualmente restrita a uma região específica, comummente o ápex, traduzindo-se em sinais e sintomas que sugerem uma síndrome coronária aguda, sem que exista, no entanto, obstrução coronária causal. Apesar da fisiopatologia não estar esclarecida, existe evidência que atribui um papel central ao eixo neurocardíaco. A abordagem terapêutica não é consensual. Métodos: Procedeu-se à caracterização dos doentes internados no Serviço de Cardiologia do Hospital de Santa Maria/CHLN com o diagnóstico de Síndrome de Takotsubo entre 2008 e 2017. Foi conduzido um levantamento de variáveis relacionadas com a apresentação clínica, antecedentes, exames complementares, terapêutica e seguimento, que foram sujeitas a processamento estatístico. Os doentes selecionados foram estratificados retrospetivamente quanto ao risco de mortalidade intrahospitalar de acordo com o score desenvolvido pela Sociedade Europeia de Cardiologia. Resultados: Foram incluídos 50 doentes, com idade média de 67,6 anos, 88% do sexo feminino; 72% foram admitidos nos últimos 5 anos e na mesma percentagem foi identificado pelo menos um fator precipitante; 70% preenchiam critérios de alto risco. O tempo de internamento foi de 10 ± 5,8 dias, sem diferenças entre os grupos de alto vs baixo risco; 67% foram medicados de novo com beta-bloqueante, inibidor da enzima conversora da angiotensina ou ambos e a 11% foram prescritos de novo fármacos da classe dos ansiolíticos, sedativos e hipnóticos; 14% dos doentes faleceram (86% dos quais após a alta), todos eles de alto risco. No entanto, o número de consultas de Cardiologia no primeiro ano foi superior nos doentes de baixo risco. Conclusões: De acordo com os resultados da casuística apresentada, o número de casos diagnosticados parece estar a aumentar. A estratificação de risco poderá ser uma ferramenta útil para a tomada de decisão em relação a alta hospitalar e planeamento do seguimento após esta.
Background: Takotsubo syndrome consists of an acute, reversible, systolic dysfunction of the left ventricle, usually restricted to a specific region, commonly the apex, translating to signs and symptoms resembling an acute coronary syndrome, however without any evidence of culprit coronary obstruction. Even though pathophysiology is not clear yet, there is evidence attributing a central role to the brain-heart axis. Therapeutic approach is not consensual. Methods: All patients with the diagnosis of Takotsubo syndrome admitted to the Cardiology department at Hospital de Santa Maria/CHLN between 2008 and 2017 were characterised. Data regarding multiple variables including clinical presentation, past medical history, diagnostic tests performed, medication and follow-up data were collected and statistically processed. Selected patients were stratified by in-hospital mortality risk according to the European Society of Cardiology score. Results: We considered 50 patients, mean age was 67,6 years, 88% were females. Most of the population (72%) was admitted over the last 5 years, and in the same percentage at least one trigger was identified; 70% fulfilled high risk criteria. Length of in-hospital stay was 10 ± 5,8 days with no difference between high- and low risk groups. Regarding pharmacological therapy, 67% were prescribed a beta-blocker or an angiotensin-converting-enzyme inhibitor or both, and in 11% an anxiolytic, sedative or hypnotic drug was prescribed, for the first time; 14% of patients died (86% after discharge), all of them high risk patients. After-discharge number of Cardiology consultations during the first year of follow-up was higher in low risk patients. Conclusions: According to our data, the diagnosis of Takotsubo syndrome seems to be increasing. Risk stratification can be a useful tool for decisions regarding the appropriate time of discharge and to design the follow-up plan.

Trabalho final de mestrado integrado em Medicina área científica de Cardiologia, apresentado á Faculdade de Medicina da Universidade de Coimbra
INTRODUÇÃO: A Cardiomiopatia de Takotsubo apresenta-se como uma disfunção aguda e transitória do ventrículo esquerdo, com hipercinésia do segmento basal e acinésia apical. Afeta principalmente mulheres na pós-menopausa, normalmente em consequência de um significativo stress emocional ou físico, continuando por esclarecer muitos dados da sua fisiopatologia. A sua apresentação clínica assemelha-se ao Enfarte Agudo do Miocárdio, contudo, não existe obstrução significativa das artérias coronárias. Definimos como OBJETIVOS desta revisão, a avaliação da utilidade prática dos meios complementares de diagnóstico não invasivos na Cardiomiopatia de Takotsubo, determinação das suas limitações e identificação de critérios que permitam um diagnóstico diferencial com o Enfarte Agudo do Miocárdio. MATERIAIS E MÉTODOS: Pesquisa bibliográfica na base de dados PubMed usando como palavras-chave Takotsubo cardiomyopathy, diagnosis e non invasive methods para as datas entre 2005 e 2012. DESENVOLVIMENTO/RESULTADOS: As publicações analisadas avaliaram os dados epidemiológicos, as características clínicas e antecedentes dos doentes, os possíveis mecanismos fisiopatológicos e o interesse do uso de exames complementares não invasivos (eletrocardiograma, biomarcadores cardíacos, ecocardiograma e ressonância magnética cardiovascular) com o objetivo de diagnosticar a Cardiomiopatia de Takotsubo, excluindo com segurança o Enfarte Agudo do Miocárdio. DISCUSSÃO: Atualmente não é possível realizar o diagnóstico de Cardiomiopatia de Takotsubo e excluir o Enfarte Agudo do Miocárdio, recorrendo apenas a exames complementares não invasivos, não existindo nenhum parâmetro que permita realizar um diagnóstico seguro. Perante um caso suspeito de Cardiomiopatia de Takotsubo considera-se ser necessário a realização de cateterismo cardíaco. O desconhecimento dos mecanismos fisiopatológicos, é uma limitação na orientação preventiva, diagnóstica e terapêutica dos doentes
Background: Takotsubo Cardiomyopathy is an acute and transitory dysfunction of the left ventricle, which results from a hyperkinesia of the basal segment and apical acinesia. It typically affects postmenopausal women subjected to significant emocional and physical stress, although it remains unclear the real pathophysiology of this illness. Its clinical presentation bears a resemblance to Acute Myocardial Infarction even though there is no significant blockage of coronary arteries. Objectives: Evaluate the clinical utility of non-invasive methods to diagnose Takotsubo Cardiomyopathy, but also determine their limitations and identify criteria that allow differential diagnosis with Acute Myocardial Infarction. Methods: Bibliographic research in PubMed using key-words Takotsubo cardiomyopathy, diagnosis and non invasive methods during the period of 2005 and 2012. Results: The analyzed documents evaluated epidemiology data, their clinical features and ill’s past medical history, the possible pathophysiology mechanism and the importance of non-invasive methods of diagnosis such as Electrocardiography, Cardiac Biomarkers, Echocardiography and Cardiac Magnetic Resonance assembling a definite diagnosis of Takotsubo Cardiomyopathy and excluding with conviction Acute Myocardial Infarction. Conclusion: Nowadays, it is not possible to diagnose Takotsubo Cardiomyopathy and exclude with certainty Acute Myocardial Infarction simply using non-invasive complementary methods since there are no parameters that provide an indubitable diagnose. Against a suspicious of Takotsubo Cardiomyopathy it is mandatory to perform a Cardiac Catheterization. The uncertainty of the pathophysiology mechanism in this illness is a limitation to preventive orientation, diagnosis and therapeutic approach.