1
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Arunkumar S, Jegaverrapandi K. Pharmacological Triggers of Takotsubo Cardiomyopathy: An Updated Review of Evidence and Recommendations. Curr Cardiol Rev 2024; 20:50-60. [PMID: 38367261 PMCID: PMC11107468 DOI: 10.2174/011573403x273613240125072754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/01/2023] [Accepted: 01/04/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Previous publications in 2011, 2016, and 2022 have presented lists of drugs associated with takotsubo cardiomyopathy (TCM). This review aims to provide updated drug lists that have been reported as potential causes of TCM. METHODS Following the same methodology employed in previous reviews, a detailed investigation was carried out in the PubMed/Medline database from June 2022 to July 2023 to identify drug-induced TCM (DITC) case reports. Various search terms related to the drug-induced transient left ventricular ballooning syndrome, ampulla cardiomyopathy, apical ballooning syndrome, drug-induced broken heart syndrome, drug triggered takotsubo cardiomyopathy, takotsubo cardiomyopathy, and iatrogenic takotsubo cardiomyopathy were utilized. Filters for fulltext availability, case reports, human studies, and English language were applied. Articles reporting drugs associated with TCM development were included in the analysis. RESULTS Foremost 192 case reports were initially identified, with 75 drugs meeting the inclusion criteria after a thorough review. The latest revision identified seven drugs that might lead to TCM, with four drugs (57.14%) already reported in previous reviews and three drugs (42.86%) newly identified. Consequently, the updated drug list potentially triggering TCM in 2023 comprises a sum of 75 drugs. CONCLUSION The recent 75 drugs provided additional evidence linking to TCM development. The updated list predominantly includes drugs that induce sympathetic overstimulation, although some drugs on the list have unclear associations with sympathetic nervous system activation.
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Affiliation(s)
- S. Arunkumar
- J.K.K.Nattraja College of Pharmacy, Kumarapalayam, Namakkal district, Tamilnadu, India
| | - K. Jegaverrapandi
- Department of Pharmacy Practice, J.K.K.Nattraja College of Pharmacy, Kumarapalayam, Namakkal district, Tamilnadu, India
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2
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Dong F, Yin L, Sisakian H, Hakobyan T, Jeong LS, Joshi H, Hoff E, Chandler S, Srivastava G, Jabir AR, Kimball K, Chen YR, Chen CL, Kang PT, Shabani P, Shockling L, Pucci T, Kegecik K, Kolz C, Jia Z, Chilian WM, Ohanyan V. Takotsubo syndrome is a coronary microvascular disease: experimental evidence. Eur Heart J 2023; 44:2244-2253. [PMID: 37170610 PMCID: PMC10290875 DOI: 10.1093/eurheartj/ehad274] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/08/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND AND AIMS Takotsubo syndrome (TTS) is a conundrum without consensus about the cause. In a murine model of coronary microvascular dysfunction (CMD), abnormalities in myocardial perfusion played a key role in the development of TTS. METHODS AND RESULTS Vascular Kv1.5 channels connect coronary blood flow to myocardial metabolism and their deletion mimics the phenotype of CMD. To determine if TTS is related to CMD, wild-type (WT), Kv1.5-/-, and TgKv1.5-/- (Kv1.5-/- with smooth muscle-specific expression Kv1.5 channels) mice were studied following transaortic constriction (TAC). Measurements of left ventricular (LV) fractional shortening (FS) in base and apex, and myocardial blood flow (MBF) were completed with standard and contrast echocardiography. Ribonucleic Acid deep sequencing was performed on LV apex and base from WT and Kv1.5-/- (control and TAC). Changes in gene expression were confirmed by real-time-polymerase chain reaction. MBF was increased with chromonar or by smooth muscle expression of Kv1.5 channels in the TgKv1.5-/-. TAC-induced systolic apical ballooning in Kv1.5-/-, shown as negative FS (P < 0.05 vs. base), which was not observed in WT, Kv1.5-/- with chromonar, or TgKv1.5-/-. Following TAC in Kv1.5-/-, MBF was lower in LV apex than in base. Increasing MBF with either chromonar or in TgKv1.5-/- normalized perfusion and function between LV apex and base (P = NS). Some genetic changes during TTS were reversed by chromonar, suggesting these were independent of TAC and more related to TTS. CONCLUSION Abnormalities in flow regulation between the LV apex and base cause TTS. When perfusion is normalized between the two regions, normal ventricular function is restored.
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Affiliation(s)
- Feng Dong
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Liya Yin
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Hamayak Sisakian
- Department of Cardiology, Yerevan State Medical University, Yerevan, Kentron, Armenia
| | - Tatevik Hakobyan
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Lacey S Jeong
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Hirva Joshi
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Ellianna Hoff
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Selena Chandler
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Geetika Srivastava
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Abdur Rahman Jabir
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Kelly Kimball
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Yeong-Renn Chen
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Chwen-Lih Chen
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Patrick T Kang
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Parisa Shabani
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Lindsay Shockling
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Thomas Pucci
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Karlina Kegecik
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Christopher Kolz
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Zhenyu Jia
- Department of Botany and Plant Sciences, University of California, Riverside, CA, USA
| | - William M Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
| | - Vahagn Ohanyan
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, Ohio 44272, USA
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3
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Ghallab M, Mohamed I, Haseeb ul Rasool M, Abdelmoteleb S, Foster A, Alagha Z, Sliem A, Ahammed MR, Noff NC, Miller D, Collura G. Reverse Takotsubo Cardiomyopathy in a Critically Ill Patient in the ICU: A Case Report With Literature Review. Cureus 2023; 15:e35752. [PMID: 37020491 PMCID: PMC10069287 DOI: 10.7759/cureus.35752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 03/06/2023] Open
Abstract
Takotsubo, or stress cardiomyopathy (SC), is described as a transient systolic dysfunction of the apical segments of the left ventricle mainly triggered by emotional or physical stress resembling the presentation of an acute coronary syndrome in the absence of obstructive coronary artery disease. Reverse Takotsubo SC is a rare variant of SC that presents with basal ballooning instead of apical ballooning seen in classic SC. We present a case of a 74-year-old male who was admitted to the ICU with septic shock. Laboratory test results showed elevated troponin. An echocardiogram showed reduced cardiac contractility and relative hypokinesis of the basal and mid segments compared to the apical segments, consistent with reverse Takotsubo SC, which recovered after 10 days. It can happen in critically ill patients in the ICU secondary to severe sepsis and could contribute to hemodynamic worsening, affecting the final clinical outcomes.
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4
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Pathangey G, Moudgal R, Lee C, Henkin S. Myocardial stunning secondary to erroneous administration of intravenous epinephrine. SAGE Open Med Case Rep 2023; 11:2050313X231159732. [PMID: 36950049 PMCID: PMC10026126 DOI: 10.1177/2050313x231159732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
Epinephrine is a commonly used medication for emergent conditions, such as anaphylaxis, respiratory distress, and shock. However, its versatility can also lead to iatrogenic errors in dosages, concentrations, and routes of administration. In this case, a 47-year-old female experiencing anaphylaxis received an intravenous dose of 0.3 mg (1:1000) epinephrine formulated for intramuscular injection, resulting in cardiac arrest and acute heart failure due to myocardial stunning, as diagnosed by echocardiography. Management included invasive ventilation and hemodynamic support until cardiac function recovered. This case highlights the potential dangers of epinephrine overdose, and to our knowledge, is the first reported case of iatrogenic epinephrine-induced Takotsubo cardiomyopathy in a rural area. In addition, we review the literature on iatrogenic epinephrine toxicity-associated cardiomyopathy and the epidemiology of epinephrine errors. Safety measures must be considered for improving communication in emergencies, increasing awareness via training, and changing epinephrine's antiquated packaging design.
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Affiliation(s)
- Girish Pathangey
- Department of Medicine,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Rohitha Moudgal
- Department of Medicine,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Christopher Lee
- Heart and Vascular Center,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Stanislav Henkin
- Heart and Vascular Center,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Stanislav Henkin, Heart and Vascular
Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH
03766, USA.
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5
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Lopera V, Pereañez JA, Amariles PJ. Drugs as Possible Triggers of Takotsubo Cardiomyopathy- Update 2022: Systematic Review. Curr Vasc Pharmacol 2023; 21:304-315. [PMID: 37198980 DOI: 10.2174/1570161121666230517121037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND A list of drugs that can induce takotsubo cardiomyopathy (TCM) was published in 2011 and 2016. The aim of the present review was to update this list. METHODS Similar to the 2011 and 2016 reviews, from April 2015 to May 2022 case reports of druginduced TCM were identified by a comprehensive search in Medline/PubMed database. The search terms were: takotsubo cardiomyopathy, tako-tsubo cardiomyopathy, stress cardiomyopathy, transientleft- ventricular ballooning syndrome, apical ballooning syndrome, ampulla cardiomyopathy OR broken heart syndrome; together with "iatrogenic", "induced by" OR "drug-induced". Registers published in English or Spanish, in humans, and with full texts were retrieved. Articles that recognized any drug associated with the development of TCM were selected. RESULTS Overall, 184 manuscripts were identified by the search. A total of 39 articles were included after an exhaustive revision. Eighteen drugs as possible triggers of TCM were identified in the current update. Of them, 3 (16.7%) have been previously identified, and 15 (83.3%) are different from the previous reports. Thus, the list of drugs as possible triggers of TCM updated in 2022 includes 72 drugs. CONCLUSION There are new case reports that link drugs with the development of TCM. The current list is principally made up of drugs that generate sympathetic overstimulation. However, some of the listed drugs do not have a clear link with sympathetic activation.
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Affiliation(s)
- Valentina Lopera
- Grupo de Investigación, Promoción y Prevención Farmacéutica, Departamento de Farmacia, Facultad de Ciencias Farmacéuticas y Alimentarias, Universidad de Antioquia, Medellín, Colombia
| | - Jaime Andrés Pereañez
- Toxinología, Alternativas Terapéuticas y Alimentarias, Departamento de Farmacia, Facultad de Ciencias Farmacéuticas y Alimentarias, Universidad de Antioquia, Medellín, Colombia
| | - Pedro Jose Amariles
- Grupo de Investigación, Promoción y Prevención Farmacéutica, Departamento de Farmacia, Facultad de Ciencias Farmacéuticas y Alimentarias, Universidad de Antioquia, Medellín, Colombia
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6
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Grigorov M, Spindel J, Katrapati P, Stoddard M, Varbanova M. Stress Cardiomyopathy: The Midventricular Variant. CASE (PHILADELPHIA, PA.) 2022; 6:406-410. [PMID: 36451868 PMCID: PMC9703095 DOI: 10.1016/j.case.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
• Midventricular TTC is a rare variant comprising 14.6% of stress cardiomyopathies. • TTC includes midventricular dyskinesis with normal basal and apical contractility. • Etiologies for all Takotsubo variants include physical/emotion stressors. • Pathophysiology remains unknown, although some theories exist.
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Affiliation(s)
- Mladen Grigorov
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jeffrey Spindel
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Praneeth Katrapati
- Department of Medicine, Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Marcus Stoddard
- Department of Medicine, Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Marina Varbanova
- Department of Anesthesiology, Division of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, Kentucky
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7
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Ko T, Morita H. Takotsubo Cardiomyopathy and Peripartum Cardiomyopathy. Int Heart J 2022; 63:651-653. [PMID: 35908852 DOI: 10.1536/ihj.22-133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Toshiyuki Ko
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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8
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Pollifrone M, Sikka S, Hamilton R. Takotsubo cardiomyopathy in a chronic spinal cord injury patient with autonomic dysreflexia: A case report. J Spinal Cord Med 2021; 44:1026-1029. [PMID: 32043945 PMCID: PMC8725744 DOI: 10.1080/10790268.2020.1724355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Context: Takotsubo cardiomyopathy (TC) is a transient stress-induced cardiomyopathy with left ventricular dysfunction of unknown etiology. A well accepted theory for the pathophysiology of TC is attributed to a massive catecholamine release [1]. This case report will review a chronic tetraplegia patient who was diagnosed with TC after a severe episode of autonomic dysreflexia (AD). He experiences mild episodes of AD several times a day; however, he had never experienced the severity of symptoms that was associated with this episode which led to his hospitalization. Autonomic dysreflexia is a syndrome of imbalanced sympathetic input secondary to loss of descending central sympathetic control in spinal cord injury due to noxious stimuli below the level of the injury, which occurs when the injury level is at thoracic level 6 (T6) or above [2].Findings: In this specific case, it is presumed that the massive catecholamine release associated with this severe AD episode resulted in TC. Although TC has been diagnosed after other instances of acute stress, it is unknown for it to be diagnosed after AD in a chronic setting.Clinical Relevance: The long-term effects of AD have not been well studied, and this case illustrates the importance of education to recognize and manage AD in the spinal cord patient who frequently has episodes of AD.
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Affiliation(s)
- Maria Pollifrone
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA,Correspondence to: Dr. Maria Pollifrone, Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Ave, Dallas TX, 75246, USA, Ph: 214-820-7192;
| | - Seema Sikka
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Rita Hamilton
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
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9
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Association of marital status with takotsubo syndrome (broken heart syndrome) among adults in the United States. World J Cardiol 2021. [DOI: 10.4330/wjc.v13.i8.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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10
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Appiah D, Farias R, Helo D, Appiah L, Olokede OA, Nwabuo CC, Nair N. Association of marital status with takotsubo syndrome (broken heart syndrome) among adults in the United States. World J Cardiol 2021; 13:340-347. [PMID: 34589169 PMCID: PMC8436683 DOI: 10.4330/wjc.v13.i8.340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/28/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pathophysiology of takotsubo syndrome (TTS) is not well understood, however, it is often precipitated by psychological or physical stress. Marital status is related to emotional stress, but its associations with TTS are limited.
AIM To explored the potential association between marital status and TTS.
METHODS We conducted a case-control study using data on patients aged ≥ 40 years with marital status data in the National Hospital Discharge Survey (2006-2010). The International Classification of Diseases Ninth Revision codes were used to identify cases with TTS and other comorbid conditions. Each case was matched to 5 controls by age, sex, year of TTS diagnosis and bed size of hospital. Two sets of controls were selected: Acute myocardial infarction (AMI) controls and non-cardiovascular disease (CVD) controls. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association of marital status with TTS.
RESULTS The 59 patients with TTS who had information on marital status were matched to 295 controls with AMI and 295 non-CVD controls, resulting in a sample of 649 patients. The average age of cases was 69.7 ± 11 years with 90% being women and 88% reporting White race. In multivariable-adjusted models, compared to singles, patients who were married had lower odds of TTS (OR = 0.86, 95%CI: 0.79–0.93) while those who were widowed (OR = 1.14, 95%CI: 1.05–1.23) or divorced/separated (OR = 1.32, 95%CI: 1.21–1.45) had elevated odds for TTS when compared to non-CVD controls. Similar results were observed when cases were compared to controls with AMI.
CONCLUSION In this study, being married was associated with lower odds for TTS while being divorced/separated or widowed was related to elevated odds for TTS. These novel findings that underscore the potential importance of social factors like marital status in the development of TTS need confirmation in larger studies.
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Affiliation(s)
- Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Rachel Farias
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Dena Helo
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Linda Appiah
- College of Education, Texas Tech University, Lubbock, TX 79409, United States
| | - Olugbenga A Olokede
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
| | - Chike C Nwabuo
- Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, United States
| | - Nandini Nair
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
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11
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Broyles AD, Banerji A, Barmettler S, Biggs CM, Blumenthal K, Brennan PJ, Breslow RG, Brockow K, Buchheit KM, Cahill KN, Cernadas J, Chiriac AM, Crestani E, Demoly P, Dewachter P, Dilley M, Farmer JR, Foer D, Fried AJ, Garon SL, Giannetti MP, Hepner DL, Hong DI, Hsu JT, Kothari PH, Kyin T, Lax T, Lee MJ, Lee-Sarwar K, Liu A, Logsdon S, Louisias M, MacGinnitie A, Maciag M, Minnicozzi S, Norton AE, Otani IM, Park M, Patil S, Phillips EJ, Picard M, Platt CD, Rachid R, Rodriguez T, Romano A, Stone CA, Torres MJ, Verdú M, Wang AL, Wickner P, Wolfson AR, Wong JT, Yee C, Zhou J, Castells M. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:S16-S116. [PMID: 33039007 DOI: 10.1016/j.jaip.2020.08.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Ana Dioun Broyles
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Sara Barmettler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Catherine M Biggs
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Kimberly Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Patrick J Brennan
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Rebecca G Breslow
- Division of Sports Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Katherine N Cahill
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Josefina Cernadas
- Allergology and Immunology Service, Centro Hospitalar Universitário de S.João Hospital, Porto, Portugal
| | - Anca Mirela Chiriac
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Elena Crestani
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Pascale Dewachter
- Department of Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Meredith Dilley
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Jocelyn R Farmer
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Dinah Foer
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Ari J Fried
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Sarah L Garon
- Associated Allergists and Asthma Specialists, Chicago, Ill
| | - Matthew P Giannetti
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David I Hong
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Joyce T Hsu
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Parul H Kothari
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Timothy Kyin
- Division of Asthma, Allergy & Immunology, University of Virginia, Charlottesville, Va
| | - Timothy Lax
- Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Min Jung Lee
- Allergy and Immunology at Hoag Medical Group, Newport Beach, Calif
| | - Kathleen Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Anne Liu
- Division of Allergy / Immunology, Stanford University School of Medicine, Palo Alto, Calif
| | - Stephanie Logsdon
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Andrew MacGinnitie
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Michelle Maciag
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Samantha Minnicozzi
- Division of Allergy and Clinical Immunology, Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Va
| | - Allison E Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, University of California, San Francisco Medical Center, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Sarita Patil
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Department of Medicine & Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Division of Allergy and Clinical Immunology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Rima Rachid
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Tito Rodriguez
- Drug Allergy Department, Al-Rashed Allergy Center, Sulaibikhat, Al-Kuwait, Kuwait
| | - Antonino Romano
- IRCCS Oasi Maria S.S., Troina, Italy & Fondazione Mediterranea G.B. Morgagni, Catania, Italy
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Maria Jose Torres
- Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, Spain
| | - Miriam Verdú
- Allergy Unit, Hospital Universitario de Ceuta, Ceuta, Spain
| | - Alberta L Wang
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Paige Wickner
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Anna R Wolfson
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Johnson T Wong
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Christina Yee
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Joseph Zhou
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Mariana Castells
- Drug hypersensitivity and Desensitization Center, Brigham and Women's Hospital, Boston, Mass
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12
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Wang X, Wang F, Sun N, Zhang L. Stress cardiomyopathy: Medical studies and extensive review. Saudi J Biol Sci 2021; 28:2598-2601. [PMID: 33911970 PMCID: PMC8071884 DOI: 10.1016/j.sjbs.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 12/02/2022] Open
Abstract
Stress cardiomyopathy (SC) was first reported in the year 1983. It is narrated as critical but quite commutative left ventricular (LV) malfunction mostly caused by poignant or psychological disorder. Numerous variations of SC have been described as well as reverse stress cardiomyopathy (rSC) which is an adaptation identified by the decreased muscle movement related with hyperkinesis that reconciles impetuously. The signature of rSC is a medical demonstration alike to syndrome by an acute coronary, with no obvious difficult coronary artery disease. The occurrence of SC is approximated to be 4% of all victims conferring with gleaned syndrome by acute coronary. The portion of victims conferring with the rSC transfiguration out of all SC patients has been inconstant, varying from 1 to 24%. Reverse stress cardiomyopathy cases are found to be common with young people, less decrease in left ventricular ejection fraction (LVEF) and more neurological disease compared to the SC. While the correct phenomenon of rSC is undetermined, postulated methods comprises of coronary microvasculature impairment, coronary artery spasm, and estrogen deficiency. Patients with rSC typically suffer with chest pain after an emotional or Psychological stressful event. The rSC can also be happened by general anesthesia, or neurological conditions. The diagnosis of rSC demands the presence of new electrocardiogram (EKG) abnormalities or elevated cardiac troponin, and absence of obstructive coronary disease, pheochromocytoma, or myocarditis. The consideration of rSC is quite analogous to that of SC, which is predominantly supportive with the treatment of complications. The recrudescence rate of rSC is around 12%. The most frequent complications of rSC include pericardial effusions, and development of LV thrombi.
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Affiliation(s)
- Xiang Wang
- Department of Cardiology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 271199, China
| | - Fangming Wang
- Department of Cardiology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 271199, China
| | - Ningwei Sun
- Department of Cardiology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 271199, China
| | - Lijun Zhang
- Department of Cardiology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 271199, China
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13
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Kakturskiy LV, Mikhaleva LM, Mishnev OD, Zayratyants OV, Kurilina EV, Komlev AE. [Takotsubo syndrome (stress-induced cardiomyopathy)]. Arkh Patol 2021; 83:5-11. [PMID: 33512121 DOI: 10.17116/patol2021830115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The article presents published and own data about Takotsubo syndrome, a relatively rare heart disease that is similar to acute coronary syndrome, but without significant damage of coronary arteries. The leading pathogenetic factor is the catecholamine-induced stress damage of myocardium with involvement of microvessels. There is a certain underestimation of Takotsubo syndrome by both clinicians and pathologists, so some cases of Takotsubo syndrome are misdiagnosed as acute coronary syndrome. Morphological manifestations of Takotsubo syndrome are characterized by mucoid edema of interstitial myocardial tissue, round-cell infiltration of stroma and focal damage of cardiomyocytes.
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Affiliation(s)
| | - L M Mikhaleva
- Research Institute of Human Morphology, Moscow, Russia
| | - O D Mishnev
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - O V Zayratyants
- Research Institute of Human Morphology, Moscow, Russia.,A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of Russia, Moscow, Russia
| | - E V Kurilina
- National Medical Research Center of Cardiology of the Ministry of Health of Russia, Moscow, Russia
| | - A E Komlev
- National Medical Research Center of Cardiology of the Ministry of Health of Russia, Moscow, Russia
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14
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Jamshidi N, Clark D, Murnion B. Recurrent Takotsubo Cardiomyopathy Associated with Opioid Withdrawal During Buprenorphine Induction. Cardiovasc Toxicol 2021; 21:349-353. [PMID: 33481183 DOI: 10.1007/s12012-020-09624-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
This case report describes a 65-year-old female with iatrogenic opioid use disorder for chronic lower back pain, who developed Takotsubo cardiomyopathy on multiple occasions following buprenorphine induction. This patient had three opioid transfers to buprenorphine, over 4 years, two of which were complicated by Takotsubo cardiomyopathy. In the transfer where she did not develop Takotsubo cardiomyopathy, she was treated with high doses of the centrally acting agonist, clonidine (three times a day, total of 600 mcg/day), up to and including the day of her transfer. This case highlights the potential consequences of a precipitated withdrawal with buprenorphine in an opioid transfer and its possible prevention with clonidine. To our knowledge, this is the first description of the recurrent Takotsubo cardiomyopathy in an opioid transfer setting. Given that buprenorphine is a partial agonist, in the presence of a full opioid agonist, it can precipitate withdrawal within minutes to hours of its administration. Opioid withdrawal can result in a sympathetic overdrive. Although complications of opioid withdrawal are extensively documented, cardiotoxicity is uncommon. As the use of buprenorphine and its new injectable formulations rise, it is important for prescribers to be aware of this life threatening complication. The prophylactic administration of clonidine can be considered to reduce the risk of cardiotoxicity, as well as manage opioid withdrawal symptoms.
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Affiliation(s)
- Nazila Jamshidi
- Department of Clinical Pharmacology and Toxicology and Drug health services, Royal Prince Alfred Hospital, Level 6, King George Building, Missenden Rd, Camperdown, NSW, Australia.
| | - Danielle Clark
- Emergency Department, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Bridin Murnion
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Drug and Alcohol Services, Central Coast Local Health District, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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15
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Naddaf S, Ehrenberg S, Hakim R, Mahamid M, Turgeman Y, Koren O. Epinephrine soaked tampons induced transient acute dilated cardiomyopathy during FESS procedure. BMC Cardiovasc Disord 2020; 20:452. [PMID: 33066731 PMCID: PMC7566064 DOI: 10.1186/s12872-020-01706-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/16/2020] [Indexed: 11/12/2022] Open
Abstract
Background Epinephrine, in all modes of use, may pose a wide range of cardiotoxic events, ranging from sinus tachycardia to heart failure, life threatening arrhythmias, and even death. Because of daily and extensive use of epinephrine, these unusual and rare events tend to be forgotten by physicians. We present a case of dilated cardiomyopathy that developed following routine use of epinephrine-impregnated tampons during function endoscopic sinus (FESS) surgery. Case presentation A healthy, 24-year-old man with no family history of heart disease has undergone elective surgery under general anesthesia to repair the paranasal sinuses using endoscopic approach. During surgery, soon after being treated with 1: 1000 diluted epinephrine-soaked tampons, an hypertensive crisis was noticed followed by pulseless electrical activity. An extensive examination led to the diagnosis of non-ischemic dilated cardiomyopathy. After several days of heart failure medical therapy, complete resolution of all structural and functional changes was achieved. Conclusion In our case, we present an unusual and rare event of acute dilated cardiomyopathy following the use of epinephrine-soaked tampons during elective FESS surgery. A prompt response was observed after several days of heart failure treatment. Awareness of the epinephrine cardiotoxic potential even in the form of soaked tampons is essential for proper diagnosis and prompt treatment.
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Affiliation(s)
- Sari Naddaf
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Scott Ehrenberg
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rony Hakim
- Department of Anaesthesia, Emek Medical Center, Afula, Israel
| | | | - Yoav Turgeman
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Heart Institute, Emek Medical Center, Afula, Israel
| | - Ofir Koren
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. .,Heart Institute, Emek Medical Center, Afula, Israel.
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16
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Takotsubo Cardiomyopathy in an Alzheimer Disease Patient: The Potential Contribution of Antidepressant Agents. Alzheimer Dis Assoc Disord 2020; 34:360-361. [PMID: 32520737 DOI: 10.1097/wad.0000000000000395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Takotsubo cardiomyopathy (TC) is an acute cardiac dysfunction, clinically similar to myocardial ischemia. The physiopathology of the syndrome seems to be related to excessive sympathetic activity that is triggered by physical or emotional stress factors. We report the case of an 83-year-old woman with advanced Alzheimer disease who had recently used nortriptyline and sertraline and was admitted with chest pain. An electrocardiogram showed ST-elevation, and markers of myocardial necrosis were slightly increased. However, coronariography did not demonstrate stenotic lesions. Transthoracic echocardiography and ventriculography identified decreased ventricular function, apical akinesia, and compensatory hyperkinesia of other segments that were compatible with TC. The patient evolved with cardiogenic shock and died. Alzheimer patients may be more susceptible to develop TC, both because of the disease itself and because of the multiple medications they are exposed to that increase catecholamine levels. In this case, antidepressant drugs were considered to be a potential factor that enhanced the susceptibility.
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17
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Yang WI, Moon JY, Shim M, Yang PS, Kang SH, Kim SH, Kim WJ, Sung JH, Kim IJ, Lim SW, Cha DH, Ha JW. Clinical features differentiating Takotsubo cardiomyopathy in the peripartum period from peripartum cardiomyopathy. Heart Vessels 2019; 35:665-671. [PMID: 31705186 DOI: 10.1007/s00380-019-01537-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/01/2019] [Indexed: 12/21/2022]
Abstract
There are some similarities in clinical features between Takotsubo cardiomyopathy during the peripartum period (PTCM) and peripartum cardiomyopathy (PPCM). Both conditions present as acute heart failure and decreased left ventricular (LV) ejection fraction in the peripartum period in previously heart-healthy women. The present study aimed to evaluate the differences in clinical features and outcomes between PTCM and PPCM. Between January 2004 and December 2016, 37 consecutive patients who demonstrated LV dysfunction during the peripartum period without previous heart disease were recruited retrospectively. The clinical, laboratory, and echocardiographic data of these patients were comprehensively reviewed. Twenty-one (57%) and 16 (43%) patients were classified into PPCM and PTCM groups, respectively, based on echocardiographic findings. The initial LV ejection fraction did not differ significantly between the 2 groups. However, all patients with PTCM showed complete recovery of LV ejection fraction at the 1-month follow-up. However, among 20 patients with PPCM who underwent 1-month echocardiography, only 6 (30%) showed complete recovery of LV ejection fraction at the 1-month follow-up. At the 12-month follow-up, only 10 patients showed complete recovery of LV ejection fraction. The incidence of PTCM was much higher than expected. Although LV dysfunction was similar at the initial diagnosis, the prognosis of LV recovery was more favorable in PTCM than in PPCM. Therefore, physicians should differentiate these two diseases entities, although they have several similarities in acute LV dysfunction.
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Affiliation(s)
- Woo-In Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Jae Youn Moon
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea.
| | - Minjung Shim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Se Hun Kang
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Sang-Hoon Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - In Jai Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Sang-Wook Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Dong-Hun Cha
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam, 13496, Republic of Korea
| | - Jong-Won Ha
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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18
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Azouzi A, Omri M, Kraiem H, Mbarek H, Slim M, Boussarsar M. Iatrogenic epinephrine-induced Takotsubo cardiomyopathy in beta-blocker poisoning: case report. COR ET VASA 2019. [DOI: 10.1016/j.crvasa.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Abstract
BACKGROUND AND PURPOSE Takotsubo cardiomyopathy (TCM), first reported by Japanese doctors, has gained an overall acknowledgment as an independent malady of international attention. It resembles the presentation of an acute myocardial infarction but lacks ischemic myocardial tissue. The objective of this article is to review the physiology, diagnostics, treatment, and complications of TCM and report a case study of a patient who developed TCM. METHODS Observation through direct patient care allowed for data collection of this unique medical phenomenon. Supporting information was obtained via investigation of scholarly articles on TCM over the past 10 years. CONCLUSIONS Although TCM is usually transient, it is important to quickly differentiate TCM from other more serious medical conditions, such as myocardial infarction, pulmonary embolism, and pheochromocytoma. Typical diagnostic workup includes electrocardiography, cardiac biomarkers, and echocardiography or coronary angiography. Complications include cardiogenic shock, left ventricular wall rupture, and life-threatening arrhythmias. IMPLICATIONS FOR PRACTICE The advanced practice nurse (APN) is instrumental in differentiating between TCM versus acute myocardial infarction, heart failure, pulmonary edema, dynamic outflow obstruction, and cardiogenic shock. Because of these possible acute and critical presentations, prompt recognition and intervention for patients with TCM are priorities for nurse practitioners.
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20
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Awad HH, McNeal AR, Goyal H. Reverse Takotsubo cardiomyopathy: a comprehensive review. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:460. [PMID: 30603648 DOI: 10.21037/atm.2018.11.08] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Takotsubo cardiomyopathy (TTC) was first described in Japan in the 1980s. It is described as an acute but often reversible left ventricular (LV) dysfunction mainly triggered by emotional or physical stress. Multiple variants of TTC have been reported including reverse Takotsubo cardiomyopathy (rTTC) which is a variant characterized by the basal akinesis/hypokinesis associated with apical hyperkinesis that resolves spontaneously. The hallmark of rTTC is a clinical presentation similar to an acute coronary syndrome (ACS), with no evident obstructive coronary artery disease. The incidence of TTC is estimated to be 2% of all troponin-positive patients presenting with suspected ACS. The proportion of patients presenting with the rTTC variant out of all TTC patients in published literature has been variable, ranging from 1-23%. Reverse Takotsubo has been associated with younger age, less decrease in left ventricular ejection fraction (LVEF), and more neurological disease compared to the TTC. While the exact mechanism of rTTC is unknown, hypothesized mechanisms include catecholamine cardiotoxicity, coronary artery spasm, coronary microvasculature impairment, and estrogen deficiency. Patients with rTTC typically present with chest pain and/or dyspnea after an emotional or physically stressful event. rTTC can also be triggered by intracranial hemorrhage, general anesthesia, or neurological conditions. Diagnosis of rTTC requires the presence of LV basal hypokinesis/akinesis, new electrocardiogram (EKG) abnormalities or elevated cardiac troponin, and absence of obstructive coronary disease, pheochromocytoma, or myocarditis. Management of rTTC is similar to that of TTC, which is predominantly supportive with the treatment of complications. The recurrence rate of rTTC is around 10%. The most common complications of rTTC include myocarditis, pleural and pericardial effusions, and development of LV thrombi. The best predictors of mortality include decreased LVEF, development of atrial fibrillation, and neurologic disease.
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Affiliation(s)
- Hamza H Awad
- Department of Community Medicine/Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Ashley R McNeal
- Medical Student, Mercer University School of Medicine, Macon, GA, USA
| | - Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
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21
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Spina R, Song N, Kathir K, Muller DWM, Baron D. Takotsubo cardiomyopathy following unintentionally large subcutaneous adrenaline injection: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty043. [PMID: 31020123 PMCID: PMC6177059 DOI: 10.1093/ehjcr/yty043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 12/31/2022]
Abstract
Introduction Stress cardiomyopathy, also known as takotsubo syndrome, is characterized by transient left ventricular dysfunction not attributable to obstructive epicardial coronary artery disease. Several pathological mechanisms have been proposed, including multivessel coronary artery vasospasm, coronary microcirculatory dysfunction, and excess catecholamine secretion. Case presentation A 68-year-old male presented to our institution for elective surgical removal of a cutaneous basal cell carcinoma on the right side of his face. Within minutes following the administration of local anaesthesia, the patient developed severe hypertension, tachycardia, ST-segment elevation on the electrocardiogram, and non-sustained broad-complex tachycardia. Urgent cardiac catheterization revealed non-obstructive coronary artery disease and left ventriculography demonstrated apical hypokinesia and moderate systolic dysfunction consistent with the takotsubo syndrome. On review of the medications administered, it was noted that an unintentionally large dose of adrenaline (4mg) had been injected subcutaneously with lignocaine. He was monitored in the coronary care and recovered fully with supportive care only. Bisoprolol was initiated on day 1 post procedure. On follow-up one month later, his left ventricular function had normalized. Discussion Our case report provides direct evidence supporting the pathogenetic role of excess catecholamine secretion in the development of the takotsubo syndrome. A review of the literature reveals that both exogenous catecholamine administration (adrenaline injection in the context of anaphylaxis or infiltrative anaesthesia) and excess endogenous catecholamine (phaechromocytoma) secretion has been associated with the takotsubo syndrome. Local infiltrative anaesthesia with the addition of adrenaline is commonly used as a vasoconstrictor in a wide variety of surgical procedures. To reduce the risk of adverse events, the lowest effective concentration of adrenaline to provide pain control and vasoconstriction is recommended.
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Affiliation(s)
- Roberto Spina
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, Australia
| | - Ning Song
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, Australia
| | - Krishna Kathir
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, Australia
| | - David W M Muller
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, Australia
| | - David Baron
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, Australia
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Shaker M, Toy D, Lindholm C, Low J, Reigh E, Greenhawt M. Summary and simulation of reported adverse events from epinephrine autoinjectors and a review of the literature. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:2143-2145.e4. [PMID: 29660429 DOI: 10.1016/j.jaip.2018.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Marcus Shaker
- Geisel School of Medicine at Dartmouth, Hanover, NH; Children's Hospital at Dartmouth, Lebanon, NH; Dartmouth-Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, NH.
| | - Dana Toy
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Christopher Lindholm
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, NH
| | - Jeffrey Low
- Geisel School of Medicine at Dartmouth, Hanover, NH; Children's Hospital at Dartmouth, Lebanon, NH
| | - Erin Reigh
- Geisel School of Medicine at Dartmouth, Hanover, NH; Dartmouth-Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, NH
| | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Department of Pediatrics, Section of Allergy and Immunology, Aurora, Colo
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Perioperative Stress-Induced (Takotsubo) Cardiomyopathy in Liver Transplant Recipients. ACTA ACUST UNITED AC 2018; 4:56-63. [PMID: 30581996 PMCID: PMC6294992 DOI: 10.2478/jccm-2018-0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/19/2018] [Indexed: 12/13/2022]
Abstract
A comprehensive analysis of published cases of Takotsubo cardiomyopathy, occurred in liver transplant recipients in the perioperative period, has been attempted in this review. Predisposing factors, precipitating events, potential physiological mechanisms, acute and post-event management have been discussed.
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24
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Longobardo L, Zito C, Carerj S, Caracciolo G, Khandheria BK. Influence of Genetics and Gender in Takotsubo Syndrome: Unexplored Areas of an Incompletely Understood Disease. GENDER AND THE GENOME 2017. [DOI: 10.1089/gg.2017.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Stress cardiomyopathy, also known as “Takotsubo syndrome” (TS), is a complex disease that typically affects postmenopausal women. The pathophysiology is still largely unknown, but evidence of a frequent association between TS and stressful events has evoked the hypothesis of a pathophysiologic role of sympathetic overdrive in the myocardial dysfunction. However, despite several studies, the role gender plays in TS onset remains unclear because stress cardiomyopathy also has been described in young women and in men. Moreover, although several cases of a familial cluster of TS have been reported, no responsible gene mutations or polymorphisms have been clearly identified so far, and neither the modality of transmission or the true impact of genetic background. In this review, we discuss the role of gender in the onset, course, and outcomes of TS and we report the available data about polymorphisms and gene mutations so far investigated, trying to critically analyze the evidence reported in the literature.
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Affiliation(s)
- Luca Longobardo
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Messina, Italy
| | - Giuseppe Caracciolo
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Bijoy K. Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
- Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, Wisconsin
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Abstract
BACKGROUND The most plausible hypothesis for takotsubo cardiomyopathy (TCM) is a catecholamine surge. Direct administration of catecholamines or medications causing catecholamine surge is frequently used in clinical practice. METHODS A Medline/PubMed database search was conducted for case reports or series of drug-induced TCM. All reported cases of drug-induced TCM were systemically identified and analyzed. RESULTS We identified 157 cases of drug-induced TCM. Fifty-seven (36.3%) cases were related to the administration of exogenous catecholamines. In 50 (31.9%) other cases, there was potential adrenergic effect. This included drugs with adrenergic vasoconstriction properties (3.2%), hyperadrenergic state due to alcohol or opioid withdrawal (7.7%), inhibitors of catecholamine reuptake (14.7%), anaphylactic reaction that is accompanied by catecholamine release (3.2%), and psychological or somatic stress coinciding with the administration of a drug that was thought to be the culprit (3.2%). Overall, 68.2% of these drug-induced TCM cases were catecholamine related. In 14 (8.9%) cases, the likely etiology of cardiomyopathy was chemotherapy-induced coronary vasospasm. CONCLUSION Our systematic review showed that over two-thirds of drug-induced TCM cases were due to direct or indirect catecholamine stimulation. The lowest effective dose and shortest duration of catecholamines should be utilized, and alternative therapies should be considered if feasible.
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Affiliation(s)
- Kazuhiko Kido
- 1 Department of Pharmacy Practice, South Dakota State University, Sioux Falls, SD, USA.,2 Department of Pharmacy, Avera McKennan Hospital, Sioux Falls, SD, USA
| | - Maya Guglin
- 3 Gill Heart Institute, University of Kentucky HealthCare, Lexington, KY, USA
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26
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Katsa I, Christia P, Massera D, Faillace R. Recurrent Stress Cardiomyopathy During COPD Exacerbation: Are Beta-adrenergic Agonists Only to Blame? Cureus 2017; 9:e1166. [PMID: 28507838 PMCID: PMC5429155 DOI: 10.7759/cureus.1166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a variant of stress-induced cardiomyopathy, characterized by transient left ventricular dysfunction that may be associated with emotional or physical triggers. We present the case of a 51-year-old Caucasian female with severe chronic obstructive pulmonary disease (COPD) who presented with syncope and was found to have her second lifetime episode of stress-induced cardiomyopathy. Eight months prior, she had been admitted with a COPD exacerbation and was found to have left ventricular (LV) dysfunction with ejection fraction (EF) of 22% attributed to TCM with subsequent normalization of her left ventricular function. Recurrence of stress-induced cardiomyopathy associated with COPD is a rare phenomenon and its presentation raises the possibility of a common underlying mechanism.
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Affiliation(s)
- Ioanna Katsa
- Medicine, North Bronx Health Network Jacobi Medical Center
| | | | | | - Robert Faillace
- Cardiology, North Bronx Health Network Jacobi Medical Center
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Khwaja YH, Tai JM. Takotsubo cardiomyopathy with use of salbutamol nebulisation and aminophylline infusion in a patient with acute asthma exacerbation. BMJ Case Rep 2016; 2016:bcr-2016-217364. [PMID: 27793870 DOI: 10.1136/bcr-2016-217364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Takotsubo cardiomyopathy, apical ballooning syndrome or stress-induced cardiomyopathy is characterised by transient left ventricular dysfunction, mimicking myocardial infarction in the absence of obstructive coronary artery disease or acute plaque rupture on coronary angiography. The exact mechanism of myocardial dysfunction in Takotsubo cardiomyopathy is unknown; however, due to its association with physical and emotional stress, it is postulated that catecholamines play a central role in its pathogenesis. We present a case of a patient who was admitted with acute asthma exacerbation and was treated with β-2 agonist nebulisation and intravenous aminophylline. During her hospital stay she developed Takotsubo cardiomyopathy.
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Affiliation(s)
| | - Javed Majid Tai
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Y-Hassan S. Clinical features and outcome of epinephrine-induced takotsubo syndrome: Analysis of 33 published cases. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:450-455. [PMID: 27499059 DOI: 10.1016/j.carrev.2016.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Takotsubo syndrome (TS) may be triggered by innumerable physical stress factors including epinephrine administration. The aim of this study is to report on the clinical features and outcome of epinephrine-induced TS (Epi-TS) in a large cohort of published cases. METHODS A computer assisted search of the electronic data base Pubmed was performed from 1990 to 2014. All cases deemed to have Epi-TS were retrieved and compared to the large recent report by Templin et al. (All-TS). RESULTS Thirty-three cases of Epi-TS were retrieved from the literature and compared to 1750 cases of All-TS. Chest pain as a presenting symptom occurred in 45% of cases. The Epi-TS patients were on average 20.6years younger than All-TS patients (p<0.0001). The women were still predominating in Epi-TS but in a significantly lower percentage compared to ALL-TS (73% in Epi-TS vs 89.8% in All-TS, p=0.0054). One third of the Epi-TS cases had basal pattern of TS compared to 2.2% of cases reported in All-TS. Epi-TS cases were characterized by high complication rates, which occurred in 57.6%. The most important risk factor for the development of TS complication was the accidental administration (P<0.001) and the dose of >1mg epinephrine (p=0.02). In spite of high complication rates, the recovery was rapid with no in-hospital mortality. CONCLUSION Epi-TS is characterized by a dramatic rapid onset of symptoms after epinephrine administration. Almost half of the cases had apical sparing and one third basal pattern of TS. In spite of high complication rates, the prognosis was good with no in-hospital mortality.
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Affiliation(s)
- Shams Y-Hassan
- Karolinska Institute at Karolinska University Hospital, Department of Cardiology.
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Brener MI, Keramati AR, Mirski MA, Cingolani OH. A Sudden Change of Heart: A Case of Rapidly Reversed Stress Cardiomyopathy in a Critically Ill Patient. Cardiol Res 2016; 7:119-121. [PMID: 28197279 PMCID: PMC5295519 DOI: 10.14740/cr471w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2016] [Indexed: 11/28/2022] Open
Abstract
We report the case of a 79-year-old woman who presented to our hospital for elective removal of an infratentorial meningioma and suffered a periprocedural cardiac arrest. Shortly after uncomplicated induction of anesthesia prior to the surgery, the patient became hypotensive and bradycardic, culminating ultimately in a cardiac arrest with pulseless electrical activity. Return of spontaneous circulation occurred within 90 seconds of arrest, but the patient remained dependent on maximal doses of epinephrine and dopamine for hemodynamic support. Echocardiography performed on the day of cardiac arrest revealed a newly depressed left ventricular ejection fraction (LVEF) of 15-20% with an apical ballooning pattern. Left heart catheterization showed no obstructive coronary lesions to explain her depressed ejection fraction. A diagnosis of stress cardiomyopathy (SCM) was made given the echocardiographic findings and absence of concomitant coronary disease. Within the next 24 hours, the patient was liberated from inotropic support, and at 6-month follow-up, her LVEF returned to 55% and she had no heart failure symptoms.
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Affiliation(s)
- Michael I Brener
- Department of Medicine and Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ali R Keramati
- Department of Medicine and Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Marek A Mirski
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Oscar H Cingolani
- Department of Medicine and Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
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Differences between Takotsubo cardiomyopathy and reverse Takotsubo cardiomyopathy associated with subarachnoid hemorrhage. IJC HEART & VASCULATURE 2016; 11:99-103. [PMID: 28616533 PMCID: PMC5441322 DOI: 10.1016/j.ijcha.2016.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/02/2016] [Indexed: 10/29/2022]
Abstract
BACKGROUND Both Takotsubo cardiomyopathy (TTC) and reverse TTC (r-TTC) are characterized by reversible regional wall motion abnormalities of the heart unrelated to coronary artery pathology. It remains unclear whether and/or how r-TTC differs from TTC. Subarachnoid hemorrhage (SAH) is occasionally causative of TTC/r-TTC, and this study was conducted to detect possible differences between TTC and r-TTC associated with SAH. METHODS A single-center retrospective study was conducted on 328 consecutive SAH patients. They routinely underwent transthoracic echocardiography (TTE), ECG, and measurements of plasma catecholamines and other cardiac biomarkers within 24 h of admission. Demographic, echocardiographic, electrocardiographic and neurochemical profiles were compared between patients with TTC and r-TTC. The diagnosis of TTC/r-TTC was based on the revised Mayo Clinic Criteria. RESULTS Data of 21 SAH-induced TTC and 10 SAH-induced r-TTC patients admitted between January 2009 and December 2014 were analyzed. The patients with r-TTC were significantly younger than those with TTC (51.8 ± 10.9 vs. 63.5 ± 14.4 years, p = 0.04). The former exhibited significantly higher plasma epinephrine levels than the latter (809 ± 710 vs. 380 ± 391 pg/mL, p = 0.04). Plasma norepinephrine levels did not differ significantly (2421 ± 1374 vs. 1724 ± 1591 pg/mL, p = 0.25). No significant differences were observed in other demographic/physiologic variables, echocardiographic parameters, frequency of ECG abnormalities, and 90-day mortality. Moreover, none of the patients who underwent a follow-up TTE exhibited morphologic change from one type to the other. CONCLUSIONS The pathomechanisms in TTC and r-TTC may not be identical: however, distinguishing the two conditions may not have great importance from the standpoint of clinical management and prognostication.
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Ledakowicz-Polak A, Bartodziej J, Majos A, Zielińska M. Inverted stress- induced cardiomyopathy as a unusual variant of acute heart failure after cesarean delivery- a case report. BMC Cardiovasc Disord 2016; 16:76. [PMID: 27130218 PMCID: PMC4850726 DOI: 10.1186/s12872-016-0253-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/22/2016] [Indexed: 11/20/2022] Open
Abstract
Background Stress- induced cardiomyopathy is acute, reversible left ventricle mainly apical dysfunction in patients with normal coronary angiography. Rarely it regards basal segments, therefore defined as “inverted stress- induced cardiomyopathy”. While classic form mostly affects postmenopausal women, inverted variant occurs essentially in younger females, always triggered by stress. It can also develop after medical procedures and surgery. Herein we report such unique case of 36- year old woman after cesarean delivery. Case presentation A 36- year- old white woman at 40 week of gestation was admitted to hospital for elective repeated cesarean delivery. During caesarean delivery under spinal anaesthesia a previously healthy woman became hypotensive, requiring ephedrine to maintain her blood pressure. Three hours after delivery the patient presented acute heart failure and pulmonary oedema. Due to low blood pressure she demanded the administration of inotropic agents. Owing to respiratory failure and gradual deterioration of consciousness, mechanical ventilation was applied. Results of additional tests finally excluded pulmonary thromboembolism and acute coronary syndrome. The transthoracic echocardiography revealed severe left ventricular systolic dysfunction, ejection fraction 30 % with hypokinesis of the mid and basal segments of posterior, anterior and lateral wall with preserved contractility of the apical segments. The diagnosis of inverted stress- induced cardiomyopathy was set upon the overall clinical data. Both echocardiography and magnetic resonance imaging performed on the fifth day showed complete recovery of myocardial function. The patient was discharged after 15 days in good overall condition. At 12- month follow- up she remained asymptomatic with no echocardiographic abnormalities. Conclusions Inverted stress- induced cardiomyopathy may occur in postpartum period, especially in combination with spinal anesthesia and adrenergic stimulants administration. The clinical awareness and multimodality imaging of possible diagnosis and further management of this unexpected variant of acute heart failure after caesarean delivery is required.
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Affiliation(s)
- Anna Ledakowicz-Polak
- Intensive Cardiac Therapy Clinic, Department of Cardiology and Cardiosurgery, Medical University, Pomorska 251, 92-213, Lodz, Poland.
| | - Jarosław Bartodziej
- Department of Anaesthesiology and Intensive Care, Jonscher Municipal Hospital, Lodz, Poland
| | - Agata Majos
- Department of Radiology, Medical University, Lodz, Poland
| | - Marzenna Zielińska
- Intensive Cardiac Therapy Clinic, Department of Cardiology and Cardiosurgery, Medical University, Pomorska 251, 92-213, Lodz, Poland
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Belliveau D, De S. Reverse Takotsubo Cardiomyopathy following Exogenous Epinephrine Administration in the Early Postpartum Period. Echocardiography 2016; 33:1089-1091. [PMID: 27018194 DOI: 10.1111/echo.13219] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is typically triggered by stress and can often mimic acute myocardial infarction. It is typically characterized by ballooning of the apex of the left ventricle following emotional or physical stress. Reverse TCM is a rare variant in which the cardiac apex is hyperkinetic and ballooning occurs at the base of the heart. We present a case of reverse TCM in the immediate postpartum period following an injection of local epinephrine, followed by spontaneous resolution within 24 hours.
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Affiliation(s)
- Dan Belliveau
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sabe De
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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35
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Madias JE. Epinephrine administration and Takotsubo syndrome: Lessons from past experiences. Int J Cardiol 2016; 207:100-2. [DOI: 10.1016/j.ijcard.2016.01.145] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 11/15/2022]
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Nakagawa N, Fukawa N, Tsuji K, Nakano N, Kato A. Takotsubo cardiomyopathy induced by dopamine infusion after carotid artery stenting. Int J Cardiol 2016; 205:62-64. [DOI: 10.1016/j.ijcard.2015.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
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Agu CC, Bakhit A, Basunia M, Bhattarai B, Oke V, Salhan D, Schmidt F. Takotsubo cardiomyopathy precipitated by delirium tremens. J Community Hosp Intern Med Perspect 2015; 5:29704. [PMID: 26653700 PMCID: PMC4677587 DOI: 10.3402/jchimp.v5.29704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 12/03/2022] Open
Abstract
A 57-year-old woman presented with alcohol withdrawal symptoms, which later progressed to delirium tremens. During hospitalization, she developed respiratory distress with acute pulmonary edema. Electrocardiogram (ECG) showed diffuse ST elevation with elevated cardiac enzymes. Echocardiogram showed estimated ejection fraction of 20–25% with characteristic apical ballooning. After several days of supportive care, the patient showed significant clinical improvement with normalization of ECG, cardiac enzymes, and echocardiographic findings. Coronary angiogram revealed no coronary abnormalities. Although Takotsubo cardiomyopathy has been associated with diverse forms of physical or emotional stress, only a few cases have been described with delirium tremens in the medical literature.
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Affiliation(s)
| | | | - Md Basunia
- Interfaith Medical Center, Brooklyn, NY, USA
| | | | - Vikram Oke
- Interfaith Medical Center, Brooklyn, NY, USA
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Wang Y, Xia L, Shen X, Han G, Feng D, Xiao H, Zhai Y, Chen X, Miao Y, Zhao C, Wang Y, Guo M, Li T, Zhu HY. A New Insight Into Sudden Cardiac Death in Young People: A Systematic Review of Cases of Takotsubo Cardiomyopathy. Medicine (Baltimore) 2015; 94:e1174. [PMID: 26266349 PMCID: PMC4616674 DOI: 10.1097/md.0000000000001174] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 02/06/2023] Open
Abstract
Takotsubo cardiomyopathy (TTC) causes sudden cardiac death and has garnered increased attention worldwide in recent years. However, few studies have clearly classified the risk factors for this disease, including gender, race and morbidity, as well as the physical and mental stressors that can exacerbate the disease, particularly in young patients. To better analyze the characteristics of young TTC patients, we performed a systematic review of reported cases involving young patients.A computer-assisted search was performed using prominent electronic medical information sources to identify literature published between January 1965 and December 2013. Relevant studies containing clinical data of young TTC patients were included.Ninety-six records that included information about 104 cases were ultimately selected for our review. Several of the following results were noted: First, physical stress was more likely to exacerbate TTC than was mental stress in young patients. Second, more female than male TTC patients were noted among both young patients and the general population. Third, ethnicity appears to play no role in the disease, as no significant differences were noted among individuals of different races with respect to clinical characteristics, morbidity or stressors. Fourth, the clinical manifestations of TTC were similar to those of other cardiac diseases, including coronary heart disease. However, TTC may be detected using the combination of echocardiography and ventriculography.Clinicians should consider TTC if young patients present with symptoms similar to those of coronary heart disease so that harmful treatments such as coronary artery stent placement may be avoided. Moreover, the answers to questions regarding the clinical diagnostic criteria, etiology, pathophysiology, and the management of this syndrome in youth remain unclear; therefore, further research is needed.
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Affiliation(s)
- Yueyue Wang
- From the Emergency Department, Chinese PLA General Hospital, Beijing, China (YW, XS, HX, YZ, XC, YL, CZ, YW, MG, TL, HYZ); Medical Logistics Administration, Chinese PLA General Hospital, Beijing, China (LX); and Hospital Management Institute, Medical Statistic Division, Chinese PLA General Hospital, Beijing, China (DF)
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Cao X, Zhou C, Chong J, Fu L, Zhang L, Sun D, Hou H, Zhang Y, Li D, Sun H. Estrogen resisted stress-induced cardiomyopathy through increasing the activity of β2AR–Gαs signal pathway in female rats. Int J Cardiol 2015; 187:377-86. [DOI: 10.1016/j.ijcard.2015.02.113] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/16/2015] [Accepted: 02/21/2015] [Indexed: 02/08/2023]
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Abstract
OBJECTIVES Reversible stress-induced cardiac dysfunction is frequently seen as a complication of a multitude of acute stress states, in particular neurologic injuries. This dysfunction may be difficult to distinguish between that caused by myocardial ischemia and may impact both the treatment strategies and prognosis of the underlying condition. Critical care practitioners should have an understanding of the epidemiology, pathophysiology, clinical characteristics, precipitating conditions, differential diagnosis, and proposed treatments for stress-induced cardiomyopathy. DATA SOURCES MEDLINE database search conducted from inception to August 2014, including the search terms "tako-tsubo," "stress-induced cardiomyopathy," "neurogenic cardiomyopathy," "neurogenic stress cardiomyopathy," and "transient left ventricular apical ballooning syndrome". In addition, references from pertinent articles were used for a secondary search. STUDY SELECTION AND DATA EXTRACTION After review of peer-reviewed original scientific articles, guidelines, and reviews resulting from the literature search described above, we made final selections for included references and data based on relevance and author consensus. DATA SYNTHESIS Stress-induced cardiomyopathy occurs most commonly in postmenopausal women. It can be precipitated by emotional stress, neurologic injury, and numerous other stress states. Patients may present with symptoms indistinguishable from acute coronary syndrome or with electrocardiogram changes and wall motion abnormalities on echocardiogram following neurologic injury. Nearly all patients will have an elevated cardiac troponin. The underlying etiology is likely related to release of catecholamines, both locally in the myocardium and in the circulation. Differential diagnosis includes myocardial infarction, myocarditis, neurogenic pulmonary edema, and nonischemic cardiomyopathy. Although the natural course of stress-induced cardiomyopathy is resolution, treatment strategies include sympathetic blockade and supportive care. CONCLUSIONS Stress-induced cardiomyopathy may mimic myocardial infarction and is an important condition to recognize in patients with underlying stress states, particularly neurologic injuries.
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Minatoguchi M, Itakura A, Takagi E, Nishibayashi M, Kikuchi M, Ishihara O. Takotsubo cardiomyopathy after cesarean: a case report and published work review of pregnancy-related cases. J Obstet Gynaecol Res 2015; 40:1534-9. [PMID: 24888912 DOI: 10.1111/jog.12437] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 02/23/2014] [Indexed: 11/29/2022]
Abstract
Takotsubo cardiomyopathy (TCM) primarily affects postmenopausal women and is an important differential diagnosis of acute coronary syndrome. We describe a rare case of post-partum TCM, and present a published work review of the cases of pregnancy-associated TCM. A 24-year-old Japanese woman pregnant with twins suffered from premature membrane rupture at 31 gestational weeks. Following emergency cesarean delivery, she complained of sudden dyspnea. Transthoracic echocardiography revealed an inverted Takotsubo pattern (ejection fraction, 46%). On post-delivery day 8, wall motion abnormalities subsided, and she was discharged on post-delivery day 16. We reviewed 18 relevant cases of peripartum TCM from the published work. Among them, 16 cases were post-partum and two cases occurred during pregnancy. Most women (81%) underwent cesarean delivery, and the first symptoms of TCM appeared during surgery in 38% of the cases. The dominant symptoms were chest pain (44%) and dyspnea (28%). Most cases (94%) exhibited electrocardiogram abnormalities, including ST changes and T-wave inversion. Serum levels of cardiac enzymes were abnormally high in 92% of the cases. Repeated echocardiography documented normalized left ventricular systolic function within 6 months in all cases. This case and review emphasize that TCM may be concealed in post-partum women by symptoms undistinguishable from acute coronary syndrome, peripartum cardiomyopathy or pulmonary thromboembolism, and that echocardiography may be a useful tool to distinguish them.
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Affiliation(s)
- Miki Minatoguchi
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama
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Bonacchi M, Vannini A, Harmelin G, Batacchi S, Bugetti M, Sani G, Peris A. Inverted-Takotsubo cardiomyopathy: severe refractory heart failure in poly-trauma patients saved by emergency extracorporeal life support. Interact Cardiovasc Thorac Surg 2015; 20:365-371. [PMID: 25535176 DOI: 10.1093/icvts/ivu421] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVES The sequelae of severe poly-trauma may include myocardial dysfunction followed by acute heart failure and death. Inverted-Takotsubo cardiomyopathy (ITC) is a variant of stress cardiomyopathy, characterized by a contractile abnormality with extensive left ventricular circumferential dyskinesia or akinesia with a hyperkinetic apex. We report our experience with refractory cardiogenic shock and/or cardiac arrest, treated with extracorporeal life support. METHODS From June 2008 to December 2011, we treated 4 adult poly-trauma patients (3 men, 1 woman, mean age: 27.7 ± 13.5 years, mean ISS score 53.2 ± 15.9) with veno-arterial (V-A) extracorporeal life support for cardiopulmonary failure/cardiac arrest refractory to conventional treatment, due to inverted-Takotsubo cardiomyopathy. We used a miniaturized extracorporeal life support (ECLS) device. RESULTS ITC myocardial dysfunction appeared 15.4 ± 11.6 h after intensive care unit admission and rapidly evolved to refractory cardiopulmonary failure and cardiac arrest (within 4.8 ± 2.5 h of the onset). At ECLS, initiation median pH was 7.12 ± 0.14 (6.91-7.25), median lactate was 6.7 ± 2.8 (4-10) mmol/l and median vasoactive-inotropic score was 192.1 ± 50.6 µg/kg/min. Tissue perfusion improved significantly within 4 h on ECLS. Cardiac function improved gradually but consistently. Initial median ejection fraction was 14.2 ± 4.7% and median global longitudinal strain test was -7.4 ± 4.7. At complete cardiac recovery, they were 62.73 ± 7.8 and -18.43 ± 2.4%, respectively. After that, 2 patients survived and were sent to neurological rehabilitation before hospital discharge. In the other 2 cases, post-traumatic cerebral death occurred and they underwent organ explantation. CONCLUSIONS Rapid heparin-free ECLS may improve outcome in the most severe cases of poly-traumatized patients demonstrating refractory inverted-Takotsubo cardiomyopathy.
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Affiliation(s)
- Massimo Bonacchi
- Department of Cardiac Surgery, Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Vannini
- Department of Cardiac Surgery, Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Guy Harmelin
- Department of Cardiac Surgery, Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Batacchi
- Department of Anesthesia and Intensive Care Unit, Emergency, Careggi Teaching Hospital, Florence, Italy
| | - Marco Bugetti
- Department of Cardiac Surgery, Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Guido Sani
- Department of Cardiac Surgery, Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Adriano Peris
- Department of Anesthesia and Intensive Care Unit, Emergency, Careggi Teaching Hospital, Florence, Italy
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Shresthra S, Juneau D, Hermann D, Wells GL. Apical Ballooning Syndrome: Recent Insights from a Consecutive Series of 104 Patients. Health (London) 2015. [DOI: 10.4236/health.2015.71002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Reverse Takotsubo cardiomyopathy after iatrogenic epinephrine injection requiring percutaneous extracorporeal membrane oxygenation. Can J Anaesth 2014; 61:1093-7. [DOI: 10.1007/s12630-014-0230-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022] Open
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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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Vaccaro A, Despas F, Delmas C, Lairez O, Lambert E, Lambert G, Labrunee M, Guiraud T, Esler M, Galinier M, Senard JM, Pathak A. Direct evidences for sympathetic hyperactivity and baroreflex impairment in Tako Tsubo cardiopathy. PLoS One 2014; 9:e93278. [PMID: 24667435 PMCID: PMC3965544 DOI: 10.1371/journal.pone.0093278] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/04/2014] [Indexed: 12/18/2022] Open
Abstract
Background The exact pathophysiology of Tako-Tsubo cardiomyopathy (TTC) remains unknown but a role for sympathetic hyperactivity has been suggested. Up to now, no direct evidence of sympathetic nerve hyperactivity has been established nor involvement of sympathetic baroreflex identified. The aim of our study was to determine, by direct sympathetic nerve activity (SNS) recording if sympathetic nervous system activity is increased and spontaneous baroreflex control of sympathetic activity reduced in patients with TTC. Methods We included 13 patients who presented with TTC and compared their SNS activity and spontaneous baroreflex control of sympathetic activity with that of 13 control patients with acutely decompensated chronic heart failure. SNS activity was evaluated by microneurography, a technique assessing muscle sympathetic nerve activity (MSNA). Spontaneous baroreflex control of sympathetic activity was evaluated as the absolute value of the slope of the regression line representing the relationship between spontaneous diastolic blood pressure values and concomitant SNS activity. Control patients were matched for age, sex, left ventricular ejection fraction and creatinine clearance. Results The mean age of the patients with TTC was 80 years, all patients were women. There were no significant differences between the two groups of patients for blood pressure, heart rate or oxygen saturation level. TTC patients presented a significant increase in sympathetic nerve activity (MSNA median 63.3 bursts/min [interquartile range 61.3 to 66.0] vs median 55.7 bursts/min [interquartile range 51.0 to 61.7]; p = 0.0089) and a decrease in spontaneous baroreflex control of sympathetic activity compared to matched control patients (spontaneous baroreflex control of sympathetic activity median 0.7%burst/mmHg [interquartile range 0.4 to 1.9] vs median 2.4%burst/mmHg [interquartile range 1.8 to 2.9]; p = 0.005). Conclusions We report for the first time, through direct measurement of sympathetic nerve activity, that patients with TTC exhibit elevated SNS activity associated with a decrease in spontaneous baroreflex control of sympathetic activity. These data may explain the pathophysiology and clinical presentation of patient with TTC.
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Affiliation(s)
- Angelica Vaccaro
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- C.I.C., Clinical Investigation Center, University Hospital of Toulouse, Toulouse, France
| | - Fabien Despas
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Clinical Pharmacology Department, University Hospital of Toulouse, Toulouse, France
| | - Clement Delmas
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Olivier Lairez
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Elisabeth Lambert
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Gavin Lambert
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marc Labrunee
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Thibaut Guiraud
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
| | - Murray Esler
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michel Galinier
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Jean Michel Senard
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Clinical Pharmacology Department, University Hospital of Toulouse, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Atul Pathak
- National Institute of Health and Medical Research (INSERM) UMR-1048, Institute of Metabolic and Cardiovascular diseases, Toulouse, France
- Toulouse University III Paul Sabatier, Toulouse, France
- Clinical Pharmacology Department, University Hospital of Toulouse, Toulouse, France
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
- Human Neurotransmitter Laboratory, Baker IDI Heart and Diabetes Institute and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- C.I.C., Clinical Investigation Center, University Hospital of Toulouse, Toulouse, France
- * E-mail:
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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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Ducruet AF, Albuquerque FC, Crowley RW, Williamson R, Forseth J, McDougall CG. Balloon-Pump Counterpulsation for Management of Severe Cardiac Dysfunction After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2013; 80:e347-52. [DOI: 10.1016/j.wneu.2012.05.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/23/2012] [Indexed: 10/27/2022]
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Spadotto V, Zorzi A, Elmaghawry M, Meggiolaro M, Pittoni GM. Heart failure due to 'stress cardiomyopathy': a severe manifestation of the opioid withdrawal syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 2:84-7. [PMID: 24062938 DOI: 10.1177/2048872612474923] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/24/2012] [Indexed: 11/15/2022]
Abstract
Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction due to akinesia of the LV mid-apical segments ('apical ballooning') in the absence of critical coronary stenoses which can be complicated in the acute phase by heart failure, mitral regurgitation, life-threatening ventricular arrhythmias, or apical LV thrombosis. The syndrome is typically precipitated by intense emotional or physical stress; however, other causes of sympathetic overstimulation including administration of exogenous sympathomimetics or withdrawal of sympathetic antagonists can trigger TTC. We report the case of a patient who unexpectedly developed an 'apical ballooning' with severe reduction in the LV systolic function and heart failure after the withdrawal of methadone. The case supports the concept that increased sympathetic activity secondary to opioids withdrawal can trigger a stress-induced severe LV dysfunction. Physicians should be aware that the abrupt discontinuation of a long-term therapy with opioids may lead to serious cardiac complications. The administration of clonidine may be considered to prevent early clinical manifestations of addictive withdrawal, including TTC.
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Citro R, Giudice R, Mirra M, Petta R, Baldi C, Bossone E, Piscione F. Is Tako-tsubo syndrome in the postpartum period a clinical entity different from peripartum cardiomyopathy? J Cardiovasc Med (Hagerstown) 2013; 14:568-75. [DOI: 10.2459/jcm.0b013e32835f1a49] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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