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Drača S. A possible relationship between Takotsubo cardiomyopathy and female sex steroid-related modulation of functional cerebral asymmetry. Med Hypotheses 2015; 84:238-40. [PMID: 25618443 DOI: 10.1016/j.mehy.2015.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/07/2015] [Indexed: 12/19/2022]
Abstract
Takotsubo cardiomyopathy (Tc) is a transient left ventricular apical ballooning syndrome, with symptoms and signs of acute myocardial infarction. Tc syndrome, which occurs predominantly in postmenopausal women, is characterized by increase of sympathetic activity. Studies on the gender-specific differences in sympatho-vagal regulation and functional cerebral asymmetry (FCA) imply that female pattern of dominance is characterized by the left hemisphere, which is believed to have parasympathetic predominance, whereas male pattern indicates dominance of the right hemisphere, which is believed to have sympathetic predominance. Fluctuating levels of female sex steroids are supposed to change FCA, modulating transcallosal inter-hemispheric inhibition across the menstrual cycle. The findings suggest that FCA is enhanced during the low steroid phase (menstrual phase), whereas, during high estrogen and/or progesterone phases (follicular and luteal phase) FCA is reduced. This theory is in line with concept of decreased magnitude of inter-hemispheric cortical lateralization in premenopausal women compared to men and postmenopausal women. Therefore, if postmenopausal women are more lateralized for a variety of cerebral functions, they have less balanced equilibrium between the right-sided sympathetic and left-sided parasympathetic predominance. Decrease of endogenous female sex steroid levels in postmenopausal women leads to reduced influence of estrogens to the left hemisphere, which is believed to have parasympathetic predominance. If both of these mechanisms result in sympatho-vagal imbalance, increasing sympathetic system activity in postmenopausal women, it seems reasonable why postmenopausal women became more susceptible to sympathetically-mediated syndromes such as Takotsubo cardiomyopathy.
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Affiliation(s)
- S Drača
- College of Applied Sciences, Ćirila i Metodija 22-24, Kruševac 37000, Serbia.
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202
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Nightmare-Induced Atypical Midventricular Tako-Tsubo Cardiomyopathy. Case Rep Med 2015; 2015:292658. [PMID: 25788945 PMCID: PMC4350873 DOI: 10.1155/2015/292658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/05/2015] [Accepted: 02/05/2015] [Indexed: 11/22/2022] Open
Abstract
Tako-Tsubo cardiomyopathy (TTC) is a reversible cardiomyopathy characterized by acute left ventricular segmental dysfunction, whose clinical presentation resembles that of acute myocardial infarction. The syndrome often follows a psychophysical stressful event and is characterized by echocardiographic evidence of akinesia of the left ventricular mid-apical segments. Atypical echocardiographic patterns of TTC have recently been described, often triggered by emotional stressors, rather than physical. In this report, we describe a case of atypical TTC triggered by an unusual stressor (recurrent nightmare) in a 45-year-old woman, with peculiar clinical presentation and evolution characterized by persistent loss of consciousness, neurological deterioration, absence of typical symptoms of TTC, and features suggestive of a hysterical crisis.
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203
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Abstract
Takotsubo syndrome has been established as an entity in the past 30 years, particularly with the introduction of interventional angiography for investigation of chest pain. Typically, it occurs in middle-aged females as a response to a stressful event, such as bad news, death, accident, natural disaster, etc. but there is not always a specific trigger. Takotsubo mimics acute myocardial infarction with electrocardiogram changes and elevated troponins. On interventional angiography the coronary arteries are normal with typical apical ballooning of the left ventricle. This feature led to its descriptive name, given by Japanese cardiologists, as the left ventricle resembles a lobster trap with a narrow neck extending into a round ventricle. This leads to a reduction in cardiac function. Takotsubo is believed to be a response to catecholamine release following a stressful event resulting in temporary myocardial damage. It usually has a benign course with spontaneous return of cardiac function. However it may recur and in a small percentage of patients can result in sudden cardiac death with arrhythmia, acute myocardial infarction and cardiac rupture. It is usually treated symptomatically depending on the severity of presentation.
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Affiliation(s)
- Mary N Sheppard
- St George's University Medical School, London, United Kingdom
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204
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Kawaji T, Shiomi H, Morimoto T, Tazaki J, Imai M, Saito N, Makiyama T, Shizuta S, Ono K, Kimura T. Clinical Impact of Left Ventricular Outflow Tract Obstruction in Takotsubo Cardiomyopathy. Circ J 2015; 79:839-46. [DOI: 10.1253/circj.cj-14-1148] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takeshi Morimoto
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masao Imai
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Naritatsu Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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205
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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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206
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Takotsubo cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan. BMC Res Notes 2014; 7:932. [PMID: 25522887 PMCID: PMC4320635 DOI: 10.1186/1756-0500-7-932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/12/2014] [Indexed: 11/17/2022] Open
Abstract
Objective There is very little literature regarding Takotsubo Cardiomyopathy (TTC) from the Asian Countries other than Japan and Korea. We conducted this study to determine the demographics, clinical presentations, complications and recovery of left ventricular (LV) systolic function in TTC patients of Pakistani origin. Methods A ten years retrospective case series study of TTC was conducted at the Aga Khan University Hospital. Patients were followed for up to six months after presentation, with special emphasis on the recovery of LV function. Conclusion TTC is classically triggered by an acute illness or by extreme stress and a triggering incident may not always be identified. It usually presents in the guise of an acute coronary syndrome (ACS). Our data was congruent with the existing literature, except for more heart failure and cardiogenic shock. Average Troponin-I (Tn-I) levels were also higher as compared to western population. The reason for more severity in our patients may be late presentation or different level of response to stress.
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207
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Núñez Gil IJ, Andrés M, Almendro Delia M, Sionis A, Martín A, Bastante T, Córdoba Soriano JG, Linares Vicente JA, González Sucarrats S, Sánchez-Grande Flecha A. Characterization of Tako-tsubo Cardiomyopathy in Spain: Results from the RETAKO National Registry. ACTA ACUST UNITED AC 2014; 68:505-12. [PMID: 25544669 DOI: 10.1016/j.rec.2014.07.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/07/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND AIMS The etiology and epidemiology of tako-tsubo cardiomyopathy remain uncertain. The symptoms of this condition are often similar to those of myocardial infarction and, although it usually has a good prognosis, it is not without complications. Our aim was to characterize this disease in our setting using a dedicated registry (Spanish REgistry for TAKOtsubo cardiomyopathy). METHODS The prospective registry included 202 incident patients in 23 hospitals from 2012 to 2013. The patients' clinical characteristics and analytical, echocardiographic, and imaging results were recorded, as were the events during follow-up. Patients were included when the attending physician considered the case proven, and incidence was calculated relative to the catheterizations requested for a presumptive diagnosis of acute coronary syndrome. RESULTS The patients were predominantly women (90%), with a mean age of 70 years, and many had cardiovascular risk factors, such as hypertension (67%), dyslipidemia (41%), diabetes mellitus (15%), and smoking (15%). The incidence of tako-tsubo cardiomyopathy was 1.2%, and there was no clear weekly or seasonal distribution pattern. Chest pain was the predominant symptom, a triggering factor (emotional, physical, or both) was present in 72%, and most patients consulted within the first 6h after symptom onset. The median duration of hospitalization was 7 days. There were heart failure symptoms in 34.0%, arrhythmia in 26.7%, and 2.4% of patients died. CONCLUSIONS The incidence of tako-tsubo cardiomyopathy is low. This disease primarily affects postmenopausal women, and occurs after a situation of emotional stress in more than half of affected individuals. It is characterized by anginal pain, shows no seasonal distribution, and has a good prognosis, although it is not without morbidity and mortality.
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Affiliation(s)
- Iván J Núñez Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
| | - Mireia Andrés
- Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ana Martín
- Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de la Princesa, Madrid, Spain
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208
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Apical myocardial infarction with bizarre coronary images mimicking left ventricular apical ballooning syndrome: a case report. J Med Case Rep 2014; 8:124. [PMID: 24716472 PMCID: PMC3994524 DOI: 10.1186/1752-1947-8-124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 01/17/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Although several etiopathogenetic mechanisms have been proposed, the causes of left ventricular apical ballooning syndrome are still controversial. Case presentation A 51-year-old Japanese woman consulted the emergency room complaining of the sudden onset of anterior chest pain while shopping. We initially suspected her disease as left ventricular apical ballooning syndrome based on her clinical background and laboratory examinations. However, the initial coronary angiogram demonstrated diffuse lesions in her distal left anterior descending coronary artery, and she was finally diagnosed with apical myocardial infarction. The blood flow in her distal left anterior descending coronary artery had markedly improved in the chronic phase. If the reduced blood flow in her distal left anterior descending coronary artery was induced by coronary vasospasm and the vasospasm was relieved before the coronary angiogram was performed, this case must be diagnosed as left ventricular apical ballooning syndrome. Conclusion We think this case may promote discussion regarding the pathophysiology of left ventricular apical ballooning syndrome.
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209
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Dias A, Franco E, Figueredo VM, Hebert K. Can previous oophorectomy worsen the clinical course of takotsubo cardiomyopathy females? Age and gender-related outcome analysis. Int J Cardiol 2014; 177:1134-6. [DOI: 10.1016/j.ijcard.2014.08.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/09/2014] [Indexed: 12/01/2022]
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210
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Murthy A, Henien S, Mcpherson CA, Logue MA. Epinephrine use results in 'stress' cardiomyopathy. J Cardiol Cases 2014; 11:85-87. [PMID: 30546537 DOI: 10.1016/j.jccase.2014.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/15/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022] Open
Abstract
Epinephrine is a frequently used catecholamine, particularly in emergencies and during resuscitation attempts. It is not without side effects. We report a rare case of epinephrine-induced cardiomyopathy. Epinephrine was administered for bradycardia in our patient. He was treated conservatively and responded well to the treatment. Through our work we wish to highlight this adverse cardiac effect of epinephrine. We hope to increase awareness among residents and practicing physicians while using epinephrine. <Learning objective: Epinephrine, although a lifesaving drug, has adverse side effects. Dosages and routes of administration determine its toxicity. Exogenous catecholamines can cause presentations similar to takotsubo cardiomyopathy. Management is supportive and the outcomes are good.>.
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Affiliation(s)
- Avinash Murthy
- Division of Cardiology, Bridgeport Hospital, Bridgeport, CT, USA
| | - Shady Henien
- Division of Cardiology, Bridgeport Hospital, Bridgeport, CT, USA
| | | | - Michael A Logue
- Division of Cardiology, Bridgeport Hospital, Bridgeport, CT, USA
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211
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Lancellotti P, Price S, Edvardsen T, Cosyns B, Neskovic AN, Dulgheru R, Flachskampf FA, Hassager C, Pasquet A, Gargani L, Galderisi M, Cardim N, Haugaa KH, Ancion A, Zamorano JL, Donal E, Bueno H, Habib G. The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Cardiovasc Imaging 2014; 16:119-46. [PMID: 25378470 DOI: 10.1093/ehjci/jeu210] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/ critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described.
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Affiliation(s)
- Patrizio Lancellotti
- University of Liège Hospital, Cardiology Care Unit, GIGA Cardiovascular Sciences, Department of Cardiology, University Hospital Sart Tilman, Belgium
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - Bernard Cosyns
- Department of Cardiology, Univeristair ziekenhuis, VUB, Centrum Voor Hart-en Vaatziekten (CHVZ), Brussels, Belgium
| | | | - Raluca Dulgheru
- University of Liège Hospital, Cardiology Care Unit, GIGA Cardiovascular Sciences, Department of Cardiology, University Hospital Sart Tilman, Belgium
| | | | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Agnes Pasquet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Luna Gargani
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Maurizio Galderisi
- Department of Medical Translational Sciences, Federico II University Hospital, Naples, Italy
| | - Nuno Cardim
- Echocardiography Laboratory, Hospital da Luz, Lisbon, Portugal
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital and University of Oslo, Norway
| | - Arnaud Ancion
- University of Liège Hospital, Cardiology Care Unit, GIGA Cardiovascular Sciences, Department of Cardiology, University Hospital Sart Tilman, Belgium
| | | | - Erwan Donal
- Cardiology Department, CHU Rennes and LTSI, Université Rennes-1, France
| | - Héctor Bueno
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón & Universidad Complutense de Madrid, Spain
| | - Gilbert Habib
- Aix-Marseille Université, APHM, La Timone Hospital, Cardiology Department, France
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212
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Murthy A, Arora J, Singh A, Gedela M, Karnati P, Nappi A. Takotsubo Cardiomyopathy: Typical and Atypical Variants, A Two-Year Retrospective Cohort Study. Cardiol Res 2014; 5:139-144. [PMID: 28348711 PMCID: PMC5358118 DOI: 10.14740/cr349w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 02/06/2023] Open
Abstract
Background Typical or classical takotsubo cardiomyopathy (TCM) is associated with the characteristic abnormality of a ballooned left ventricular apex with basal segmental hyperkinesis. TCM may not present with the “classical” wall motion abnormalities but can have a variety of segmental wall motion abnormalities. The aim of our work was to assess for any unique identifying factors that can help distinguish typical and atypical variants of TCM. Methods We studied 11 consecutive patients between 2010 and 2012 admitted with chest pain, electrocardiographic and cardiac biomarker changes consistent with acute coronary syndrome (ACS) who underwent left heart angiography and were clinically diagnosed to have TCM. Results Our study found no specific features distinguishing typical and atypical variants of TCM. In our study, all patients were female and all had excellent outcome. One patient was in fourth decade of life, three patients in fifth and sixth decade of life, while remaining were older. One patient had diabetes mellitus, five had hypertension, four had concurrent coronary artery disease, but no patient had any family history of TCM. Nine of 11 patients had immediate clear-cut stressors. Three patients had normal ECG, two with ST segment elevation, with nine patients having only modest troponin elevations. One patient had an anomalous RCA take-off from the right coronary cusp, otherwise remaining patients had normal anatomy. One patient had only apical involvement, remaining had multiple wall motion abnormalities, and all patients had involvement of the anterior wall. Four patients had apical sparing. No inverted TCM pattern with basal akinesis with normal wall motion in the midventricular and apical regions was found among our patients. Conclusions We report that the classification of TCM as typical versus atypical is probably not clinically meaningful. The regional wall motion abnormalities are related to catecholamine excess and to the susceptibility of that particular region to excess catecholamine. We do not know why such differences in regional susceptibility exist, and agree with the other authors that sub-classification would only add to confusion, and a delay in understanding of the disease process.
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Affiliation(s)
- Avinash Murthy
- Division of Cardiology, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06484, USA
| | - Jaspreet Arora
- Department of Internal Medicine, Albany Medical Center, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Arti Singh
- Division of Cardiology, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06484, USA
| | - Maheedhar Gedela
- Division of Cardiology, Department of Internal Medicine, Albany Medical Center, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Pavan Karnati
- Department of Medicine, Clinch Valley Medical Center, 6801 Gov. G. C. Peery Highway, Richlands, VA 24641, USA
| | - Anthony Nappi
- Division of Cardiology, Department of Internal Medicine, Albany Medical Center, 47 New Scotland Avenue, Albany, NY 12208, USA
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213
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Standard and advanced echocardiography in takotsubo (stress) cardiomyopathy: clinical and prognostic implications. J Am Soc Echocardiogr 2014; 28:57-74. [PMID: 25282664 DOI: 10.1016/j.echo.2014.08.020] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Indexed: 12/27/2022]
Abstract
Echocardiography is frequently the initial noninvasive imaging modality used to assess patients with takotsubo cardiomyopathy (TTC). Standard transthoracic echocardiography can provide, even in the acute care setting, useful information about left ventricular (LV) morphology as well as regional and global systolic or diastolic function. It allows the differentiation of different LV morphologic patterns according to the localization of wall motion abnormalities. A "circumferential pattern" of LV myocardial dysfunction characterized by symmetric wall motion abnormalities involving the midventricular segments of the anterior, inferior, and lateral walls should be considered suggestive of TTC and included in the differential diagnosis of acute coronary syndromes. Moreover, advanced echocardiographic techniques, including speckle-tracking, myocardial contrast, and coronary flow studies, are providing mechanistic and pathophysiologic insights into this unique syndrome. Early identification of any potential complications (i.e., LV outflow tract obstruction, reversible moderate to severe mitral regurgitation, right ventricular involvement, thrombus formation, and cardiac rupture) are crucial for the management, risk stratification, and follow-up of patients with TTC. Because of the dynamic evolution of the syndrome, comprehensive serial echocardiographic examinations should be systematically performed. This review focuses on these aspects of imaging and the increasing understanding of the clinical and prognostic utility of echocardiography in TTC.
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214
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Fontanella C, Aita M, Cinausero M, Aprile G, Baldin MG, Dusi V, Lestuzzi C, Fasola G, Puglisi F. Capecitabine-induced cardiotoxicity: more evidence or clinical approaches to protect the patients' heart? Onco Targets Ther 2014; 7:1783-91. [PMID: 25302025 PMCID: PMC4189715 DOI: 10.2147/ott.s65653] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Fluoropyrimidines, such as capecitabine and 5-fluorouracil, may cause cardiac toxicity. In recent years, the incidence of this side effect has increased and it is expected to further rise due to the population aging and the disproportionate incidence of breast and gastrointestinal cancers in older individuals. The spectrum of cardiac manifestations includes different signs and symptoms and the diagnosis may be difficult. Here, we report the case of a 43-year-old woman with advanced breast cancer who was rechallenged with a capecitabine-based regimen after experiencing a cardiac adverse event during the first fluoropyrimidine exposure. This real-practice case serves as a springboard for discussion about the current evidence on differential diagnosis of capecitabine-related cardiac toxicity, its risk factors, and the underpinning mechanisms of early onset. Moreover, we discussed whether a rechallenge with fluoropyrimidines could be safe in patients who had experienced a previous cardiac adverse event.
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Affiliation(s)
| | - Marianna Aita
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Marika Cinausero
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Veronica Dusi
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Lestuzzi
- Department of Cardiology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Fabio Puglisi
- Department of Oncology, University Hospital of Udine, Udine, Italy ; Department of Medical and Biological Sciences, University of Udine, Udine, Italy
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215
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Champion S, Belcour D, Vandroux D, Drouet D, Gaüzère BA, Bouchet B, Bossard G, Djouhri S, Jabot J, Champion M, Lefort Y. Stress (Tako-tsubo) cardiomyopathy in critically-ill patients. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 4:189-96. [PMID: 25202025 DOI: 10.1177/2048872614547686] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Stress cardiomyopathy (SC) is a transient ventricular dysfunction rarely described in the critical care setting. OBJECTIVE To evaluate the mechanisms, incidence, treatment and prognosis of SC. METHOD This is a retrospective observational study of every critically-ill patient admitted to the ICU over a period of two years. RESULTS Among 1314 patients admitted in the ICU, 20 patients (1.5%) were diagnosed with SC. A total of 249 patients experienced cardiogenic shock, whereas 8% were suffering from SC. SC was suspected because of hemodynamic impairment (80% of cases), ECG modifications (15%) and/or dyspnea (15%). SC was apical (typical Tako-tsubo) in 90% and atypical in 10% of cases. Several mechanisms or conditions may explain the occurrence of SC and are may be combined: catecholamine toxicity (45%), psychological stress, seizures or neurological impairment (35%), non-epicardial coronary ischemia (20%) and left ventricular outflow track (LVOT) obstruction (10%). SC could have indirectly caused death by worsening heart failure in three patients and arrhythmias were seen in 40% of patients. SAPS2, renal impairment, malnutrition, norepinephrine infusion and thrombocytopenia were associated with death in the univariate analysis. Catecholamines were required in 85% and intra-aortic balloon pump in 20% of patients. CONCLUSIONS SC is a rare reversible cardiac impairment in the critically-ill patient that can induce arrhythmias and cardiogenic shock. The likely mechanisms are combined: catecholamine toxicity, stress or neurological involvement and less frequently ischemia or LVOT obstruction.
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Affiliation(s)
- Sébastien Champion
- Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France
| | - Dominique Belcour
- Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France
| | - David Vandroux
- Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France
| | - Didier Drouet
- Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France
| | - Bernard A Gaüzère
- Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France
| | - Bruno Bouchet
- Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France
| | - Guillaume Bossard
- Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France
| | - Sabina Djouhri
- Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France
| | - Julien Jabot
- Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France
| | | | - Yannick Lefort
- Centre Hospitalier Universitaire de La Réunion, Site Félix Guyon, Allée des Topazes, Réunion, France
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Schneider B, Athanasiadis A, Schwab J, Pistner W, Gottwald U, Schoeller R, Toepel W, Winter KD, Stellbrink C, Müller-Honold T, Wegner C, Sechtem U. Complications in the clinical course of tako-tsubo cardiomyopathy. Int J Cardiol 2014; 176:199-205. [DOI: 10.1016/j.ijcard.2014.07.002] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 05/12/2014] [Accepted: 07/05/2014] [Indexed: 02/07/2023]
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Aturdimiento miocárdico, miocardiopatías de estrés y síndrome de takotsubo. Med Clin (Barc) 2014; 143:252-4. [DOI: 10.1016/j.medcli.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 04/24/2014] [Indexed: 11/22/2022]
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218
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Goodloe AH, Evans JM, Middha S, Prasad A, Olson TM. Characterizing genetic variation of adrenergic signalling pathways in Takotsubo (stress) cardiomyopathy exomes. Eur J Heart Fail 2014; 16:942-9. [PMID: 25132214 DOI: 10.1002/ejhf.145] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/20/2014] [Accepted: 06/27/2014] [Indexed: 01/21/2023] Open
Abstract
AIMS Exome sequencing was used to genotype comprehensively a Takotsubo (stress) cardiomyopathy (TC) cohort, enabling investigation of a vast 486 gene network for adrenergic signalling. METHODS AND RESULTS Twenty-eight TC subjects, including a mother-daughter pair and five recurrent cases, underwent whole-exome sequencing. Frequencies of 17 common, functional adrenergic polymorphisms were statistically similar to those of population controls. Filtering for rare, predicted-deleterious, catecholamine/adrenergic signalling variants revealed heterozygosity in 55 genes in TC cases and 59 genes in healthy controls. Overall allele burden was similar and did not discriminate clinical variables among TC subjects, but gene identities were largely cohort specific, and TC cases were enriched for variants within functional domains (68% vs. 48%, P = 0.031). Two-thirds of TC cases carried more than one filtered adrenergic pathway variant, and 11 genes harboured a variant in ≥ 2 cases. The mother-daughter pair shared missense variants in highly conserved functional domains of ADH5, CACNG1, EPHA4, and PRKCA. An adrenergic pathway-independent analysis of the cohort exposed no common gene for TC. CONCLUSIONS Overall, these data support genetic heterogeneity in TC susceptibility and a likely polygenic basis, conferring a cumulative effect on adrenergic pathway dysregulation in a subset of individual subjects. Study of larger cohorts and non-coding regulatory regions is warranted to define genetic risk factors for TC further.
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Abstract
Since Takotsubo cardiomyopathy was first described by Sato in 1990, multiple cases have been reported, but only few in children, among whom this type of cardiomyopathy is to some extent underappreciated. A series of children with this syndrome were therefore reviewed, drawing comparison with cases reported by others. The review addresses the current challenges in diagnosis, presentation, triggers, clinical course, management, and possible pathogenic mechanisms of the entity.
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220
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Verschure DO, Somsen GA, van Eck-Smit BLF, Knol RJJ, Booij J, Verberne HJ. Tako-tsubo cardiomyopathy: how to understand possible pathophysiological mechanism and the role of (123)I-MIBG imaging. J Nucl Cardiol 2014; 21:730-8. [PMID: 24464623 DOI: 10.1007/s12350-014-9855-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 12/23/2013] [Indexed: 01/29/2023]
Abstract
Tako-tsubo cardiomyopathy (TCM) is an increasingly recognized clinical syndrome characterized by acute reversible apical ventricular dysfunction, commonly preceded by exposure to severe physical or emotional stress. In this review, we give a short overview on clinical presentation and treatment of TCM and discuss the possible pathophysiological mechanisms of TCM and the role of various non-invasive imaging modalities in TCM with a focus on the potential role of (123)I-meta-iodobenzylguanidine (MIBG) scintigraphy. Currently, the dominating hypothesis on the pathophysiology of TCM postulates that high levels of the neurotransmitter epinephrine may trigger a change in intracellular signaling in ventricular myocytes. More specific, epinephrine stimulates G-protein coupled β2 adenoreceptors (β2AR) which are located on ventricular myocytes. Normal levels of this neurotransmitter predominantly stimulate the intracellular G-protein, and induce a positive inotropic effect. However, with significant increasing levels of epinephrine, the predominance of stimulation is shifted from G-stimulating to the G-inhibitor protein coupling, which leads to a negative inotropic effect. Interestingly, this negative inotropic effect is the largest in the apical myocardium where the β2AR:β1AR ratio is the highest within the heart. Echocardiography and ventriculography are essential to diagnose TCM, but new imaging tools are promising to diagnose TCM and to evaluate therapeutic efficacy. Cardiovascular magnetic resonance can be used to differentiate TCM from other myocardial diseases, such as myocarditis. (123)I-meta-iodobenzylguanidine ((123)I-MIBG) scintigraphy can be used to assess ventricular adrenergic activity and may guide optimization of individual (pharmacological) therapy. These new insights into the possible pathophysiological mechanisms and novel diagnostic imaging modalities can be used as starting point for the development of international guidelines of TCM which may increase the awareness, and optimize the treatment of TCM.
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Affiliation(s)
- Derk O Verschure
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, F2-Noord, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands,
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Nishida J, Kouzu H, Hashimoto A, Fujito T, Kawamukai M, Mochizuki A, Muranaka A, Kokubu N, Shimoshige S, Yuda S, Hase M, Tsuchihashi K, Miura T. "Ballooning" patterns in takotsubo cardiomyopathy reflect different clinical backgrounds and outcomes: a BOREAS-TCM study. Heart Vessels 2014; 30:789-97. [PMID: 25059855 DOI: 10.1007/s00380-014-0548-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/27/2014] [Indexed: 01/17/2023]
Abstract
Whether different patterns of ventricular ballooning in takotsubo cardiomyopathy (TCM) reflect differences in trigger mechanisms or clinical outcomes is unclear. Here we examined differences in the clinical characteristics of typical and atypical forms of TCM. TCM patients (n = 251) in the BOREAS Registry were enrolled for comparison of TCM with apical ballooning (type A, n = 217) and TCM with non-apical ballooning (type non-A, n = 34). The percentage of females was significantly lower in the type non-A group (58.8 vs. 75.6 %), while other demographic parameters and triggers of TCM were similar in the two groups. Rate of mid-ventricular obstruction (MVO) was lower (2.9 vs. 14.3 %) in the type non-A group than in the type A group, though left ventricular ejection fractions in the two groups were comparable. During a follow-up period of 2.6 ± 2.8 years, TCM recurred in 2.9 % of the patients and cardiac death occurred in 4.0 %. Cox proportional hazard analysis indicated that body mass index (hazard ratio [HR]: 0.75, 95 % confidence interval [CI] 0.54-0.99) and MVO (HR: 14.71, CI 1.87-304.66) were determinants of TCM recurrence and that advanced age (HR: 1.09, CI 1.02-1.17) and cardiogenic shock (HR: 4.27, CI 1.07-18.93) were significantly associated with cardiac death. In conclusion, approximately 20 % of TCM patients show non-apical left ventricular ballooning, and female sex and MVO are less frequent in this type than in apical ballooning type TCM. Low body mass index and MVO are risk factors of recurrence, and advanced age and cardiogenic shock are risk factors of cardiac death in TCM.
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Affiliation(s)
- Junichi Nishida
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Mina Kawamukai
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Atsushi Mochizuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Shinya Shimoshige
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Satoshi Yuda
- Department of Clinical Laboratory Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Mamoru Hase
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Kazufumi Tsuchihashi
- Division of Health Care Administration and Management, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
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222
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Postpartum coronary vasospasm with literature review. Case Rep Cardiol 2014; 2014:523023. [PMID: 25105029 PMCID: PMC4109216 DOI: 10.1155/2014/523023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/12/2014] [Accepted: 06/14/2014] [Indexed: 11/18/2022] Open
Abstract
Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm. To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin.
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223
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Chou AY, Saw J. Basis for Sex-Specific Expression of Takotsubo Cardiomyopathy, Cardiac Syndrome X, and Spontaneous Coronary Artery Dissection. Can J Cardiol 2014; 30:738-46. [DOI: 10.1016/j.cjca.2013.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 12/01/2013] [Accepted: 12/05/2013] [Indexed: 12/20/2022] Open
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224
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Singh K, Carson K, Usmani Z, Sawhney G, Shah R, Horowitz J. Systematic review and meta-analysis of incidence and correlates of recurrence of takotsubo cardiomyopathy. Int J Cardiol 2014; 174:696-701. [DOI: 10.1016/j.ijcard.2014.04.221] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/17/2014] [Accepted: 04/19/2014] [Indexed: 12/17/2022]
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225
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Prunet B, Basely M, D'Aranda E, Cambefort P, Pons F, Cimarelli S, Dagain A, Desse N, Veyrieres JB, Jego C, Lacroix G, Esnault P, Boret H, Goutorbe P, Bussy E, Habib G, Meaudre E. Impairment of cardiac metabolism and sympathetic innervation after aneurysmal subarachnoid hemorrhage: a nuclear medicine imaging study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R131. [PMID: 24964817 PMCID: PMC4230019 DOI: 10.1186/cc13943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/13/2014] [Indexed: 12/11/2022]
Abstract
Introduction Although aneurysmal subarachnoid hemorrhage (SAH) is often complicated by myocardial injury, whether this neurogenic cardiomyopathy is associated with the modification of cardiac metabolism is unknown. This study sought to explore, by positron emission tomography/computed tomography, the presence of altered cardiac glucose metabolism after SAH. Methods During a 16-month period, 30 SAH acute phase patients underwent myocardial 18 F- fluorodesoxyglucose positron emission tomography (18F-FDGPET), 99mTc-tetrofosmin and 123I-meta-iodobenzylguanidine (123I-mIBG) scintigraphy, respectively, assessing glucose metabolism, cardiac perfusion, and sympathetic innervation. Patients with initial abnormalities were followed monthly for two months for 18F-FDG, and six months later for 123I-mIBG. Results In this SAH population, acute cardiac metabolic disturbance was observed in 83% of patients (n = 25), and sympathetic innervation disturbance affected 90% (n = 27). Myocardial perfusion was normal for all patients. The topography and extent of metabolic defects and innervation abnormalities largely overlapped. Follow-up showed rapid improvement of glucose metabolism in one or two months. Normalization of sympathetic innervation was slower; only 27% of patients (n = 8) exhibited normal 123I-mIBG scintigraphy after six months. Presence of initial altered cardiac metabolism was not associated with more unfavorable cardiac or neurological outcomes. Conclusions These findings support the hypothesis of neurogenic myocardial stunning after SAH. In hemodynamically stable acute phase SAH patients, cardiomyopathy is characterized by diffuse and heterogeneous 18F-FDG and 123I-mIBG uptake defect. Trial registration Clinicaltrials.gov NCT01218191. Registered 6 October 2010.
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226
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Weihs V, Szücs D, Fellner B, Eber B, Weihs W, Lambert T, Metzler B, Titscher G, Hochmayer B, Dechant C, Eder V, Siostrzonek P, Leisch F, Pichler M, Pachinger O, Gaul G, Weber H, Podczeck-Schweighofer A, Nesser HJ, Huber K. Stress-induced cardiomyopathy (Tako-Tsubo syndrome) in Austria. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 2:137-46. [PMID: 24222823 DOI: 10.1177/2048872613483592] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/02/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tako-Tsubo syndrome (TS) is a still rarely diagnosed clinical syndrome, which is characterized by acute onset of chest pain, transient cardiac dysfunction with (frequently) reversible wall motion abnormalities (WMAs), but with no relevant obstructive coronary artery disease. METHODS AND RESULTS Among 179 consecutive patients with proven diagnosis of TS that were retrospectively analysed in this multicentre registry, women represented the majority of patients (94%) while only 11 men (6%) developed TS. Mean age was 69.1±11.5 years (range 35-88 years). Cardinal symptoms of TS, which led to admission, were acute chest pain (82%) and dyspnoea (32%), respectively. All patients demonstrated typical WMAs, whereby four different types of WMAs could be defined: (1) a more common apical type of TS (n=89; 50%); (2) a combined apical and midventricular form of TS (n=23; 13%); (3) the midventricular TS (n=6; 3%); and (4) an unusual type of basal WMAs of the left ventricle (n=3). Only in 101 patients (57%), a clear causative trigger for onset of symptoms could be identified. In-hospital cardiovascular complications occurred in 25 patients (14%) and consisted of cardiac arrhythmias in 10 patients (40%), cardiogenic shock in six patients (24%), cardiac decompensation in eight patients (32%) and cardiovascular death in one patient, respectively. Echocardiographic control of left ventricular function after the initial measurement was available in almost 70% of the patients: complete recovery of WMAs was found in 73 patients (58.87%); 49 patients (39.52%) showed persistent WMAs. Recurrences of TS were only seen in four patients. During the follow-up period, 13 patients died: three of cardiovascular causes and 10 of non-cardiac causes. In-hospital mortality was 0.6%, 30-day mortality was 1.3% and 2-year mortality was 6.7%. CONCLUSIONS This study represents to date the largest series of patients suffering from TS in Austria and worldwide. Similar to others, in our series the prevalence of TS was significantly higher in women than in men, while in contrast to other studies, the apical type of TS was detected most frequently. The similar clinical presentation of TS patients to the clinical picture of acute myocardial infarction demonstrates the importance of immediate coronary angiography for adequate differential diagnosis of TS. TS is not necessarily a benign disease due to cardiovascular complications as well as persistent WMAs with delayed recovery.
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227
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Cardiac ⁹⁹mTc sestamibi SPECT and ¹⁸F FDG PET as viability markers in Takotsubo cardiomyopathy. Int J Cardiovasc Imaging 2014; 30:1407-16. [PMID: 24852336 DOI: 10.1007/s10554-014-0453-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/15/2014] [Indexed: 01/19/2023]
Abstract
In patients with heart failure (HF) due to coronary disease, a combined evaluation of perfusion and glucose metabolism by cardiac single photon emission computed tomography (SPECT)/positron emission tomography (PET) can be used to distinguish viable from non-viable myocardium, and current guidelines recommend cardiac SPECT and fluorodeoxyglucose (FDG) PET for viability assessment. Takotsubo cardiomyopathy (TTC) is a disease characterized by acute but reversible HF leaving no scarring. To explore how robust the semi-quantitative viability criteria used in cardiac SPECT and FDG PET stands their ground in a population with TTC. From 1 September 2009 to 1 October 2012, 24 patients suspected of TTC were enrolled in a multimodality cardiac imaging research project. Echocardiography, (99m)Tc SPECT, and (18)F FDG PET were performed during the acute admission and at follow-up 4 months later. Nineteen patients had a final diagnosis of TTC consistent with Mayo Clinic Diagnostic Criteria. Three of these patients were excluded from further analysis, since wall motion abnormalities were not persistent at the time of nuclear imaging. The remaining sixteen patients exhibited a distinct pattern with HF, "apical ballooning" and a perfusion-metabolism defect in the midventricular/apical region. When viability criteria were applied, they identified significant scarring/limited hibernation in the akinetic part of the left ventricle. However, full recovery was found in all TTC patients on follow-up. Using the current guideline-endorsed viability criteria for semiquantitative cardiac SPECT and FDG PET, these modalities failed to demonstrate the presence of viability in the acute state of TTC.
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228
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Patel B, Assad D, Wiemann C, Zughaib M. Repeated use of albuterol inhaler as a potential cause of Takotsubo cardiomyopathy. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:221-5. [PMID: 24855502 PMCID: PMC4029766 DOI: 10.12659/ajcr.890388] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/12/2014] [Indexed: 01/01/2023]
Abstract
Patient: Female, 78 Final Diagnosis: Takotsubo cardiomyopathy Symptoms: Chest discomfort, chest pain, dyspnea, short of breath Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Brijesh Patel
- Department of Internal Medicine, Providence Hospital and Medical Center, Southfield, MI, U.S.A
| | - Dania Assad
- Department of Internal Medicine, Providence Hospital and Medical Center, Southfield, MI, U.S.A
| | - Charlotte Wiemann
- Department of Internal Medicine, Providence Hospital and Medical Center, Southfield, MI, U.S.A
| | - Marcel Zughaib
- Department of Cardiology, Providence Hospital and Medical Center, Southfield, MI, U.S.A
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229
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de Boer HD, Booij LHDJ. Takotsubo cardiomyopathy and anaesthesia: case report and review of the literature. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2014; 61:284-289. [PMID: 23796841 DOI: 10.1016/j.redar.2013.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 06/02/2023]
Abstract
Takotsubo cardiomyopathy is an acute syndrome characterized by cardiac failure from disturbances in the contractility of the left ventricle. It is presumably caused by sympathetic over stimulation. We describe a case of postoperatively developed Takotsubo cardiomyopathy in a 69-year-old female. The syndrome developed in connection with awareness during complete residual paralysis. The literature on this syndrome is reviewed and implications for anaesthesia described.
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Affiliation(s)
- H D de Boer
- Department of Anaesthesiology and Pain Medicine, Martini Hospital, Groningen, The Netherlands.
| | - L H D J Booij
- Department of Anaesthesiology, Pain Medicine and Palliative Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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230
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Singh K, Carson K, Shah R, Sawhney G, Singh B, Parsaik A, Gilutz H, Usmani Z, Horowitz J. Meta-analysis of clinical correlates of acute mortality in takotsubo cardiomyopathy. Am J Cardiol 2014; 113:1420-8. [PMID: 24685327 DOI: 10.1016/j.amjcard.2014.01.419] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 12/27/2022]
Abstract
The incidence and clinical correlates of acute in-hospital mortality of takotsubo cardiomyopathy (TTC) are not clear. We performed a systematic review and meta-analysis to consolidate the current evidence on acute mortality in TTC. We then assessed the impact of "secondary" TTC, male gender, advancing age, and catecholamine use on mortality. A comprehensive search of 4 major databases (EMBASE, Ovid MEDLINE, PubMed, and Google Scholar) was performed from their inception to the first week of July 2013. We included original research studies, recruiting ≥10 participants, published in English language, and those that reported data on mortality and cause of death in patients with TTC. Of 382 citations, 37 studies (2,120 patients with TTC) from 11 different countries were included in the analyses. The mean age of the cohort was 68 years (95% confidence interval [CI] 67 to 69) with female predominance (87%). The in-hospital mortality rate among patients with TTC was 4.5% (95% CI 3.1 to 6.2, I2=60.8%). Among all deaths, 38% were directly related to TTC complications and rest to underlying noncardiac conditions. Male gender was associated with higher TTC mortality rate (odds ratio 2.6, 95% CI 1.5 to 4.6, p=0.0008, I2=0%) so was "secondary" TTC (risk difference -0.11, 95% CI -0.18 to -0.04, p=0.003, I2=84%). The mean age of patients dying tended to be greater than that in the whole cohort (72±7 vs 65±7 years). In conclusion, TTC is not as benign as once thought. To reduce the mortality rate, greater efforts need to be directed to the diagnosis, treatment, and ultimately prevention of "secondary" TTC.
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Affiliation(s)
- Kuljit Singh
- Department of Cardiology, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
| | - Kristin Carson
- Department of Respiratory Medicine, University of Adelaide, Queen Elizabeth Hospital, Basil Hetzel Institute, Woodville, South Australia, Australia
| | - Ranjit Shah
- Department of Cardiology, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | | | - Balwinder Singh
- Department of Clinical Neurosciences, University of North Dakota School of Medicine & Health Sciences, Fargo, North Dakota
| | - Ajay Parsaik
- Department of Cardiology, Soroka Medical Centre, Ben Gurion University of the Negev, Beersheba, Israel
| | - Harel Gilutz
- Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Texas
| | - Zafar Usmani
- Department of Respiratory Medicine, University of Adelaide, Queen Elizabeth Hospital, Basil Hetzel Institute, Woodville, South Australia, Australia
| | - John Horowitz
- Department of Cardiology, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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231
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Dias A, Franco E, Figueredo VM, Hebert K, Quevedo HC. Occurrence of Takotsubo cardiomyopathy and use of antidepressants. Int J Cardiol 2014; 174:433-6. [PMID: 24768456 DOI: 10.1016/j.ijcard.2014.04.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/02/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Andre Dias
- Danbury Hospital, Internal Medicine Department, Danbury, Connecticut; Einstein Medical Center, Department of Cardiology, and Jefferson Medical College, Philadelphia, PA, USA.
| | - Emiliana Franco
- Danbury Hospital, Internal Medicine Department, Danbury, Connecticut
| | - Vincent M Figueredo
- Einstein Medical Center, Department of Cardiology, and Jefferson Medical College, Philadelphia, PA, USA
| | - Kathy Hebert
- University of Miami, Department of Cardiology, Miami, FL, USA
| | - Henry C Quevedo
- Tulane University, Department of Cardiology, New Orleans, LA, USA
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232
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Andò G, Boretti I, Tripodi R. Stress cardiomyopathies beyond Takotsubo: does a common catecholaminergic pathophysiology fit all? Expert Rev Cardiovasc Ther 2014; 12:643-5. [PMID: 24716866 DOI: 10.1586/14779072.2014.903156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diagnostic criteria for Takotsubo cardiomyopathy (TTC) still remains a matter of debate. The similarities between cardiac dysfunction which complicates cerebrovascular events and 'typical' TTC let us hypothesize that the current diagnostic criteria of TTC need to be widened. Moreover, clinical, histological and scintigraphic similarities have been robustly reported between TTC and other Takotsubo-like syndromes, and we agree that central to this unifying hypothesis is a catecholamine surge which triggers the abnormality in left ventricular contraction. Given these overlapping features, we propose that the terms 'acute ballooning cardiomyopathy' or 'catecholamine-induced stress cardiomyopathy' could be used to refer to these conditions in the future.
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Affiliation(s)
- Giuseppe Andò
- Department of Clinical and Experimental Medicine, Cardiology Section, Policlinico "G. Martino", University of Messina, Messina, Italy
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233
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McKernan NP, Rondeau BJ, McAllister RK. Stress-induced (takotsubo) cardiomyopathy following thoracic epidural steroid injection for postherpetic neuralgia. Proc (Bayl Univ Med Cent) 2014; 27:120-1. [PMID: 24688194 DOI: 10.1080/08998280.2014.11929079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We present what may be the first documented case of takotsubo cardiomyopathy following a thoracic epidural steroid injection. The 77-year-old patient had many risk factors predisposing her to takotsubo cardiomyopathy, including gender, postmenopausal status, and numerous recent stressful events in her life. Although she presented to the emergency department with symptoms of an acute myocardial infarction, her findings on electrocardiography, echocardiography, coronary angiography, and cardiac enzymes supported the diagnosis of takotsubo cardiomyopathy. While takotsubo cardiomyopathy is rare, it is important for the clinician to distinguish it from an acute myocardial infarction, as the two conditions present similarly but may have distinctly different clinical outcomes.
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Affiliation(s)
- Nicholas P McKernan
- Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Bryan J Rondeau
- Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Russell K McAllister
- Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine, Temple, Texas
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Veillet-Chowdhury M, Hassan SF, Stergiopoulos K. Takotsubo cardiomyopathy: A review. ACTA ACUST UNITED AC 2014; 16:15-22. [DOI: 10.3109/17482941.2013.869346] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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235
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Sundbøll J, Pareek M, Høgsbro M, Madsen EH. Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine. BMJ Case Rep 2014; 2014:bcr-2013-202401. [PMID: 24554679 DOI: 10.1136/bcr-2013-202401] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A 67-year-old man underwent surgery under general anaesthesia to obtain a biopsy from a tumour in the left maxillary sinus. Before the procedure a mucosal detumescence containing epinephrine and cocaine was applied onto the nasal mucosa. Shortly after termination of anaesthesia the patient developed tachycardia and an abrupt rise in blood pressure followed by a drop to critical levels. The patient turned pale and clammy but denied chest pain at any time. An ECG showed inferolateral ST-segment elevation, and troponin T was elevated at 0.773 ng/mL. An acute coronary angiography demonstrated normal coronary arteries; however, left ventriculography showed apical ballooning of the left ventricle, and the diagnosis of takotsubo cardiomyopathy was made. This was confirmed by a subsequent transthoracic echocardiography. Four days later the patient had complete resolution of the symptoms, and a new echocardiography showed normalisation of the left ventricular systolic function with no signs of apical ballooning.
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Affiliation(s)
- Jens Sundbøll
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark
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236
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Takotsubo Cardiomyopathy in Two Patients without Any Cardiac Symptom on Maintenance Hemodialysis. Case Rep Nephrol 2014; 2013:640976. [PMID: 24527248 PMCID: PMC3914169 DOI: 10.1155/2013/640976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022] Open
Abstract
Takotsubo cardiomyopathy is a disorder characterized by left ventricular apical ballooning and electrocardiographic changes in the absence of coronary artery disease. While reversible in many cases, the mechanism of this disorder remains unclear. The most frequent clinical symptoms of takotsubo cardiomyopathy on admission are chest pain and dyspnea, resembling acute myocardial infarction. Here, we describe two cases of takotsubo cardiomyopathy without chest pain or dyspnea in patients on maintenance hemodialysis. The asymptomatic nature of these two cases may be due to the patients being on hemodialysis. Periodic electrocardiograms (ECG) may be helpful in screening this population for asymptomatic takotsubo cardiomyopathy and in evaluating its incidence.
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237
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Martin CS, Ionescu LN, Barbu CG, Sirbu AE, Lambrescu IM, Lacau IS, Dimulescu DR, Fica SV. Takotsubo cardiomyopathy and transient thyrotoxicosis during combination therapy with interferon-alpha and ribavirin for chronic hepatitis C. BMC Endocr Disord 2014; 14:10. [PMID: 24491229 PMCID: PMC3913789 DOI: 10.1186/1472-6823-14-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/29/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Thyroid dysfunction is a common complication of chronic hepatitis C (CHC) and its therapy. Takotsubo cardiomyopathy (TCM) is a multifactorial, stress related cardiomyopathy, rarely reported in association with thyrotoxicosis. Simultaneous occurrence of TCM and thyrotoxicosis due to hepatitis C and its treatment has never been reported. CASE PRESENTATION A 47-year-old woman was admitted for acute chest pain, dyspnea, palpitations and diaphoresis. She had been diagnosed with CHC and had undergone 7 months of IFNα and Ribavirin therapy. At admission electrocardiogram (ECG) showed ST segment elevation, negative T waves and troponin was elevated suggesting ST segment elevation myocardial infarction (STEMI). Echocardiography demonstrated left ventricular apical akinesia and ballooning, with a left ventricular ejection fraction (LVEF) of 35%. Contrast angiography showed normal epicardial coronaries, yet a ventriculogram revealed left ventricular apical ballooning, consistent with TCM. Cardiac MRI showed left ventricle apical ballooning and no late enhancement suggesting the absence of any edema, scar or fibrosis in the left myocardium. She was diagnosed with non-autoimmune destructive thyroiditis: TSH=0.001 mU/L, free T4=2.41 ng/dl, total T3=199 ng/dl and negative thyroid antibodies. The thyroid ultrasonography showed a diffuse small goiter, no nodules and normal vascularization of the parenchyma. Following supportive treatment she experienced a complete recovery after a few weeks and she successfully completed her antiviral treatment, with no thyroid or cardiovascular dysfunction ever since. In patients treated with IFNα for CHC, the prevalence of thyroid dysfunction varies between 2.5-45.3% of cases. TCM is a stress related cardiomyopathy characterized by elevated cardiac enzymes, normal coronary angiography and an acute, transient, left ventricular apical dysfunction that mimics myocardial infarction. Most of the patients survive the initial acute event, typically recover normal ventricular function within one to four weeks and have a favorable outcome, as was the case with our patient. Thyrotoxicosis induced stress cardiomyopathy is rare and has been mostly reported in association with Graves' disease, thyroid storm, thyrotoxicosis factitia or following radioiodine therapy for toxic multinodular goiter. CONCLUSION Routine thyroid screening should be done in patients receiving IFN-alpha and Ribavirin for CHC and thyrotoxicosis should be considered as a possible and treatable underlying cause of TCM.
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Affiliation(s)
- Carmen Sorina Martin
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Elias University Hospital, 17 Marasti Blvd, sector 1, 011461 Bucharest, Romania
| | | | - Carmen Gabriela Barbu
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Elias University Hospital, 17 Marasti Blvd, sector 1, 011461 Bucharest, Romania
| | - Anca Elena Sirbu
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Elias University Hospital, 17 Marasti Blvd, sector 1, 011461 Bucharest, Romania
| | - Ioana Maria Lambrescu
- Endocrinology Department, Elias University Hospital, 17 Marasti Blvd, sector 1, Bucharest, Romania
| | | | - Doina Ruxandra Dimulescu
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, Elias University Hospital, 17 Marasti Blvd, sector 1, Bucharest, Romania
| | - Simona Vasilica Fica
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy, Elias University Hospital, 17 Marasti Blvd, sector 1, 011461 Bucharest, Romania
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238
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Baydoun H, Khoueiry G, Ghandour Z, Olkovsky Y. From right to left heart failure: an unexpected transition. Heart Lung 2014; 43:41-4. [PMID: 24373339 DOI: 10.1016/j.hrtlng.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 11/17/2022]
Abstract
Right and left heart failure are very common clinical syndromes with close correlation. Right-sided or right ventricular heart failure usually occurs as a result of left-sided failure. We report a very rare case of transition from right heart failure due to pulmonary embolism, followed by its resolution, to left heart failure due to Tako-tsubo syndrome within 48 h of hospitalization.
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Affiliation(s)
- Hassan Baydoun
- Department of Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
| | - George Khoueiry
- Department of Cardiology, Dartmouth Hitchcock Medical Center, NH, USA
| | - Zahraa Ghandour
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Yefim Olkovsky
- Department of Cardiology, Staten Island University Hospital, NY, USA
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239
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Takotsubo’s Cardiomyopathy in a Patient with Kartagener’s Syndrome. Case Rep Med 2014; 2014:690151. [PMID: 25386196 PMCID: PMC4214047 DOI: 10.1155/2014/690151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/06/2014] [Accepted: 09/20/2014] [Indexed: 11/28/2022] Open
Abstract
A 46-year-old African-American male with past medical history significant for Kartagener's syndrome, essential hypertension, and HIV presented with acute chest pain. ECG and troponins indicated an acute myocardial infarction. Ventriculography confirmed dyskinesia of the left ventricle, with an EF of 25%. However the coronary catheterization showed nonobstructed coronaries. Ventricular contraction and EF were restored in 4 weeks. To our knowledge, this is the first incidence of Takotsubo's reported in a young patient with Kartagener's syndrome. Chronic lung disease may contribute to the development of Takotsubo's cardiomyopathy, which is a documented yet not fully understood phenomenon.
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240
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Takotsubo cardiomyopathy: The challenging diagnosis in clinical routine. Medicina (B Aires) 2014; 50:1-7. [DOI: 10.1016/j.medici.2014.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/24/2013] [Indexed: 01/14/2023] Open
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241
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Kawai S, Shimada T. Inflammation in takotsubo cardiomyopathy? Inquiry from "Guidelines for Diagnosis and Treatment of Myocarditis (JCS 2009)". J Cardiol 2013; 63:247-9. [PMID: 24373943 DOI: 10.1016/j.jjcc.2013.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/01/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Sachio Kawai
- Department of Cardiology, Juntendo University, Tokyo, Japan.
| | - Toshio Shimada
- Clinical Research Center, Shizuoka General Hospital, Shizuoka, Japan
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242
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Wybraniec M, Mizia-Stec K, Krzych L. Stress cardiomyopathy: yet another type of neurocardiogenic injury: 'stress cardiomyopathy'. Cardiovasc Pathol 2013; 23:113-20. [PMID: 24462197 DOI: 10.1016/j.carpath.2013.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/16/2013] [Accepted: 12/20/2013] [Indexed: 01/29/2023] Open
Abstract
Tako-tsubo syndrome pertains to rare acquired cardiomyopathies, characterized by left ventricular dyskinesia and symptomatology typical for acute myocardial infarction (AMI). Despite its low incidence and relatively benign course, stress cardiomyopathy should be thoroughly differentiated from AMI. The importance of tako-tsubo consists of the fact that its manifestation initially resembles AMI. Despite seemingly low incidence of tako-tsubo, acute coronary syndromes globally constitute a major epidemiological issue and both clinical entities should be accurately differentiated. Many patients present with only mild troponin release, certain extent of regional wall motion abnormalities (RWMA) and absence of hemodynamically significant coronary artery stenosis. In such instances, a careful interview aimed at preceding emotional or physical traumatic event should be undertaken. The subsequent verification of the diagnosis is based upon prompt recovery of contractile function. Although precise diagnostic criteria were formulated, symptomatology of tako-tsubo might be clinically misleading due to the possibility of concomitant coronary vasospasm, atypical pattern of RWMA and presence of non-significant coronary disease. For this reason, its exact rate might be underestimated. Stress cardiomyopathy reflects merely a single aspect of a much wider range of neurocardiogenic injury, which encompasses cardiac dysfunction associated with subarachnoid hemorrhage, intracranial hypertension and cerebral ischemia. Both psychological and physical insult to central nervous system may trigger a disastrous response of sympathetic nervous system, eventually leading to end-organ catecholamine-mediated damage. This review sought to delineate the phenomenon of tako-tsubo cardiomyopathy and deliver evidence for common pathophysiology of the broad spectrum of neurocardiogenic injury.
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Affiliation(s)
- Maciej Wybraniec
- First Department of Cardiology, Medical University of Silesia, Upper Silesian Medical Centre in Katowice, Poland.
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, Medical University of Silesia, Upper Silesian Medical Centre in Katowice, Poland
| | - Lukasz Krzych
- Department of Cardiac Surgery, Medical University of Silesia, Upper Silesian Medical Centre in Katowice, Poland
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243
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Pericarditis in takotsubo cardiomyopathy: a case report and review of the literature. Case Rep Cardiol 2013; 2013:917851. [PMID: 24826300 PMCID: PMC4008403 DOI: 10.1155/2013/917851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/26/2013] [Indexed: 11/17/2022] Open
Abstract
Case. A 64-year-old Caucasian woman was brought to the emergency department with severe dysphagia and left chest pain for last 4 days. Initial evaluation revealed elevated ST segment in precordial leads on EKG with elevated cardiac enzymes. Limited echocardiogram showed infra-apical wall hypokinesia. Cardiac angiography was done subsequently which showed nonflow limiting mild coronary artery disease. Takotsubo cardiomyopathy was diagnosed and she was treated medically. On the third day of admission, a repeat ECG showed diffuse convex ST-segment elevations in precordial leads, compatible with acute pericarditis pattern of EKG. Decision was made to start colchicine empirically for possible pericarditis. Follow-up EKG in 2 days showed decreased ST-segment elevations in precordial leads. The patient was discharged with colchicine and a follow-up echocardiogram in 4 weeks demonstrated a normal ejection fraction with no evidence of pericarditis. Conclusion. Acute pericarditis can be associated either as a consequence of or as a triggering factor for Takotsubo cardiomyopathy. It is vital for physicians to be aware of pericarditis as a potential complication of Takotsubo cardiomyopathy.
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244
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Reynolds HR. Mechanisms of myocardial infarction without obstructive coronary artery disease. Trends Cardiovasc Med 2013; 24:170-6. [PMID: 24444810 DOI: 10.1016/j.tcm.2013.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 11/26/2022]
Abstract
Angiography in patients with myocardial infarction (MI) most commonly reveals one or more significantly narrowed coronary arteries, but a substantial minority of patients with spontaneous MI have no obstructive coronary artery disease (CAD) at angiography. This review summarizes evidence for the most commonly hypothesized mechanisms, including plaque disruption, plaque erosion, vasospasm, embolism, and spontaneous coronary dissection. In addition, tako-tsubo syndrome and myocarditis are discussed. The best treatment of MI without obstructive CAD is likely to differ substantially based on the underlying cause. Additional mechanistic research is needed to facilitate the design of research studies aimed at documenting the best treatments for these patients, numbering as many as 225,000 per year in the US.
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Affiliation(s)
- Harmony R Reynolds
- Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Medical Center, 530 First Ave, Skirball 9R, New York, NY 10016, USA.
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245
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Szardien S, Möllmann H, Willmer M, Akashi YJ, Hamm CW, Nef HM. Mechanisms of stress (takotsubo) cardiomyopathy. Heart Fail Clin 2013; 9:197-205, ix. [PMID: 23562120 DOI: 10.1016/j.hfc.2012.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Stress cardiomyopathy is a form of reversible systolic dysfunction of the mid and apical left ventricle with pathologic changes of the electrocardiogram in the absence of an obstructive coronary artery disease. The prevalence of stress cardiomyopathy among patients with symptoms suggestive of myocardial infarction is 0.7% to 2.5%, and it is found predominantly in postmenopausal women (90%). No large studies have confirmed the cause of stress cardiomyopathy. Published data suggest that substantially elevated plasma catecholamine levels, due to emotional or physical stress, may be relevant.
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Affiliation(s)
- Sebastian Szardien
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, Bad Nauheim 61231, Germany.
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246
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Bossone E, Savarese G, Ferrara F, Citro R, Mosca S, Musella F, Limongelli G, Manfredini R, Cittadini A, Perrone Filardi P. Takotsubo cardiomyopathy: overview. Heart Fail Clin 2013; 9:249-66, x. [PMID: 23562126 DOI: 10.1016/j.hfc.2012.12.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Takotsubo cardiomyopathy (TTC) is a unique acute syndrome characterized by transient left ventricular systolic dysfunction in the absence of significant coronary artery disease, occurring mostly in postmenopausal women after emotional and/or physical stress. Given the nonspecific symptoms and signs, a high clinical index of suspicion is necessary to detect the disease in different clinical settings and scenarios. Noninvasive multimodality imaging may be useful to distinguish this cardiomyopathy from other acute cardiac and thoracic diseases. Coronary angiography remains, however, mandatory to differentiate TTC from acute coronary syndromes. This article reviews the clinical features and management of TTC and some new insights.
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Affiliation(s)
- Eduardo Bossone
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, 20097 San Donato Milanese, Italy
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247
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Mukherjee A, Sünkel-Laing B, Dewhurst N. 'Broken Heart' syndrome in Scotland: a case of Takotsubo cardiomyopathy in a recently widowed lady. Scott Med J 2013; 58:e15-9. [PMID: 23596033 DOI: 10.1177/0036933012474605] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Takotsubo cardiomyopathy (TCM), first described in Japan in the early 1990s, is a reversible non-ischaemic cardiomyopathy of unclear aetiology characterised by transient left ventricular dysfunction. It mimics acute myocardial infarction with ST segment changes (STEMI), although evidence of occlusive coronary artery disease is absent. TCM is typically triggered by an intense physical or emotional stress event. We report a case of TCM diagnosed in a recently widowed lady in whom a myocardial infarction was initially suspected. This case illustrates the importance of an awareness of this unique clinical entity. Without appreciation of differentiating features, TCM can easily be misdiagnosed as an acute coronary syndrome. Misdiagnosis and the subsequent inappropriate and potentially harmful use of fibrinolytic therapy can be avoided through careful history-taking, clinical examination and appropriate investigations. Although well reported in the medical literature, this case of TCM provides the basis of a timely summary and update on current understanding of this perplexing condition.
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248
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Stress-related cardiomyopathy, ventricular dysfunction, artery thrombosis: a hidden pheochromocytoma. Am J Emerg Med 2013; 32:286.e5-9. [PMID: 24210888 DOI: 10.1016/j.ajem.2013.09.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 09/25/2013] [Indexed: 11/22/2022] Open
Abstract
Clinical presentation of pheochromocytoma can vary, and it can sometimes mimic other diseases. Some patients with pheochromocytoma may have atypical presentations, such as clinical features consistent with an acute coronary syndrome, that only later suggest a classical picture of stress-related cardiomyopathy. To our best knowledge, pheochromocytoma has been incidentally revealed in a few cases of catecholamine-induced cardiomyopathy and in only 1 case of peripheral arterial thrombosis. This is the first case of pheochromocytoma revealed after left ventricular dysfunction caused by stress-related cardiomyopathy associated with inferior limb artery thrombosis in a patient with a complex cardiovascular history.
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249
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Transient left ventricular and stomach apical ballooning syndromes: when the trigger is also a clinical emergency. Am J Emerg Med 2013; 32:108.e1-3. [PMID: 24079990 DOI: 10.1016/j.ajem.2013.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/09/2013] [Indexed: 11/23/2022] Open
Abstract
A 59-year-old woman was referred to our emergency department because of epigastric pain and incoercible vomit. Electrocardiogram showed ST-segment elevation in anterior-lateral leads, but coronary angiogram revealed normal coronary tree and left ventricular angiography showed apical and midventricular akinesis with preserved basal systolic function: a diagnosis of apical ballooning syndrome was made. During the following days, the patient complained about persistent abdominal pain, and a nasogastric tube drained more than 1000 cc of dark fecaloid material. Urgent abdominal computed tomography scan showed a mural thrombus in the apex of the left ventricle and a huge diaphragmatic hernia through which more than one-half of the stomach was herniated and presented a sort of “apical stomach ballooning.” Gastropexy was done; surgical diagnosis was a type IV giant diaphragmatic hernia complicated by recent gastric volvulus caused by rotation along the longitudinal cardiopyloric axis. Type IV giant diaphragmatic hernia is relatively rare, representing only about 5% to 7% of all hernias. Gastric volvulus is a severe complication, with acute mortality reported to be as high as 30% to 50%. In our case, a severe life-threatening condition as gastric volvulus triggered an apical ballooning syndrome, a transient cardiomyopathy, usually induced by emotional stressors with a long-term good prognosis. Apical ballooning syndrome must be considered an epiphenomenon of other organic diseases that may have an important role in the prognosis of the patient not only in acute but also in chronic setting. Only early determination of the true cause of apical ballooning syndrome ensures a proper treatment.
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250
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De Caterina AR, Leone AM, Galiuto L, Basile E, Fedele E, Paraggio L, De Maria GL, Porto I, Niccoli G, Burzotta F, Trani C, Rebuzzi AG, Crea F. Angiographic assessment of myocardial perfusion in Tako-Tsubo syndrome. Int J Cardiol 2013; 168:4717-22. [DOI: 10.1016/j.ijcard.2013.07.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 06/18/2013] [Accepted: 07/20/2013] [Indexed: 11/27/2022]
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