Happy heart syndrome

Takotsubo sindrom (TTS), također poznat kao sindrom apikalnog baloniranja, oblik je reverzibilnog akutnog zatajenja srca koji nastaje uslijed prolazne disfunkcije lijeve klijetke (LV), a najčešće zahvaća apeks srca. Budući da je epizoda negativnog stresnog događaja čest okidač nastanka, naziva se i "sindromom slomljenog srca". Patofiziologija TTS-a još uvijek nije sasvim jasna, i usprkos različitim predloženim hipotezama, omamljenost miokarda posredovana toksičnim učinkom katekolamina najčešće je prihvaćena. Većina pacijenata klinički se prezentira sa simptomima sličnim akutnoj koronarnoj bolesti (AKS), zbog čega je klinički teško razlikovati TTS od AKS. Ukupna incidencija TTS-a je oko 1% do 2%, što uključuje i bolesnike koji su prvobitno bili dijagnosticirani pod AKS. Iako se pretežno nalazi u žena u postmenopauzi, TTS se može naći u oba spola bilo koje dobi. Iako se sretne ili neke druge pozitivne emocije nisu u samom početku identificirale kao mogući provocirajući faktori TTS, sada se pokazuje da nastanku TTS-a, u specifičnom obliku „sindroma sretnog srca“ mogu prethoditi intenzivni pozitivni osjećaji. Klinička prezentacija bolesnika sa "sindromom sretnog srca" slična je onoj kod bolesnika sa "sindromom slomljenog srca“ – s bolovima u prsima i dispnejom kao najčešćim simptomima u obje skupine, sa sličnim elektrokardiografskim obilježjima te laboratorijskim nalazima, bez razlika u konačnom jednogodišnjem ishodu. Optimalne terapijske smjernice još nisu uspostavljene, ali suportivna terapija doprinosi spontanom oporavku funkcije LV s općenito povoljnijim konačnim ishodom. Međutim, sindrom je daleko složeniji i heterogenijih kliničkih značajki nego što se u početku smatralo, tako da je za jasno razlikovanje TTS-a od AKS-a, kao i za utvrđivanje smjernica u liječenju akutnog stadija i sprječavanje recidiva, potrebno najprije razjasniti patofiziologiju sindroma.Takotsubo syndrome (TTS), also known as apical ballooning syndrome, is a form of an acute reversible heart failure occurring as a result of transitory left ventricular (LV) dysfunction, which most commonly affects the apex of the heart. Being often triggered by a negative stressful life episode, it is also called the “broken heart syndrome“. The pathophysiology of TTS is still not completely clear and several different hypotheses have been proposed, but catecholamine mediated myocardial stunning is the most favored one. Most patients present with symptoms similar to acute coronary syndrome (ACS), thus making it more difficult to diagnostically distinguish the TTS from ACS. The overall incidence of TTS is about 1% to 2% which includes patients initially diagnosed with classic ACS. Even though TTS can occur at any age and affect both sexes, it predominantly affects postmenopausal women. Although neither the happiness nor positive emotional state were at first identified as possible inciting factors for apical ballooning syndrome, now it has been accepted that TTS can be triggered by positive life events, presenting as a “happy heart syndrome“. The clinical presentation of patients with “happy heart syndrome“ was similar to that of patients with “broken heart syndrome“, with chest pain and dyspnea as the most common symptoms in both groups. The same applies to electrocardiogram parameters, laboratory findings and 1-year outcomes. The optimal management has not yet been established, but supportive therapy leads to spontaneous recovery of the LV function with a generally favorable final result. As the syndrome is far more complex and heterogeneous than initially considered, to establish the best possible noninvasive diagnostic tool to differentiate TTS from ACD as early as possible and to determine the exact treatment approach for the acute stage of TTS and for prevention of recurrences, new discoveries need to be made to clarify the pathophysiology of syndrome