| Abstract | Sindrom slomljenog srca ili Takotsubo kardiomiopatija relativno je rijedak sindrom i čini 1-3 % svih slučajeva kod pacijenata koji se inicijalno prezentiraju sa simptomima sličnima akutnom koronarnom sindromu (ACS). Najčešće se javlja u žena starijih od 50 godina. Do danas nije u potpunosti razjašnjena etiologija i patofiziološki mehanizmi nastanka ovog sindroma, ali je poznato da je sindrom najčešće uzrokovan nekim jačim emocionalnim ili fizičkim stresom. Klinička slika Takotsubo sindroma (TTS) je vrlo slična ACS-u, te se pacijenti najčešće žale na bolove u prsima i otežano disanje. Pacijenti s TTS-om mogu razviti neke od komplikacija uključujući zatajivanje srca, kardiogeni šok, maligne aritmije, opstrukciju izlaznog trakta lijeve klijetke, mitralnu regurgitaciju ili formiranje tromba. Zbog nepostojanja specifičnih dijagnostičkih kriterija, dijagnoza TTS-a se postavlja isključivanjem drugih sličnih stanja, a kao pomoć mogu se koristiti i revidirani kriteriji Mayo Klinike iz 2008. godine i InterTAK dijagnostički zbroj. Od dijagnostičkih metoda koriste se elektrokardiogram (EKG), biomarkeri iz krvi, ehokardiografija, koronarna angiografija i lijeva ventrikulografija koja čini zlatni standard u postavljanju dijagnoze. Može se koristiti i magnetska rezonanca srca (CMR), no u praksi je to vrlo rijetko. Po prijemu u bolnicu pacijenti se najčešće vode pod radnom dijagnozom ACS-a, a po isključivanju istog prelazi se na suportivni oblik liječenja. Od izuzetne važnosti je na vrijeme prepoznati i liječiti komplikacije TTS-a, a veliki značaj pridaje se i prevenciji rekurencija ovog sindroma. Prognoza TTS-a je dobra te se 95 % pacijenata u potpunosti oporavi, dok je stopa bolničkog mortaliteta 5 %. Iako je prognoza dobra, TTS još uvijek nije u potpunosti istražen stoga su u budućnosti potrebna dodatna istraživanja kako bi što bolje razumjeli mehanizme nastanka sindroma i mogućnosti liječenja. |
| Abstract (english) | Broken heart syndrome or Takotsubo cardiomyopathy is a relatively rare condition, accounting for 1-3 % of all cases in patients initially presenting with symptoms similar to acute coronary syndrome (ACS). It mostly occurs in women over the age of 50. To date, the etiology and pathophysiological mechanisms of this syndrome's development have not been fully clarified, but it is known that it is most often caused by significant emotional or physical stress. The clinical presentation of Takotsubo syndrome (TTS) is very similar to ACS, with patients most commonly complaining of chest pain and difficulty breathing. Patients with TTS may develop some complications, including heart failure, cardiogenic shock, malignant arrhythmias, left ventricular outflow tract obstruction, mitral regurgitation or thrombus formation. Due to the lack of specific diagnostic criteria, the diagnosis of TTS is made by excluding other similar conditions, with the revised Mayo Clinic criteria from 2008 and the InterTAK diagnostic score being sometimes used as helpful tools. Diagnostic methods include electrocardiogram (ECG), blood biomarkers, echocardiography, coronary angiography and left ventriculography, which constitutes the gold standard in making a diagnosis. Cardiac magnetic resonance (CMR) imaging can also be used, though it is rarely done in practice. Upon hospital admission, patients are most often treated under the working diagnosis of ACS, and after its exclusion, treatment shifts to a supportive approach. It is extremely important to recognize and treat TTS complications in a timely manner, and great importance is also placed on preventing recurrences of this syndrome. The prognosis of TTS is good, with 95 % of patients making a full recovery, while the in-hospital mortality rate is 5 %. Although the prognosis is favorable, TTS has not yet been fully investigated. Additional research is needed in the future to better understand the mechanisms of the syndrome and treatment options. |
