Cardiomiopatia di Takotsubo
Generalità
La cardiomiopatia di Takotsubo è caratterizzata da una transitoria acinesia dell’apice e dei segmenti medi del ventricolo sinistro con risparmio dei segmenti basali.
Sebbene la cardiomiopatia di Takotsubo abbia una presentazione clinica indistinguibile da quelle dell’infarto del miocardio acuto (dolore toracico improvviso con sopraslivellamento del tratto ST all’ECG e aumento degli indici di necrosi miocardica, creatin-chinasi MB e troponina T), le arterie coronariche sono angiograficamente normali o presentano lesioni che non alterano in modo significativo il flusso coronarico.
Sintomi
Caratteristicamente i sintomi sono preceduti da un forte stress fisico o psicologico e il quadro regredisce completamente senza terapia entro qualche giorno o un paio di settimane: tale regressione del quadro clinico è essenziale per confermare la diagnosi ed escludere altre cause di disfunzione acuta del ventricolo sinistro. Sono possibili, sebbene poco frequenti, delle recidive, così come quadri che vanno incontro al progressivo peggioramento fino allo shock cardiogeno.
Eziologia
E’ ancora sconosciuta, ma probabilmente le cause sono molteplici; sono stati descritti diversi meccanismi, tra cui rilascio di catecolamine in seguito a stress, disfunzione del microcircolo coronarico, spasmo delle arterie coronarie epicardiche, miocardite acuta.
Perché si chiama così?
Takotsubo è una parola di origine giapponese. Il ventricolo sinistro assume la forma di un cestello (tsubo) usato dai pescatori giapponesi per la pesca dei polpi caratterizzato dal collo stretto. Alle immagini ecocardiografiche o di risonanza magnetica, il ventricolo sinistro del paziente assume una forma del tutto simile al takotsubo per la pesca dei polpi.
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