Geriatrik Bir Olgu Üzerinden Takotsubo Sendromu: Patofizyolojiden Klinik Yönetime Güncel Yaklaşım
Özet
Takotsubo sendromu (TTS) özellikle postmenopozal kadınlarda akut miyokard infarktüsünü (AMI) klinik, elektrokardiyografik ve biyokimyasal olarak taklit edebilen geçici bir sol ventrikül disfonksiyonu tablosudur. Bu bölümde, dış merkez acil servise göğüs ağrısı şikayetiyle başvuran, elektrokardiyogramında ST segment elevasyonu ve kardiyak troponin yüksekliği saptanan 80 yaşındaki bir kadın hasta sunulmaktadır. Literatürde sendromun genellikle emosyonel veya fiziksel bir stresör sonrası geliştiği vurgulansa da sunulan vakada herhangi bir belirgin tetikleyici faktör saptanmamıştır. Koroner anjiyografi ile obstrüktif koroner arter hastalığının dışlandığı ve karakteristik ventriküler apikal balonlaşmanın izlendiği bu vaka; ileri yaş grubunda AMI ön tanısı alan hastalarda, klasik bir stresör olmasa dahi TTS’nin ayırıcı tanıda hayati bir yer tuttuğunu kanıtlamaktadır. Bölüm kapsamında, TTS vakalarının tanısal özellikleri, patofizyolojisi ve klinik yönetim stratejileri güncel literatür eşliğinde tartışılmaktadır.
Takotsubo syndrome (TTS) is a transient left ventricular dysfunction that can clinically, electrocardiographically, and biochemically mimic acute myocardial infarction (AMI), particularly in postmenopausal women. In this section, we present the case of an 80-year-old female patient who presented to an external emergency department with chest pain and was found to have ST-segment elevation on electrocardiogram and elevated cardiac troponin levels. Although the literature emphasizes that the syndrome typically develops following an emotional or physical stressor, no distinct triggering factor was identified in the presented case. This case—in which obstructive coronary artery disease was excluded via coronary angiography and characteristic ventricular apical ballooning was observed—demonstrates that TTS maintains a vital role in the differential diagnosis of elderly patients pre-diagnosed with AMI, even in the absence of a classic stressor. Within the scope of this section, the diagnostic features, pathophysiology, and clinical management strategies of TTS cases are discussed in light of current literature.
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