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https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehy077/5025411

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International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management

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Echocardiography

Echocardiography is the most used imaging tool to assess changes in LV function such as symmetric regional wall motion abnormalities (RWMAs).⁴ Different variants can be identified with echocardiography which include:

1. Apical ballooning, hypo-, a-, or dyskinesia of mid-apical myocardial segments is typical, sometimes associated with hypokinetic mid-segments.^2,40 The anterior or entire interventricular septum, inferior or midventricular anterolateral wall may also be involved.^41,42 LV twisting on 2D speckle-tracking imaging is reduced or reversed to clockwise apical rotation and the rate of untwisting (a sensitive index of regional diastolic dysfunction) is reduced in the acute phase.⁴³
2. Midventricular TTS featured by hypo-, a-, or dyskinesia of midventricular segments, most often resembling a cuff.^2,40,44,45
3. Basal forms where only basal segments are involved^2,40: This phenotype is rare and appears commonly in patients with subarachnoid haemorrhage,⁴⁶ epinephrine-induced TTS⁴⁷ or phaeochromocytoma.⁴⁸
4. Focal TTS mostly involving an anterolateral segment has been described.^2,40Differentiating this unusual TTS type from ACS or myocarditis requires CMR.⁴⁹

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O ecocardiograma é fundamental para o diagnóstico de Takotsubo.

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Acreditamos que é fundamental para explicar o fenômeno também.

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Vísceras distendidas doem, isto pode explicar a dor, causada por o balonamento apical.

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O gradiente de via de saída revela uma barreira a ejeção, que altera o débito e gera mais desconforto.

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Casos de Takotsubo provocados por Ecoestresse com Dobutamina mostram que pode ser a hipercontratilidade basal a causa de todos os achados.

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As alterações do ECG são secundárias à distensão apical e ao esforço ejetivo com a barreira dinâmica.

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O cateterismo poderia ser dispensado, trocado por uma Tomo de coronária nos casos suspeitos?

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