Takotsubo Kardiyomiyopatisinde Yoğun Bakım Yönetimi
Özet
61 yaş bilinen kronik obstrüktif akciğer hastalığı ve hipertansiyonu olan kadın hastaya 20 yıl önce geçilmiş tüberküloz öyküsü nedeniyle 2014 yılında sağ üst lobektomi yapılmıştır. Ancak ara ara hemoptizi , balgam çıkarma ve pnömotoraks öyküsü nedeniyle göğüs cerrahisi kliniğine başvurmuş olan hastaya sağ tamamlayıcı pnömonektomi planlanmıştır. Hasta uygun şartlarda operasyona alınmış olup operasyon sırasında stabil olmayan hasta inotrop altında yoğun bakım ünitesine entübe transfer edilmiştir. Hastanın yoğun bakım takiplerinde troponin artışı ve elektrokardiyogramda inferior derivasyonlarda ST segment elevasyonu gelişen hasta kardiyolojiye konsülte edilmiştir. Yapılan ekokardiyografisinde apeks akinetik ve segment duvar hareket kusuru tesbit edilmesi üzerine hasta acil koşullarda koroner anjiyografiye alınmıştır. Yapılan koroner anjiyografisi normal raporlanan hasta yoğun bakım ünitesinde takiplerinde ventriküler taşikardi gelişmiş olup hemodinamisi stabil olmayan hastaya kardiyoversiyon yapılmış aynı zamanda takibinin 12.saatinde Troponin artışının devam etmesi ve elektrokardiyogramda tekrar inferior derivasyonunda ST segment elevasyonun gelişmesi üzerine hastaya acil şartlarda koroner anjiografi yapılmış olup tekrar normal olarak değerlendirilmesi üzerine hastada takatsubo kardiyomiyopatisi düşünülmüştür.
A 61-year-old female patient with known chronic obstructive pulmonary disease and hypertension underwent right upper lobectomy in 2014 due to a history of tuberculosis 20 years ago. However, a right completion pneumonectomy was planned for the patient, who was admitted to the thoracic surgery clinic due to a history of intermittent hemoptysis, expectoration and pneumothorax. The patient was operated on under appropriate conditions, and the patient, who was unstable during the operation, was transferred to the intensive care unit to be intubated under inotrope. During intensive care follow-up, the patient developed increased troponin levels and ST segment elevation in the inferior leads on the electrocardiogram, and the patient was consulted to cardiology. Upon detection of apex akinetic and segment wall motion defect in the echocardiography, the patient was taken to coronary angiography under emergency conditions. The patient, whose coronary angiography was reported as normal, developed ventricular tachycardia during the follow-up in the intensive care unit and cardioversion was performed on the patient whose hemodynamics were unstable. At the same time, in the 12th hour of the follow-up, the troponin increase continued and the ST segment elevation in the inferior derivation developed again in the electrocardiogram. Coronary angiography was performed on the patient under emergency conditions and it was normal again. Upon evaluation, the patient was considered to have Takatsubo cardiomyopathy.
Referanslar
Hansen PR. Takotsubo cardiomyopathy: an under-recognized myocardial syndrome. Eur J Intern Med 2007; 18: 561- 5. [CrossRef]
Bybee KA, Prasad A, Barsness G, Wright RS, Rihal CS. Clinical characteristics, outcomes, and impaired myocardial microcirculation in patients with transient left ventricular apical ballooning syndrome: a case-series from a U.S. medial center. Am J Cardiol. 2004; 94: 343–346.
Akashi YJ, Nakazawa K, Sakakibara M, Miyake F, Koike H, Sasaka K. The clinical features of takotsubo cardiomyopathy. QJM 2003; 96: 563-73. [CrossRef]
Bybee KA, Kara T, Prasad A Lerman A, Barsness GW, Wright RS, Rihal CS. Transient left ventricular apical ballooning syndrome: a mimic of ST-segment elevation myocardial infarction. Ann Intern Med. 2004; 141: 858–865.
Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 2004;94:343-6. [CrossRef]
Pernicova I, Garg S, Bourantas CV, Alamgir F, Hoye A. Takotsubo cardiomyopathy: a review of the literature. Angiology 2010;61:166-73.
Deshmukh, Abhishek, et al. "Prevalence of Takotsubo cardiomyopathy in the United States." American heart journal 164.1 (2012): 66-71.
Khera, Rohan, et al. "Trends in hospitalization for takotsubo cardiomyopathy in the United States." American heart journal 172 (2016): 53-63.
Templin, Christian, et al. "Clinical features and outcomes of takotsubo (stress) cardiomyopathy." New England Journal of Medicine 373.10 (2015): 929-938.
Citro R, Rigo F, D’Andrea A, Ciampi Q, Parodi G, Provenza G, Piccolo R, MirraM, Zito C, Giudice R, Patella MM, Antonini-Canterin F, Bossone E, PiscioneF, Salerno-Uriarte J. Echocardiographic correlates of acute heart failure, car-diogenic shock, and in-hospital mortality in tako-tsubo cardiomyopathy. JACCCardiovasc Imaging 2014;7:119–129
Redfors B, Vedad R, Angerås O, Råmunddal T, Petursson P, Haraldsson I, Ali A,Dworeck C, Odenstedt J, Ioaness D, Libungan B, Shao Y, Albertsson P, StoneGW, Omerovic E. Mortality in takotsubo syndrome is similar to mortality inmyocardial infarction—A report from the SWEDEHEART1 registry. Int J Cardiol2015;185:282–289
Schneider B, Athanasiadis A, Schwab J, Pistner W, Gottwald U, Schoeller R,Toepel W, Winter KD, Stellbrink C, Muller-Honold T, Wegner C, Sechtem U.Complications in the clinical course of tako-tsubo cardiomyopathy. Int J Cardiol2014;176:199–205
Singh SB, Harle IA. Takotsubo cardiomyopathy secondary in part to cancer-related pain crisis: a case report. J Pain Symptom Manage. 2014;48:137-42.
Sharkey SW, Lesser JR, Maron BJ. Cardiology Patient Page. Takotsubo (stress) cardiomyopathy. Circulation. 2011 Nov 1;124(18):e460-2. doi: 10.1161/CIRCULATIONAHA.111.052662. PMID: 22042929.
