Cinsel İlişki Sırasında Ani Emosyonel Stres ve Sildenafil Kullanımına Bağlı Takotsubo Kardiyomiyopatisi: Yoğun Bakım Yönetimi
Özet
Cinsel aktivite sırasında gelişen ani emosyonel stres ve eş zamanlı sildenafil kullanımı sonrasında ortaya çıkan, ventriküler fibrilasyon ile komplike bir Takotsubo kardiyomiyopatisi (TKM) olgusu sunulmaktadır. TKM, obstrüktif koroner arter hastalığı olmaksızın gelişen ve akut koroner sendromu taklit edebilen geçici sol ventrikül disfonksiyonu ile karakterize bir stres kardiyomiyopatisidir. Hastada kardiyak arrest sonrası erken defibrilasyon ile spontan dolaşım sağlanmış, yoğun bakımda mekanik ventilasyon, inotropik destek ve kılavuzlara uygun kalp yetersizliği tedavisi uygulanmıştır. Koroner anjiyografide anlamlı lezyon saptanmamış, ekokardiyografide apikal balonlaşma ve düşük ejeksiyon fraksiyonu izlenmiştir. Klinik izlemde sol ventrikül fonksiyonları tamamen düzelmiştir. Bu olgu; ani emosyonel stres, PDE5 inhibitörü kullanımı ve malign ventriküler aritmilerin etkileşiminin nadir ancak potansiyel olarak ölümcül sonuçlar doğurabileceğini göstermektedir. Erken tanı ve multidisipliner yoğun bakım yönetimi prognoz açısından belirleyicidir.
During sexual activity, a case of Takotsubo cardiomyopathy (TCM) complicated by ventricular fibrillation following acute emotional stress and concomitant sildenafil use is presented. TCM is a stress-induced cardiomyopathy characterized by transient left ventricular dysfunction in the absence of obstructive coronary artery disease and may mimic acute coronary syndrome. In this patient, return of spontaneous circulation was achieved after early defibrillation following cardiac arrest. The patient was managed in the intensive care unit with mechanical ventilation, inotropic support, and guideline-directed heart failure therapy. Coronary angiography revealed no significant obstructive lesions, while echocardiography demonstrated apical ballooning and reduced left ventricular ejection fraction. During clinical follow-up, left ventricular systolic function fully recovered. This case illustrates that the interaction between acute emotional stress, PDE5 inhibitor use, and malignant ventricular arrhythmias may lead to rare but potentially life-threatening outcomes. Early recognition and multidisciplinary intensive care management are crucial determinants of prognosis.
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