Takotsubo Syndrome: A Review of Presentation, Diagnosis and Management

Takotsubo Syndrome (TTS) is a condition of transient left ventricular dysfunction that is typically triggered by emotional or physical stress. Since first described in Japan in 1990, it has increasingly been recognised in clinical practice, accounting for up to 2% of Acute Coronary Syndrome (ACS) presentations. In fact, the clinical presentation can be indistinguishable from a myocardial infarction. Although current evidence suggests a catecholamine induced myocardial stunning, the pathophysiological mechanisms remain unknown. Interestingly, it is more common in woman, particularly those who are post-menopausal. This review aims to summarise the current research and provide an overview of the diagnostic strategies and treatment options.

Peranan Pre dan Post Ischemic Conditioning Sebagai Pencegahan Cedera Reperfusi

Reperfusi pneada jaringan iskemik sering mengakibatkan proses patofisiologi, seperti gangguan endotelium pada arteriol, peradangan dan ekstravasasi protein plasma di venula. Ada berbagai mekanisme yang menyebabkan cedera reperfusi. Salah satu mekanismenya adalah dengan diproduksinya radikal oksigen sehingga dapat melepaskan mediator inflamasi. Manifestasi klinis yang timbul juga beragam, salah satu contohnya, pada jantung, dapat terjadi myocardial stunning. Penulisan literature review ini bertujuan untuk memahami peranan pre dan post ischemic conditioning sebagai pencegahan cedera reperfusi sehingga dapat mengarahkan ke asesmen dan pemberian terapi yang tepat kepada pasien. Secara epidemiologi, cukup banyak didapatkan kejadian cedera reperfusi yang tidak mendapatkan manajemen yang memadai, sehingga diperlukan pembahasan peranan pre dan post ischemic conditioning dari berbagai literatur. Literature review ini dilakukan pada April 2019 dengan mengambil sumber data dari berbagai sumber buku dan jurnal medis. Referensi yang diambil dari original research dan buku. Ada berbagai studi yang mengungkapkan terapi atau tindakan untuk mencegah cedera reperfusi, yaitu ischemic conditioning. Fokus terapi atau tindakan untuk mencegah cedera reperfusi berdasarkan mekanisme-mekanisme yang terjadi pada cedera reperfusi. Mekanisme ischemic conditioning mencegah cedera reperfusi dengan cara mencegah apoptosis, onkosis, dan meningkatkan antioksidan. Mekanisme ischemic conditioning ini berawal dari stimulus dan aktivasi terhadap sinyal transduksi kardioproteksi. Sinyal ini memiliki efek akhir untuk menghambat pembukaan mPTP, sehingga efek cedera reperfusi bisa dikurangi.

The Defibrillation Conundrum: New Insights into the Mechanisms of Shock-Related Myocardial Injury Sustained from a Life-Saving Therapy

Implantable cardiac defibrillators (ICDs) are recommended to prevent the risk of sudden cardiac death. However, shocks are associated with an increased mortality with a dose response effect, and a strategy of reducing electrical therapy burden improves the prognosis of implanted patients. We review the mechanisms of defibrillation and its consequences, including cell damage, metabolic remodeling, calcium metabolism anomalies, and inflammatory and pro-fibrotic remodeling. Electrical shocks do save lives, but also promote myocardial stunning, heart failure, and pro-arrhythmic effects as seen in electrical storms. Limiting unnecessary implantations and therapies and proposing new methods of defibrillation in the future are recommended.

Case report of successful peripheral veno-arterial extracorporeal membrane oxygenation in a patient with chronic type B aortic dissection

A case report of successful application of peripheral veno-arterial extracorporeal membrane oxygenation in a patient with chronic type B aortic dissection and myocardial stunning to bridge to recovery was presented. Good outcomes from the application of peripheral veno-arterial extracorporeal membrane oxygenation in aortic dissection have rarely been reported, and the considerations of starting veno-arterial extracorporeal membrane oxygenation in this situation were seldom discussed. The orthodox that peripheral veno-arterial extracorporeal membrane oxygenation is an absolute contraindication for initiation of peripheral veno-arterial extracorporeal membrane oxygenation should be challenged. With proper planning and real-time transesophageal echocardiography–guided cannulation, peripheral veno-arterial extracorporeal membrane oxygenation is possibly beneficial. The considerations and echocardiography-guided techniques would be discussed in this report.

Recurrent asymptomatic Takotsubo syndrome after 20 years: are we looking at the tip of the iceberg only?

Takotsubo syndrome (TS) is an acute and reversible form of myocardial stunning preceded by emotional or physical stress, not explained by an obstruction of an epicardial coronary artery as in acute coronary syndrome. Over the last decades, TS is receiving growing attention, leading to an increase in awareness and diagnostic rate. Chest pain and dyspnea are the most common presenting symptoms; however, nonspecific presentations make the diagnosis challenging for clinicians. Here, we present the case of a 76-year-old female who experienced two completely asymptomatic episodes of TS 20 years apart.