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Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis
The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart without obstruction of coronary artery, moderate increase in m...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Bentham Science Publishers
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226199/ https://www.ncbi.nlm.nih.gov/pubmed/31995013 http://dx.doi.org/10.2174/1573403X16666200129114330 |
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author | Prokudina, Ekaterina S. Kurbatov, Boris K. Zavadovsky, Konstantin V. Vrublevsky, Alexander V. Naryzhnaya, Natalia V. Lishmanov, Yuri B. Maslov, Leonid N. Oeltgen, Peter R. |
author_facet | Prokudina, Ekaterina S. Kurbatov, Boris K. Zavadovsky, Konstantin V. Vrublevsky, Alexander V. Naryzhnaya, Natalia V. Lishmanov, Yuri B. Maslov, Leonid N. Oeltgen, Peter R. |
author_sort | Prokudina, Ekaterina S. |
collection | PubMed |
description | The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart without obstruction of coronary artery, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old, than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. Physical or emotional stress do not precede disease in all patients with TS. Most of patients with TS have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β(2) adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using (125)I-metaiodobenzylguanidine ((125)I -MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is a reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS. |
format | Online Article Text |
id | pubmed-8226199 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Bentham Science Publishers |
record_format | MEDLINE/PubMed |
spelling | pubmed-82261992022-03-01 Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis Prokudina, Ekaterina S. Kurbatov, Boris K. Zavadovsky, Konstantin V. Vrublevsky, Alexander V. Naryzhnaya, Natalia V. Lishmanov, Yuri B. Maslov, Leonid N. Oeltgen, Peter R. Curr Cardiol Rev Article The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart without obstruction of coronary artery, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old, than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. Physical or emotional stress do not precede disease in all patients with TS. Most of patients with TS have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β(2) adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using (125)I-metaiodobenzylguanidine ((125)I -MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is a reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS. Bentham Science Publishers 2021-03 2021-03 /pmc/articles/PMC8226199/ /pubmed/31995013 http://dx.doi.org/10.2174/1573403X16666200129114330 Text en © 2021 Bentham Science Publishers https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited. |
spellingShingle | Article Prokudina, Ekaterina S. Kurbatov, Boris K. Zavadovsky, Konstantin V. Vrublevsky, Alexander V. Naryzhnaya, Natalia V. Lishmanov, Yuri B. Maslov, Leonid N. Oeltgen, Peter R. Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis |
title | Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis |
title_full | Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis |
title_fullStr | Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis |
title_full_unstemmed | Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis |
title_short | Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis |
title_sort | takotsubo syndrome: clinical manifestations, etiology and pathogenesis |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226199/ https://www.ncbi.nlm.nih.gov/pubmed/31995013 http://dx.doi.org/10.2174/1573403X16666200129114330 |
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