%0 Journal Article
%T Pseudoinfarto agudo do mioc¨¢rdio devido ¨¤ s¨ªndrome da disfun  o ventricular apical transit¨®ria (s¨ªndrome de Takotsubo) Pseudo-acute myocardial infarction due to transient apical ventricular dysfunction syndrome (Takotsubo syndrome)
%A Bruno Ara¨²jo Maciel
%A Alan Alves de Lima Cidr£¿o
%A ¨ªtalo Bruno dos Santos Sousa
%A Jos¨¦ Adailson da Silva Ferreira
%J Revista Brasileira de Terapia Intensiva
%D 2013
%I Associa??o de Medicina Intensiva Brasileira
%X A s¨ªndrome de Takotsubo caracteriza-se por disfun  o ventricular esquerda transit¨®ria, predominantemente medioapical, desencadeada caracteristicamente por estresse f¨ªsico ou emocional. Relata-se aqui o caso de uma paciente de 61 anos de idade, admitida com tontura, sudorese profusa e mal-estar s¨²bito, ap¨®s intenso estresse emocional. Exame f¨ªsico e eletrocardiograma inicial foram normais, por¨¦m havia eleva  o de troponina I e CKMB massa. Suspeitou-se de infarto agudo do mioc¨¢rdio sem supradesnivelamento do segmento ST, indicando cineangiocoronariografia de urg¨ºncia. Foram evidenciados ventr¨ªculo esquerdo com hipocinesia difusa grave, balonamento sist¨®lico medioapical e coron¨¢rias sem les es significativas. A paciente foi encaminhada aos cuidados intensivos, evoluindo satisfatoriamente com terapia de suporte. Conforme visto, a cardiomiopatia de Takotsubo pode simular infarto agudo do mioc¨¢rdio, sendo a cineangiocoronariografia importante para distin  o na fase aguda. Neste caso, a paciente evoluiu com resolu  o espontanea da disfun  o ventricular, sem sequelas. Takotsubo syndrome is characterized by predominantly medial-apical transient left ventricular dysfunction, which is typically triggered by physical or emotional stress. The present article reports the case of a 61-year-old female patient presenting with dizziness, excessive sweating, and sudden state of ill feeling following an episode involving intense emotional stress. The physical examination and electrocardiogram were normal upon admission, but the troponin I and creatine kinase-MB concentrations were increased. Acute myocardial infarction without ST segment elevation was suspected, and coronary angiography was immediately performed, which showed severe diffuse left ventricular hypokinesia, medial-apical systolic ballooning, and a lack of significant coronary injury. The patient was referred to the intensive care unit and was successfully treated with supportive therapy. As this case shows, Takotsubo syndrome might simulate the clinical manifestations of acute myocardial infarction, and coronary angiography is necessary to distinguish between both myocardial infarction and myocardial infarction in the acute stage. The present patient progressed with spontaneous resolution of the ventricular dysfunction without any sequelae.
%K Disfun  o ventricular esquerda
%K Terapia intensiva
%K Cardiomiopatia de Takotsubo
%K Hemodinamica
%K Choque cardiog¨ºnico
%K Estresse psicol¨®gico
%K Relatos de casos
%K Ventricular dysfunction
%K left
%K Intensive care
%K Takotsubo
%K cardiomyopathy
%K Hemodynamics
%K Shock
%K cardiogenic
%K Stress
%K psychological
%K Case reports
%U http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-507X2013000100012