Das Tako-Tsubo-Syndrom - Eine passagere linksventrikuläre Kardiopathie unklarer Ätiologie

Zusammenfassung

Es wird der Fall einer 69-jährigen Patientin, welche mit einer instabilen Angina Pectoris mit pathologischem EKG und sekundär pathologischen Herzenzymen hospitalisiert wurde. Die Koronarangiographie zeigte keine signifikanten Stenosen. In der Ventrikulographie und im Herzecho fand sich eine linksventrikuläre apikale Wandbewegungsstörung, welche bereits zwei Tage nach Symptombeginn wieder nahezu verschwunden war. Mit der Symptomatik und den Befunden erfüllte die Patientin die Kriterien für ein Tako-Tsubo-Syndrom, eine seltene passagere linksventrikuläre Kardiopathie unklarer Ätiologie. Es wird eine Übersicht über den Stand der Literatur und das mögliche Therapiemanagement gegeben. Bei weiblichen Patienten ab dem 60. Lebensjahr mit einer Angina-Pectoris-Symptomatik, sollte bei unauffälliger Angiographie und typischen Echokardiographiebefunden auch an dieses seltene Syndrom gedacht werden, das von der Prognose her als günstig einzustufen ist. Differenzialdiagnostische Überlegungen beinhalten einen Koronarspasmus respektive eine Prinzmetal-Angina.

Abstract

In this study we present the case of a 69-year-old female patient admitted to hospital with unstable angina pectoris, pathological ECG and secondary increase of troponin. Coronary angiography showed no significant stenosis of the coronary artery. Left ventriculography and heart echo revealed abnormal apical wall movement which had almost disappeared again two days after onset of symptoms. The patient's symptoms and diagnostic findings fufill the criteria for the Tako-Tsubo syndrome, which is a rare, transitory left ventricular cardiomyopathy of obscure etiology. We provide an overview of current literature and a possible therapeutic approach. In the case of female patients over 60 years of age presenting with symptoms of angina pectoris, unsuspicious angiography and typical echocardiographic findings, this rare syndrome should also be considered. Prognosis is favorable. Differential diagnostics should include coronary spasms and Prinzmetal angina.

Schlüsselwörter

Tako-Tsubo-Kardiomyopathie - Linksschenkelblock - Koronarspasmus - apikale Dyskinesie - Koronarangiographie

Key words

Tako-Tsubo cardiomyopathy - left bundle-branch block - coronary spasms - apical dyskinesia - coronary angiography

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