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Apresentação clínica e abordagem terapêutica na Síndrome de Takotsubo
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Introdução: A Síndrome de Takotsubo caracteriza-se por disfunção sistólica aguda e reversível do ventrículo esquerdo, usualmente restrita a uma região específica, comummente o ápex, traduzindo-se em sinais e sintomas que sugerem uma síndrome coronária aguda, sem que exista, no entanto, obstrução coronária causal. Apesar da fisiopatologia não estar esclarecida, existe evidência que atribui um papel central ao eixo neurocardíaco. A abordagem terapêutica não é consensual.
Métodos: Procedeu-se à caracterização dos doentes internados no Serviço de Cardiologia do Hospital de Santa Maria/CHLN com o diagnóstico de Síndrome de Takotsubo entre 2008 e 2017. Foi conduzido um levantamento de variáveis relacionadas com a apresentação clínica, antecedentes, exames complementares, terapêutica e seguimento, que foram sujeitas a processamento estatístico. Os doentes selecionados foram estratificados retrospetivamente quanto ao risco de mortalidade intrahospitalar de acordo com o score desenvolvido pela Sociedade Europeia de Cardiologia.
Resultados: Foram incluídos 50 doentes, com idade média de 67,6 anos, 88% do sexo feminino; 72% foram admitidos nos últimos 5 anos e na mesma percentagem foi identificado pelo menos um fator precipitante; 70% preenchiam critérios de alto risco. O tempo de internamento foi de 10 ± 5,8 dias, sem diferenças entre os grupos de alto vs baixo risco; 67% foram medicados de novo com beta-bloqueante, inibidor da enzima conversora da angiotensina ou ambos e a 11% foram prescritos de novo fármacos da classe dos ansiolíticos, sedativos e hipnóticos; 14% dos doentes faleceram (86% dos quais após a alta), todos eles de alto risco. No entanto, o número de consultas de Cardiologia no primeiro ano foi superior nos doentes de baixo risco.
Conclusões: De acordo com os resultados da casuística apresentada, o número de casos diagnosticados parece estar a aumentar. A estratificação de risco poderá ser uma ferramenta útil para a tomada de decisão em relação a alta hospitalar e planeamento do seguimento após esta.
Background: Takotsubo syndrome consists of an acute, reversible, systolic dysfunction of the left ventricle, usually restricted to a specific region, commonly the apex, translating to signs and symptoms resembling an acute coronary syndrome, however without any evidence of culprit coronary obstruction. Even though pathophysiology is not clear yet, there is evidence attributing a central role to the brain-heart axis. Therapeutic approach is not consensual. Methods: All patients with the diagnosis of Takotsubo syndrome admitted to the Cardiology department at Hospital de Santa Maria/CHLN between 2008 and 2017 were characterised. Data regarding multiple variables including clinical presentation, past medical history, diagnostic tests performed, medication and follow-up data were collected and statistically processed. Selected patients were stratified by in-hospital mortality risk according to the European Society of Cardiology score. Results: We considered 50 patients, mean age was 67,6 years, 88% were females. Most of the population (72%) was admitted over the last 5 years, and in the same percentage at least one trigger was identified; 70% fulfilled high risk criteria. Length of in-hospital stay was 10 ± 5,8 days with no difference between high- and low risk groups. Regarding pharmacological therapy, 67% were prescribed a beta-blocker or an angiotensin-converting-enzyme inhibitor or both, and in 11% an anxiolytic, sedative or hypnotic drug was prescribed, for the first time; 14% of patients died (86% after discharge), all of them high risk patients. After-discharge number of Cardiology consultations during the first year of follow-up was higher in low risk patients. Conclusions: According to our data, the diagnosis of Takotsubo syndrome seems to be increasing. Risk stratification can be a useful tool for decisions regarding the appropriate time of discharge and to design the follow-up plan.
Background: Takotsubo syndrome consists of an acute, reversible, systolic dysfunction of the left ventricle, usually restricted to a specific region, commonly the apex, translating to signs and symptoms resembling an acute coronary syndrome, however without any evidence of culprit coronary obstruction. Even though pathophysiology is not clear yet, there is evidence attributing a central role to the brain-heart axis. Therapeutic approach is not consensual. Methods: All patients with the diagnosis of Takotsubo syndrome admitted to the Cardiology department at Hospital de Santa Maria/CHLN between 2008 and 2017 were characterised. Data regarding multiple variables including clinical presentation, past medical history, diagnostic tests performed, medication and follow-up data were collected and statistically processed. Selected patients were stratified by in-hospital mortality risk according to the European Society of Cardiology score. Results: We considered 50 patients, mean age was 67,6 years, 88% were females. Most of the population (72%) was admitted over the last 5 years, and in the same percentage at least one trigger was identified; 70% fulfilled high risk criteria. Length of in-hospital stay was 10 ± 5,8 days with no difference between high- and low risk groups. Regarding pharmacological therapy, 67% were prescribed a beta-blocker or an angiotensin-converting-enzyme inhibitor or both, and in 11% an anxiolytic, sedative or hypnotic drug was prescribed, for the first time; 14% of patients died (86% after discharge), all of them high risk patients. After-discharge number of Cardiology consultations during the first year of follow-up was higher in low risk patients. Conclusions: According to our data, the diagnosis of Takotsubo syndrome seems to be increasing. Risk stratification can be a useful tool for decisions regarding the appropriate time of discharge and to design the follow-up plan.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Síndrome de Takotsubo Apresentação Terapêutica Seguimento Cardiologia