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Myocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomyopathy: Imaging evidence, presumed mechanisms, and implications for therapy. Heart Rhythm 2015; 12:1867-77. [PMID: 25937439 DOI: 10.1016/j.hrthm.2015.04.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Indexed: 02/07/2023]
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102
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Entacapone, Parkinson's disease, “functional adrenergic denervation”, and Takotsubo syndrome. Parkinsonism Relat Disord 2015; 21:426. [DOI: 10.1016/j.parkreldis.2014.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 11/06/2014] [Indexed: 11/19/2022]
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103
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Said SAM, Bloo R, Nooijer RD, Slootweg A. Cardiac and non-cardiac causes of T-wave inversion in the precordial leads in adult subjects: A Dutch case series and review of the literature. World J Cardiol 2015; 7:86-100. [PMID: 25717356 PMCID: PMC4325305 DOI: 10.4330/wjc.v7.i2.86] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/14/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe the electrocardiographic (ECG) phenomena characterized by T-wave inversion in the precordial leads in adults and to highlight its differential diagnosis.
METHODS: A retrospective chart review of 8 adult patients who were admitted with ECG T-wave inversion in the anterior chest leads with or without prolongation of corrected QT (QTc) interval. They had different clinical conditions. Each patient underwent appropriate clinical assessment including investigation for myocardial involvement. Single and multimodality non-invasive, semi-invasive and invasive diagnostic approach were used to ascertain the diagnosis. The diagnostic assessment included biochemical investigation, cardiac and abdominal ultrasound, cerebral and chest computed tomography, nuclear medicine and coronary angiography.
RESULTS: Eight adult subjects (5 females) with a mean age of 66 years (range 51 to 82) are analyzed. The etiology of T-wave inversion in the precordial leads were diverse. On admission, all patients had normal blood pressure and the ECG showed sinus rhythm. Five patients showed marked prolongation of the QTc interval. The longest QTc interval (639 ms) was found in the patient with pheochromocytoma. Giant T-wave inversion (≥ 10 mm) was found in pheochromocytoma followed by electroconvulsive therapy and finally ischemic heart disease. The deepest T-wave was measured in lead V3 (5 ×). In 3 patients presented with mild T-wave inversion (patients 1, 5 and 4 mm), the QTc interval was not prolonged (432, 409 and 424 msec), respectively.
CONCLUSION: T-wave inversion associated with or without QTc prolongation requires meticulous history taking, physical examination and tailored diagnostic modalities to reach rapid and correct diagnosis to establish appropriate therapeutic intervention.
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Madias JE. Dobutamine Stress Echocardiography, Diastolic Function, and Myocardial Performance Index in Patients With History of Takotsubo Syndrome. J Card Fail 2015; 21:89. [DOI: 10.1016/j.cardfail.2014.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 10/16/2014] [Indexed: 11/29/2022]
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105
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Aikawa T, Sakakibara M, Takahashi M, Asakawa K, Dannoura Y, Makino T, Koya T, Tsutsui H. Critical takotsubo cardiomyopathy complicated by ventricular septal perforation. Intern Med 2015; 54:37-41. [PMID: 25742891 DOI: 10.2169/internalmedicine.54.3475] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 81-year-old woman was admitted with chest pain. An electrocardiogram demonstrated ST segment elevation in leads II, III and aVF, and echocardiography revealed left ventricular apical asynergy with a left-to-right ventricular shunt. Meanwhile, emergent coronary angiography showed no significant coronary artery stenosis, whereas left ventriculography indicated apical ballooning and a left-to-right ventricular shunt. We therefore diagnosed the patient with Takotsubo cardiomyopathy complicated by ventricular septal perforation and cardiogenic shock. An electrocardiogram disclosed a prolonged QT interval over time, and the patient became hemodynamically stable under treatment with inotropes; however, she suddenly developed fatal ventricular fibrillation three days after hospitalization. Takotsubo cardiomyopathy complicated by ventricular septal perforation is a critical condition that requires careful monitoring.
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Affiliation(s)
- Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Japan
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106
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Duran-Cambra A, Sutil-Vega M, Fiol M, Núñez-Gil IJ, Vila M, Sans-Roselló J, Cinca J, Sionis A. Systematic review of the electrocardiographic changes in the takotsubo syndrome. Ann Noninvasive Electrocardiol 2014; 20:1-6. [PMID: 25367822 DOI: 10.1111/anec.12228] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- A Duran-Cambra
- Cardiology Department, Hospital of the Holy Cross and Saint Paul, Biomedical Research Institute Sant Pau, Barcelona, Spain
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107
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Madias JE. Marked attenuation of the electrocardiogram QRS complexes in a patient with pheochromocytoma and Takotsubo syndrome. Int J Cardiol 2014; 177:211-2. [DOI: 10.1016/j.ijcard.2014.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 09/17/2014] [Indexed: 11/16/2022]
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108
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York City; and Division of Cardiology, Elmhurst Hospital Center, Elmhurst, New York
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109
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Electrocardiographic differentiation of Takotsubo syndrome from acute anterior ST-elevation myocardial infarction. J Electrocardiol 2014; 47:760-1. [DOI: 10.1016/j.jelectrocard.2014.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Indexed: 01/18/2023]
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110
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Abstract
Takotsubo cardiomyopathy, also known as left ventricular apical ballooning syndrome and stress-induced cardiomyopathy, is typically characterized by transient systolic dysfunction of the apical and mid-segments of the left ventricle, in the absence of obstructive coronary artery lesions. Patients may present with symptoms and signs of acute coronary syndrome, and the provider is challenged to differentiate between these conditions. In this review, we guide the reader through the diagnostic pathway, focusing on differential diagnoses and diagnostic criteria for takotsubo cardiomyopathy.
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Affiliation(s)
- Dawn C Scantlebury
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic
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111
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Madias JE. Coronary artery systolic "milking" and "bridging" in Takotsubo syndrome: substrate or an epiphenomenon? Glob Cardiol Sci Pract 2014; 2014:99. [PMID: 25054127 PMCID: PMC4104385 DOI: 10.5339/gcsp.2014.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 11/28/2022] Open
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112
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Madias JE. Coronary vasospasm is an unlikely cause of Takotsubo syndrome, although we should keep an open mind. Int J Cardiol 2014; 176:1-5. [PMID: 25043215 DOI: 10.1016/j.ijcard.2014.06.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/29/2014] [Indexed: 12/12/2022]
Abstract
This viewpoint pertains to the still elusive pathophysiology of the Takotsubo syndrome (TTS), maintaining the position that this affliction is not the result of coronary vasospasm (CV) involving one or more coronary arteries. Although CV has been rarely encountered in the acute stage of TTS, or elicited via provocative testing in the subacute stage of the disease, it does not appear to be the cause of TTS as shown by the bulk of the published relevant literature. The author provides some speculations to explain the spontaneous appearance of CV, or its artificial elicitation, in some patients with TTS. However while we are striving to unravel the pathophysiology of TTS, we should keep an open mind about a possible role for CV in the causation of TTS.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States.
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113
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Madias JE. Ventricular fibrillation and Takotsubo syndrome: which one was first? Int J Cardiol 2014; 173:506. [PMID: 24708932 DOI: 10.1016/j.ijcard.2014.03.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/09/2014] [Indexed: 12/18/2022]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States.
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114
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Abstract
Takotsubo cardiomyopathy (TCM) is a unique type of reversible cardiomyopathy that is precipitated by a stressful mental or physical event. Although TCM was generally considered to be a benign reversible condition, arrhythmic risk is increasingly recognised. We discuss a case of TCM presenting with aborted sudden cardiac death. We have also explained the pathophysiology of QTc prolongation and repolarisation abnormalities associated with the condition.
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115
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Madias JE. Is there a link between Takotsubo syndrome and some cases of nonischemic cardiomyopathy? A proposal of an animal model. Int J Cardiol 2014; 172:e212-3. [DOI: 10.1016/j.ijcard.2013.12.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
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116
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Guerra F. Low-voltage QRS and amplitude attenuation in Takotsubo syndrome: just an intriguing hypothesis or potential preangiographic markers? Am J Cardiol 2014; 113:571-2. [PMID: 24433608 DOI: 10.1016/j.amjcard.2013.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 11/18/2013] [Indexed: 11/16/2022]
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117
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Gasparetto N, Zorzi A, Perazzolo Marra M, Migliore F, Napodano M, Corrado D, Iliceto S, Cacciavillani L. Atypical (mid-ventricular) Takotsubo syndrome in a survival of out-of-hospital ventricular fibrillation: cause or consequence? Int J Cardiol 2013; 172:e51-3. [PMID: 24486060 DOI: 10.1016/j.ijcard.2013.12.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 12/21/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Nicola Gasparetto
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
| | - Alessandro Zorzi
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Martina Perazzolo Marra
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Massimo Napodano
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Domenico Corrado
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Sabino Iliceto
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Luisa Cacciavillani
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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118
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Zhong-Qun Z, Bo Y, Nikus KC, Pérez-Riera AR, Chong-Quan W, Xian-Ming W. Correlation between ST-segment elevation and negative T waves in the precordial leads in acute pulmonary embolism: insights into serial electrocardiogram changes. Ann Noninvasive Electrocardiol 2013; 19:398-405. [PMID: 24206526 DOI: 10.1111/anec.12115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute pulmonary embolism (APE) is often misdiagnosed as acute coronary syndrome because of the similarity of the presenting symptoms and of the electrocardiogram (ECG) manifestations. In APE, ST-segment elevation (STE) in leads V1 to V3 /V4 , mimicking anteroseptal myocardial infarction, is not a rare phenomenon. Negative T waves (NTW) in the precordial leads mimicking the "Wellens' syndrome" is an important ECG manifestation of APE. The evolution of these ECG changes-STE and NTW-in APE has not been thoroughly studied. METHODS We present two patient cases with APE and their evolving serial ECGs to analyze the correlation between STE and NTW. RESULTS NTW developed later than STE in these two patient cases. CONCLUSIONS NTW might represent a "postischemic" ECG pattern indicating a previous stage with transmural myocardial ischemia.
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Affiliation(s)
- Zhan Zhong-Qun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
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119
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Madias JE. Electrocardiogram lead-specific QRS attenuation in an atypical midventricular case of Takotsubo syndrome. J Electrocardiol 2013; 46:728-9. [DOI: 10.1016/j.jelectrocard.2013.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Indexed: 10/26/2022]
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120
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Akutsu Y, Kaneko K, Kodama Y, Li HL, Suyama J, Toshida T, Kayano H, Shinozuka A, Gokan T, Kobayashi Y. Reversible T-wave inversions and neurogenic myocardial stunning in a patient with recurrent stress-induced cardiomyopathy. Ann Noninvasive Electrocardiol 2013; 19:285-8. [PMID: 24147830 DOI: 10.1111/anec.12100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 72-year-old female was diagnosed as a stress-induced cardiomyopathy from apical ballooning pattern of left ventricular dysfunction without coronary artery stenosis after the mental stress. ECG showed the transient T-wave inversions after the ST-segment elevations. By the mental stress after 1 year, she showed a transient dysfunction with similar ECG changes again. T-wave inversions recovered earlier, and cardiac sympathetic dysfunction showed a lighter response corresponding to the less severe dysfunction than those after the first onset. Wellens' ECG pattern was associated with the degree of neurogenic myocardial stunning with sympathetic hyperinnervation caused by mental stress.
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Affiliation(s)
- Yasushi Akutsu
- Division of Cardiology, Department of Medicine; Department of Internal Medicine (Cardiology), Clinical Trial Center for Clinical Pharmacology, Showa University Karasuyama Hospital, Tokyo, Japan
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121
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Madias JE. Plausible mechanisms of the rapid conversion of ST-segment elevation to T-wave inversion in Takotsubo syndrome. Int J Cardiol 2013; 168:4593-5. [DOI: 10.1016/j.ijcard.2013.08.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/03/2013] [Indexed: 10/26/2022]
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122
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Migliore F, Perazzolo Marra M, Zorzi A, Cademartiri F, Corrado D, Iliceto S, Tarantini G. Myocardial bridging, apical ballooning syndrome and myocardial stunning: Shall we connect the dots? Int J Cardiol 2013; 168:3109-11. [DOI: 10.1016/j.ijcard.2013.04.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
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123
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Spadotto V, Zorzi A, Elmaghawry M, Meggiolaro M, Pittoni GM. Heart failure due to 'stress cardiomyopathy': a severe manifestation of the opioid withdrawal syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 2:84-7. [PMID: 24062938 DOI: 10.1177/2048872612474923] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/24/2012] [Indexed: 11/15/2022]
Abstract
Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction due to akinesia of the LV mid-apical segments ('apical ballooning') in the absence of critical coronary stenoses which can be complicated in the acute phase by heart failure, mitral regurgitation, life-threatening ventricular arrhythmias, or apical LV thrombosis. The syndrome is typically precipitated by intense emotional or physical stress; however, other causes of sympathetic overstimulation including administration of exogenous sympathomimetics or withdrawal of sympathetic antagonists can trigger TTC. We report the case of a patient who unexpectedly developed an 'apical ballooning' with severe reduction in the LV systolic function and heart failure after the withdrawal of methadone. The case supports the concept that increased sympathetic activity secondary to opioids withdrawal can trigger a stress-induced severe LV dysfunction. Physicians should be aware that the abrupt discontinuation of a long-term therapy with opioids may lead to serious cardiac complications. The administration of clonidine may be considered to prevent early clinical manifestations of addictive withdrawal, including TTC.
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124
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Madias JE. Transient attenuation of the amplitude of the QRS complexes in the diagnosis of Takotsubo syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 3:28-36. [PMID: 24562801 DOI: 10.1177/2048872613504311] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Currently, there are no specific diagnostic electrocardiogram (ECG) signs for Takotsubo syndrome (TTS) to differentiate it from acute coronary syndromes (ACS). Myocardial oedema has been detected by cardiac magnetic resonance imaging in patients with TTS. Recently it has been postulated that myocardial oedema may be the cause of low QRS voltage (LQRSV) in the admission ECG and attenuation of the amplitude of the QRS complexes (AAQRS) in serial ECGs, noted in a few published cases of patients with TTS. The objective of this study was to evaluate whether the admission ECG of patients with documented TTS reveals LQRSV and whether AAQRS is found when serial ECGs are compared in such patients. METHODS This study evaluated the prevalence of LQRSV in the admission ECG and AAQRS in serial ECGs in patients with TTS. ECGs of 368 patients with TTS from published reports in the international literature were evaluated for LQRSV (≤5 mm in limb leads and/or ≤10 mm in precordial leads) and AAQRS in serial ECGs. RESULTS LQRSV was seen in 91.5% of 200 patients with TTS and one ECG, with a distribution of 49.0, 42.8, 51.0, 52.0, and 46.9%, in lead aVR, and inferior, anterior, lateral, and high lateral ECG lead groups, respectively. AAQRS was seen in 93.5% of 168 patients with TTS and two or more ECGs, with a distribution of 78.3, 74.5, 60.1, 70.7, and 74.5% in lead aVR, and inferior, anterior, lateral, and high lateral ECG lead groups, respectively. CONCLUSIONS LQRSV and AAQRS are highly prevalent ECG signs in patients with TTS, and should be useful in aiding in its diagnosis and differentiation from ACS, on first contact with the patient on admission to the hospital, and the ensuing 24 hours, in conjunction with echocardiography and coronary arteriography.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, USA
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125
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Madias JE. Two Cases of Reversible Left Ventricular Hypertrophy during Recovery from Takotsubo Cardiomyopathy. Echocardiography 2013; 30:989. [DOI: 10.1111/echo.12249] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- John E. Madias
- Mount Sinai School of Medicine of the New York University, and the Division of Cardiology; Elmhurst Hospital Center; New York; NY
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126
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Kato T, Ban Y, Kuruma S, Ishida S, Doi C, Iura T, Terawaki H, Inoko M, Nohara R. Reply. Echocardiography 2013; 30:990-1. [DOI: 10.1111/echo.12250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Takao Kato
- Cardiovascular Center; Kitano Hospital; Tazuke Kofukai Medical Research Institute; Osaka; Japan
| | - Yoko Ban
- Clinical Laboratory Division; Kitano Hospital; Tazuke Kofukai Medical Research Institute; Osaka; Japan
| | - Saori Kuruma
- Clinical Laboratory Division; Kitano Hospital; Tazuke Kofukai Medical Research Institute; Osaka; Japan
| | - Seiko Ishida
- Clinical Laboratory Division; Kitano Hospital; Tazuke Kofukai Medical Research Institute; Osaka; Japan
| | - Chikako Doi
- Clinical Laboratory Division; Kitano Hospital; Tazuke Kofukai Medical Research Institute; Osaka; Japan
| | - Tamae Iura
- Clinical Laboratory Division; Kitano Hospital; Tazuke Kofukai Medical Research Institute; Osaka; Japan
| | - Hiromi Terawaki
- Clinical Laboratory Division; Kitano Hospital; Tazuke Kofukai Medical Research Institute; Osaka; Japan
| | - Moriaki Inoko
- Cardiovascular Center; Kitano Hospital; Tazuke Kofukai Medical Research Institute; Osaka; Japan
| | - Ryuji Nohara
- Cardiovascular Center; Kitano Hospital; Tazuke Kofukai Medical Research Institute; Osaka; Japan
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127
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Panic attacks and Takotsubo syndrome: how we can prove the connection. Am J Emerg Med 2013; 31:1146-7. [DOI: 10.1016/j.ajem.2013.03.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 11/18/2022] Open
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128
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Zhong-qun Z, Chong-quan W, Nikus KC, Sclarovsky S. Correlation between ECG presentation and cardiovascular magnetic resonance imaging in takotsubo cardiomyopathy. J Electrocardiol 2013; 46:343-5. [DOI: 10.1016/j.jelectrocard.2013.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Indexed: 12/13/2022]
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129
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Zorzi A, Perazzolo Marra M, Migliore F, De Lazzari M, Tarantini G, Iliceto S, Corrado D. Relationship between repolarization abnormalities and myocardial edema in atypical Tako-Tsubo syndrome. J Electrocardiol 2013; 46:348-51. [PMID: 23809207 DOI: 10.1016/j.jelectrocard.2013.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Indexed: 01/30/2023]
Abstract
In typical "apical" Tako-Tsubo syndrome (TTS), an association between dynamic T-wave inversion/QTc interval prolongation and myocardial edema as evidenced by cardiac magnetic resonance has been reported. We describe a patient with atypical "mid-ventricular" TTS who showed T-waves inversion/QTc prolongation confined to the lateral leads. Cardiac magnetic resonance revealed transmural myocardial edema with the highest signal intensity in the mid-lateral wall, in accordance with the ECG location of repolarization abnormalities. This finding indicates that the association of dynamic T-wave inversion/QTc interval prolongation with myocardial edema is demonstrable also in atypical variant of TTS and contributes to support the emerging concept of a cause-effect relationship between transient myocardial edema and dynamic repolarization changes.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padova, Italy
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130
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Madias JE, Madias C. To the Editor— Electrocardiogram correlates of myocardial edema in patients with Takotsubo syndrome. Heart Rhythm 2013; 10:e67. [DOI: 10.1016/j.hrthm.2013.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Indexed: 10/27/2022]
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131
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Reply to the Letter— Electrocardiogram Correlates of Myocardial Edema with Takotsubo Syndrome. Heart Rhythm 2013; 10:e67-8. [DOI: 10.1016/j.hrthm.2013.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Indexed: 11/20/2022]
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132
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Santoro F, Carapelle E, Cieza Ortiz SI, Musaico F, Ferraretti A, d'Orsi G, Specchio LM, Di Biase M, Brunetti ND. Potential links between neurological disease and Tako-Tsubo cardiomyopathy: a literature review. Int J Cardiol 2013; 168:688-91. [PMID: 23608401 DOI: 10.1016/j.ijcard.2013.03.093] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 01/19/2013] [Accepted: 03/29/2013] [Indexed: 01/19/2023]
Abstract
Tako-Tsubo cardiomyopathy (TTC), is defined as a fully reversible acute deterioration of left-ventricular (LV) function, which is mainly found in women after an episode of emotional or physical stress (e.g. psychosocial stress, sepsis, surgery). The underlying mechanisms remain unclear. There is evidence suggesting a possible link between neurological disease and TTC. The pathophysiology of the several neurologic diseases has been reviewed searching for possible mechanisms that could lead to TTC in these patients.
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Spadotto V, Elmaghawry M, Zorzi A, Migliore F, Marra MP. Apical ballooning with mid-ventricular obstruction: the many faces of Takotsubo cardiomyopathy. Glob Cardiol Sci Pract 2013; 2013:163-8. [PMID: 24689016 PMCID: PMC3963740 DOI: 10.5339/gcsp.2013.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/14/2013] [Indexed: 01/14/2023] Open
Abstract
Takotsubo cardiomyopathy (TTC) is a transient left ventricular dysfunction due to akinesia of the left-ventricular (LV) mid-apical segments (apical ballooning), which can cause severe reduction in LV systolic function. The typical clinical picture of TTC include chest pain, electrocardiographic changes consisting of mild ST-segment elevation followed by diffuse deep T-wave inversion, QTc interval prolongation and mild troponin release in the absence of significant coronary stenoses. The syndrome often affects post-menopausal women and is triggered by sympathetic overstimulation, like intense physical or emotional stress, so that it is called the "broken heart syndrome". Although left-ventricular systolic dysfunction usually fully recovers within few days, heart failure can still complicate the early phase. We report a case of stress-induced cardiomyopathy that had full recovery after 4 weeks of follow up. The main electrocardiographic, angiographic and imaging features are discussed.
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Affiliation(s)
- Veronica Spadotto
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Alessandro Zorzi
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Martina Perazzolo Marra
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Ventricular repolarization gradient and electrocardiogram characteristics of Tako-Tsubo cardiomyopathy. Heart Rhythm 2012; 10:78-9. [PMID: 22985661 DOI: 10.1016/j.hrthm.2012.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Indexed: 11/20/2022]
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