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Madias JE. Left ventricular outflow tract obstruction/hypertrophic cardiomyopathy/takotsubo syndrome: A new hypothesis of takotsubo syndrome pathophysiology. Curr Probl Cardiol 2024; 49:102668. [PMID: 38797507 DOI: 10.1016/j.cpcardiol.2024.102668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
The pathophysiology of TTS is still elusive. This viewpoint proposes that TTS is an acute coronary syndrome, engendered by an ASNS/catecholamine-induced LVOTO, which results in an enhanced wall stress and afterload-based supply/demand mismatch, culminating in a segmental myocardial ischemic injury state, in susceptible individuals. Such individuals are felt to be particularly women with chronic hypertension, known or latent HCM, or non-HCM segmental myocardial hypertrophy, and certain structural abnormalities involving the LV and the MV apparatus. Recommendations are provided to explore further this hypothesis, while maintaining our focus on all other advanced TTS pathophysiology hypotheses for all patients, or those who do not experience LVOTO, men, the young, and patients with reverse, mid-ventricular, or right ventricular TTS, in whom more prolonged hyperadrenergic stimulation and/or larger amounts of blood-ridden catecholamines, segmental particularities of cardiac innervation and/or density of α-, and β-adrenergic receptors, pheochromocytoma, neurological chronic or acute comorbidities/catastrophies, coronary epicardial/microvascular vasospasm, and CMD.
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Affiliation(s)
- John E Madias
- From the Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States.
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Simões JLB, Braga GDC, Coiado JV, Scaramussa AB, Rodrigues APB, Bagatini MD. Takotsubo syndrome as an outcome of the use of checkpoint inhibitor therapy in patients with COVID-19. Biochem Pharmacol 2024; 226:116388. [PMID: 38914315 DOI: 10.1016/j.bcp.2024.116388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/11/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024]
Abstract
Takotsubo Syndrome (TS) is a heart disease caused by extreme exposure of the body to physical or psychological stress. In the context of COVID-19, the virus can be a significant source of stress, with particular attention being paid to the cytokine storm as a cause of damage to the body. New research shows that the production of specific cytokines is linked to the activation of immune checkpoint proteins such as PD-1, PD-L1, and CTLA-4 on T cells. Although initially beneficial in combating infections, it can suppress defense and aid in disease progression. Therefore, checkpoint inhibitor therapy has been highlighted beyond oncological therapies, given its effectiveness in strengthening the immune system. However, this treatment can lead to excessive immune responses, inflammation, and stress on the heart, which can cause Takotsubo Syndrome in patients. Several studies investigate the direct link between this therapy and cardiac injuries in these patients, which can trigger TS. From this perspective, we must delve deeper into this treatment and consider its effects on the prognosis against SARS-CoV-2 infection.
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Affiliation(s)
| | | | - João Victor Coiado
- Medical School, Federal University of Fronteira Sul, Chapecó, SC, Brazil
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Gregory J, Uzuner C. Reverse takotsubo induced cardiogenic shock in the peripartum period: A case report and literature review. Int J Gynaecol Obstet 2024. [PMID: 39049622 DOI: 10.1002/ijgo.15819] [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: 03/15/2024] [Revised: 07/02/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
Reverse takotsubo cardiomyopathy is a rare variant of a rare disease characterized by basal ballooning and dysfunction of the left ventricle. While it can render patients profoundly unwell and reliant on intensivist care, it is a transient phenomenon, with the worst symptoms subsiding after 2-3 days. At term, a young woman spontaneously entered labor prior to a planned repeat cesarean section. After experiencing physical and psychological distress during labor and a vacuum extraction, she developed cardiogenic shock from reverse takotsubo cardiomyopathy, quickly diagnosed with transthoracic echocardiogram. She required 2 days of intensive care support and made an excellent recovery. This very rare condition should be considered in systemically unwell women in the peripartum as it can be quickly diagnosed, providing patients with the best appropriate care.
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Affiliation(s)
- James Gregory
- Department of Obstetrics and Gynecology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Cansu Uzuner
- Department of Obstetrics and Gynecology, Nepean Hospital, Sydney, New South Wales, Australia
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Daralammouri Y, Hamayel H, Abugaber D, Nabulsi S. Takotsubo Cardiomyopathy: Patients Characteristics, Mortality, and Clinical Significance of Left Ventricular Outflow Tract Gradient, Retrospective Study. Cardiol Res Pract 2024; 2024:5549795. [PMID: 39015408 PMCID: PMC11251787 DOI: 10.1155/2024/5549795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/15/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024] Open
Abstract
Background Takotsubo cardiomyopathy (TC) is a reversible left ventricular systolic dysfunction with apical ballooning. Left ventricular outflow tract (LVOT) obstruction may develop in these cases due to hyperdynamic state of the left ventricle. Limited data are available on the prevalence of LVOT gradient in TC and its association with patient outcomes and mortality. Methods Data were collected retrospectively for patients diagnosed with TC in a single tertiary center, demographic information, blood analysis results, and imaging finding including ejection fraction, and LVOT gradient was obtained from medical records. Additionally, medical treatment and outcome during hospitalization were extracted. Follow-up was conducted through cardiology clinic or phone contact. Result A total of 59 patients diagnosed with TC were reviewed during hospitalization, and 40 patients were followed up after discharge by phone contact and cardiology clinic. Most patients were female (91.5%), and nonsignificant coronary artery disease was present in 16.9% of patients. Approximately two-third of the patients had a reduced ejection fraction on admission, and only two patients (5.4%) continued to have reduced ejection fraction on echocardiography follow-up within a period of 2-14 days. LVOT gradient was present in 17 patients (28.5%); patients with preserved ejection fraction had a higher probability of having an LVOT gradient. However, there was no association between LVOT gradient and shock or mortality. Four patients (6.7%) experienced 30-day mortality, while all-cause mortality was reported in eight patients (13.5%) over the follow-up period (mean (±SD) 20.8 months ± 16.2). Conclusion LVOT obstruction may occur in TC patients; it has no correlation with shock or mortality. However, determining whether there is a gradient is important for deciding on specific treatment approach.
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Affiliation(s)
- Yunis Daralammouri
- Department of CardiologyAn-Najah National University Hospital, Nablus, State of Palestine
- Department of MedicineFaculty of Medicine and Health SciencesAn-Najah National University, Nablus, State of Palestine
| | - Hamza Hamayel
- Department of CardiologyAn-Najah National University Hospital, Nablus, State of Palestine
| | - Dina Abugaber
- Department of MedicineFaculty of Medicine and Health SciencesAn-Najah National University, Nablus, State of Palestine
- Department of Critical CareAn-Najah National University Hospital, Nablus, State of Palestine
| | - Sari Nabulsi
- Department of MedicineAn-Najah National University Hospital, Nablus, State of Palestine
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Rizly S, Trivedi D. A Rare Case of Complete Heart Block and Takotsubo Cardiomyopathy in an Elderly Patient: A Case Report. Cureus 2024; 16:e62572. [PMID: 39027780 PMCID: PMC11257766 DOI: 10.7759/cureus.62572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Although Takotsubo cardiomyopathy (TC) is often linked to various tachyarrhythmias, the coexistence of Takotsubo cardiomyopathy and complete heart block is rare, and the cause-and-effect relationship remains unclear. We present the case of an 83-year-old female with a history of known second-degree atrioventricular (AV) block who presented with syncopal episodes and bradycardia. She was diagnosed with a complete heart block requiring a dual-chamber pacemaker. Upon case review, transthoracic echocardiography revealed severe apical hypokinesis, prompting coronary angiography, which showed normal coronary arteries, consistent with Takotsubo cardiomyopathy. This case explores the relationship between Takotsubo cardiomyopathy and complete heart block, as well as the potential pathophysiological mechanisms involved.
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Affiliation(s)
- Shaheen Rizly
- Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Dhaval Trivedi
- Internal Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
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Jessen N, Butt JH, Torp-Pedersen C, Kragholm K. Reply to: More data on the association of Takotsubo syndrome and stroke are warranted. Int J Cardiol 2024; 402:131848. [PMID: 38346452 DOI: 10.1016/j.ijcard.2024.131848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Nicolai Jessen
- General medicine Department and Internal Medicine Outpatient Clinic, Jakobstad, Finland.
| | | | | | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Li S, Yang S, Zhou S, Zhang S, Li X, Zhang H, Ren P, Liu Y, Liu Y, Chen Y. Is Takotsubo syndrome induced by patent ductus arteriosus occlusion? BMC Cardiovasc Disord 2024; 24:135. [PMID: 38431545 PMCID: PMC10908159 DOI: 10.1186/s12872-024-03788-0] [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: 10/10/2023] [Accepted: 02/14/2024] [Indexed: 03/05/2024] Open
Abstract
Takotsubo syndrome (TTS), commonly referred to as "broken heart syndrome," is a distinctive form of acute and reversible heart failure that primarily affects young to middle-aged individuals, particularly women. While emotional or physical stressors often trigger TTS, rare cases have been linked to interventional procedures for congenital heart disease (CHD). Despite its recognition, the exact causes of TTS remain elusive. Research indicates that dysregulation in autonomic nerve function, involving sympathetic and parasympathetic activities, plays a pivotal role. Genetic factors, hormonal influences like estrogen, and inflammatory processes also contribute, unveiling potential gender-specific differences in its occurrence. Understanding these multifaceted aspects of TTS is crucial for refining clinical approaches and therapies. Continued research efforts will not only deepen our understanding of this syndrome but also pave the way for more targeted and effective diagnostic and treatment strategies. In this report, we conduct an in-depth analysis of a case involving a TTS patient, examining the illness progression and treatment procedures. The aim of this analysis is to enhance the understanding of TTS among primary care physicians. By delving into this case, we aspire to prevent misdiagnosis of typical TTS cases that patients may present, thereby ensuring a more accurate diagnosis and appropriate treatment.
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Affiliation(s)
- Shuhao Li
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China
| | - Senyan Yang
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China
| | - Shujing Zhou
- Faculty of Medicine, University of Debrecen, 4032, Debrecen, Hungary
| | - Shuang Zhang
- MianYang Central Hospital, Sichuan Province, People's Republic of China
| | - Xueying Li
- Second People's Hospital of Ya'an City, Sichuan Province, People's Republic of China
| | - Haibo Zhang
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China
| | - Ping Ren
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China
| | - Yanwu Liu
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China
| | - Ying Liu
- Department of Cardiology, Sixth Medical Center, PLA General Hospital, Beijing, People's Republic of China.
| | - Yuanguo Chen
- Department of Cardiovascular Medicine, the Ya'an People's Hospital, Sichuan Province, People's Republic of China.
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Mishra T, Saha R, Paramasivam G. Takotsubo cardiomyopathy in India and its electrocardiography (ECG) comparison to myocardial infarction. Egypt Heart J 2024; 76:26. [PMID: 38381355 PMCID: PMC10881923 DOI: 10.1186/s43044-024-00453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Owing to the limited research on Takotsubo Cardiomyopathy (TCM) in Asia, we aim to evaluate in detail the clinical profiles, lab parameters, investigations, and major adverse cardiovascular events (MACE) seen in patients with TCM in the Indian subcontinent. Additionally, we have compared the electrocardiographic findings of patients with TCM to those of patients with myocardial infarction (MI). RESULTS The average age of the patients affected was found to be 60 ± 11 years. Women (87.5%) and patients with hypertension (40%) were found to be at an increased risk of developing the syndrome. The most common presenting symptom was dyspnea (48%) following a trigger most commonly emotional (45%). ST elevation and significant T wave inversions were observed in 40% of patients with TCM. Echocardiography revealed a low left ventricular ejection fraction of 43 ± 9%. Coronary angiography was normal in 60%, the rest had mild/subcritical stenoses. The 6-month MACE was 20% and the mortality rate was 7.5%. Follow-up echocardiography of patients with TCM showed improvement in EF in 75% patients. CONCLUSIONS TCM was majorly seen in postmenopausal women following an emotional trigger, but a variety of other triggers were noted. T-wave inversions in TCM follow a diffuse pattern in contrast to specific leads seen in MI. Normal or subcritical stenosis in coronaries at presentation, along with a low EF which improves on follow up provide greater evidence for the diagnosis of TCM.
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Affiliation(s)
- Tanisha Mishra
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India
| | - Rijushree Saha
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India
| | - Ganesh Paramasivam
- Department of Cardiology, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Manipal, Karnataka, 576104, India.
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Simões JLB, Braga GDC, Mittelmann TH, Bagatini MD. Current Pharmacology and Modulation of the Purinergic System in Takotsubo Syndrome Triggered by Cytokine Storm. Curr Probl Cardiol 2024; 49:102019. [PMID: 37544631 DOI: 10.1016/j.cpcardiol.2023.102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Studies show that with the COVID-19 pandemic, the world's population went through multiple stress and anxiety factors, generating serious psychological problems, in addition, the virus also caused damage and physical stress to those contaminated. In this way, the intense emotional experiences and stressful effects on the body caused by SARS-CoV-2 are capable of triggering the excessive release of catecholamines in the body. Thus, the framework of Takotsubo Syndrome is characterized by myocardial dysfunction as a response of cardiac receptors to the spillage of such hormones in an unregulated way in the human body. The purinergic system plays a central role in this process, as it actively participates in actions responsible for the syndromic cascade, such as the stress generated by the cytokine storm triggered by the virus and the stimulation of deregulated catecholamine release. Therefore, further pharmacological studies on the role of purines in this pathology should be developed in order to avoid the evolution of the syndrome and to modulate its P1 and P2 receptors aiming at developing means of reversing or treating the Takotsubo Syndrome.
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Hwang EH, Koo JH, Lee YH, Song JH, Lim YC. Neurogenic pulmonary edema and Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2023; 165:3677-3684. [PMID: 37924360 DOI: 10.1007/s00701-023-05824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Neurogenic pulmonary edema (NPE) combined with Takotsubo cardiomyopathy (TCM) is a rare condition associated with aneurysmal subarachnoid hemorrhage (aSAH). Although several mechanisms have been proposed, the pathophysiology and management strategies are not yet fully established. We aimed to determine the radiological and clinical outcomes of patients with NPE and with TCM after aSAH to propose management strategies. METHODS We analyzed the data of 564 patients with aSAH recorded at a single medical center from February 2015 to July 2022. This study retrospectively investigated the incidence and demographics of SAH combined with both NPE and TCM and the clinical outcomes of the patients. Correlating factors, independently associated with NPE-TCM, were also investigated. RESULTS During the 7 years, 11 (2.0%) of 564 patients had NPE complicated with TCM after aSAH. Seven of 11 (63.6%) patients had poor-grade SAH (Hunt-Hess Grade 4 to 5). Three of 11 patients had a posterior circulation in the NPE-TCM group. The most prevalent treatment option was endovascular coil embolization, except for one case of clip. Long-term outcomes were favorable in 6 of 11 patients, and there was one case of mortality. Age, troponin I level, and alveolar-arterial oxygen gradient were correlating factors of NPE-TCM. CONCLUSION Although NPE-TCM represents a rare complication associated with aSAH, achieving active resolution of underlying neurological causes through early and appropriate treatment may contribute to a favorable prognosis. Considering the limited incidence of SAH complicated with NPE-TCM, a multi-center study may be needed.
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Affiliation(s)
- Eui-Hyun Hwang
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ja Ho Koo
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yeon Hu Lee
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ji Hye Song
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
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Jessen N, Andersen JA, Tayal B, Østergaard L, Andersen MP, Schmidt M, Fosbøl EL, Schou M, Søgaard P, Gislason G, Torp-Pedersen C, Køber L, Kragholm K. Takotsubo syndrome and stroke risk: A nationwide register-based study. Int J Cardiol 2023; 392:131283. [PMID: 37619873 DOI: 10.1016/j.ijcard.2023.131283] [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: 07/04/2023] [Revised: 08/10/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
AIMS Previous small-scale studies have indicated a short-term stroke incidence of 1.0-1.3% following Takotsubo (syndrome). In this nationwide register-based study, we investigated the 90-day risk of ischemic stroke (IS) or transient ischemia attack (TIA) and mortality of patients with Takotsubo. METHODS AND RESULTS Patients with incident Takotsubo between January 1st 2009 to September 30th 2018 were identified from Danish nationwide registries. Takotsubo patients were age- and sex-matched with background-, atrial fibrillation/flutter- (AF) and myocardial infarction (MI) cohorts. Cumulative incidences and Cox proportional-hazard regression models were used to analyze the following outcomes: 1) composite of IS/TIA and 2) all-cause mortality. A total of 890 patients with Takotsubo were followed for 90 days. The cumulative 90-day incidence of IS/TIA in the Takotsubo-, background-, AF- and MI cohort, was 2.1% (n = 19), 0.1% (n = 4), 1.1% (n = 47) and 1.5% (n = 66), respectively. The cumulative 90-day mortality in the Takotsubo-, background-, AF- and MI cohort was 5.1% (n = 45), 0.3% (n = 13), 1.7% (n = 75) and 5.6% (n = 230), respectively. The adjusted hazard ratio (HR) for 90-day IS/TIA was when compared to the background-, AF- and MI cohort, 26.43 (95% CI: 8.82-79.24), 1.91 (95% CI: 1.09-3.35) and 2.06 (95% CI: 1.12-3.79), respectively. The adjusted HR for 90-day mortality was when compared to the background-, AF- and MI cohort, 14.19 (95% CI: 7.43-27.09), 0.73 (95% CI: 0.52-1.02) and 1.96 (95% CI: 1.25-3.07), respectively. CONCLUSION Patients with Takotsubo had an increased 90-day hazard for IS/TIA when compared to age- and sex-matched background-, AF- and MI cohorts.
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Affiliation(s)
- Nicolai Jessen
- General medicine department and Internal Medicine Outpatient Clinic, Jakobstad, Finland.
| | | | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Lauge Østergaard
- The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Morten Schmidt
- Department of Cardiology and Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | | | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Ramírez-Aragón S, Del Pino-Camposeco J, Villanueva-Castro E, Canela-Calderon O, Arriada-Mendicoa JN, Ponce-Gómez JA. A Postoperative Complication of Takotsubo Syndrome in the Spinal Surgery: A Case Report. Cureus 2023; 15:e51034. [PMID: 38264385 PMCID: PMC10805121 DOI: 10.7759/cureus.51034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
We present the case of a 32-year-old woman with a diagnosis of lumbar root syndrome and spondylolisthesis, which is why she underwent surgery. Anterior discectomy and intersomatic box placement plus posterior fixation were performed with percutaneous transpedicular screws in L5-S1. At 24 hours of the procedure, the patient presents sustained hypotension, adding sudden and intense chest pain with neck irradiation, dyspnea, and diaphoresis, as well as electrocardiographic abnormalities and elevation of cardiac enzymes suggestive of an acute coronary syndrome, subsequently evidence of basal hypokinesis in the echocardiogram. After providing hemodynamic support and analgesic management, the symptoms were resolved, and the electrocardiogram (ECG) and cardiac enzymes were normalized, allowing an adequate postoperative evolution.
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Affiliation(s)
- Sergio Ramírez-Aragón
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Jorge Del Pino-Camposeco
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Obet Canela-Calderon
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Sayama K, Sugiyama T, Kanaji Y, Hoshino M, Misawa T, Hada M, Nagamine T, Hanyu Y, Nogami K, Ueno H, Matsuda K, Sakamoto T, Yonetsu T, Kakuta T. Prognostic utility of the pericoronary fat attenuation index in patients with takotsubo cardiomyopathy. J Cardiovasc Comput Tomogr 2023; 17:413-420. [PMID: 37743156 DOI: 10.1016/j.jcct.2023.09.001] [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: 05/02/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND The etiology of takotsubo cardiomyopathy (TCM) remains poorly understood and no optimal management strategy has been established. Identification of features associated with poor outcomes may improve the prognosis of patients with TCM. We aimed to identify the predictors of poor prognosis in patients with TCM using coronary computed tomography angiography (CCTA). METHODS We enrolled consecutive patients with TCM who underwent CCTA during the acute disease phase. The pericoronary fat attenuation index (FAI) of adipose tissue was obtained from CCTA images. Major adverse cardiac and cerebrovascular events (MACCE) were defined as all-cause death, non-fatal myocardial infarction, stroke, rehospitalization due to congestive heart failure, and TCM recurrence. The relationships between patient characteristics and CCTA findings were compared between patients with and without MACCE. RESULTS A total of 52 patients were included (10 men [19.2%]; mean age, 71 years). After a median follow-up of 23 months, MACCE had developed in 10 patients (19.2%). There were significant differences in clinical characteristics [including the three-vessel mean FAI (FAI-mean)] between patients with and without MACCE. Univariate Cox regression analyses showed that FAI-mean ≥ -68.94 Hounsfield units (cut-off value derived from receiver operating characteristic curve analysis) (hazard ratio [HR], 13.52; 95% confidence interval [CI], 1.705-107.2; p = 0.014) and NT-proBNP (HR, 1.000; 95% CI, 1.000-1.000; p = 0.022) were significant predictors of MACCE. FAI-mean ≥ -68.94 HU was significantly associated with MACCE (chi-squared statistic = 10.3, p = 0.001). CONCLUSION In patients with TCM, a higher FAI-mean was significantly associated with poorer outcomes independent of the conventional risk factors.
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Affiliation(s)
- Kodai Sayama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Toru Misawa
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tatsuhiro Nagamine
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoshihiro Hanyu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hiroki Ueno
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kazuki Matsuda
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tatsuya Sakamoto
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
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14
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Al‐sadi A, Al‐Qahtani A, Al‐Khalaila O, Jawarneh I, Karim SA. An ophthalmologist with myocardial bridging developed takotsubo cardiomyopathy while operating; A case report and literature review. Clin Case Rep 2023; 11:e7353. [PMID: 38028065 PMCID: PMC10665582 DOI: 10.1002/ccr3.7353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message Healthcare workers are prone to very high level of physical as well as emotional stress that lead to devastating health-related consequences which include but not limited to cardiovascular events that may lead to death. Recognizing the risk of Takotsubo Cardiomyopathy among healthcare worker is the main aim of this report. Abstract Takotsubo Cardiomyopathy (TC) is a reversible left ventricular wall motion abnormality that could not be explained by coronary artery disease and is typically precipitated by either emotional or physical stress. There is no sufficient data regarding the incidence of TC among healthcare workers and people with myocardial bridging. Here we are describing a case of an ophthalmologist with myocardial bridging who developed TC while in the operation theater.
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Affiliation(s)
- Anas Al‐sadi
- Department of Internal MedicineHamad medical corporationDohaQatar
| | - Awad Al‐Qahtani
- Department of Cardiology, Heart HospitalHamad Medical CorporationDohaQatar
| | - Osama Al‐Khalaila
- Department of Cardiology, Heart HospitalHamad Medical CorporationDohaQatar
| | - Israa Jawarneh
- Department of Internal MedicineKing Abdullah University HospitalAr RamthaJordan
| | - Sabir Abdul Karim
- Department of Cardiology, Heart HospitalHamad Medical CorporationDohaQatar
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15
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Saito Y, Watanabe T, Ishigaki T, Toyoshima M, Katawaki W, Toshima T, Takahashi T, Yamanaka T, Watanabe M. Recurrent Takotsubo Syndrome Presenting with Different Ballooning Patterns and Electrocardiographic Abnormalities. Intern Med 2023; 62:2977-2980. [PMID: 36889703 PMCID: PMC10641188 DOI: 10.2169/internalmedicine.1564-23] [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: 01/06/2023] [Accepted: 02/01/2023] [Indexed: 03/09/2023] Open
Abstract
A 73-year-old woman presented with takotsubo syndrome with apical ballooning patterns after quarreling with her husband. Two years later, she was admitted to the hospital with chest pain after experiencing the same emotional stress. Her electrocardiogram showed different abnormalities compared to the previous event, and her left ventriculogram demonstrated takotsubo syndrome with mid-ventricular ballooning patterns. Recurrence of takotsubo syndrome with different ballooning patterns is rare. We herein report our experience with a patient who developed recurrent takotsubo syndrome with various ballooning patterns and different electrocardiographic abnormalities along with a literature review.
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Affiliation(s)
- Yuji Saito
- Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Japan
| | - Taiga Ishigaki
- Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Mashu Toyoshima
- Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Wataru Katawaki
- Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Taku Toshima
- Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Tetsuya Takahashi
- Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Tamon Yamanaka
- Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Japan
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16
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Gaddam RR, Amalkar VS, Sali VK, Nakuluri K, Jacobs JS, Kim YR, Li Q, Bahal R, Irani K, Vikram A. Role of miR-204 in segmental cardiac effects of phenylephrine and pressure overload. Biochem Biophys Res Commun 2023; 675:85-91. [PMID: 37454401 DOI: 10.1016/j.bbrc.2023.07.011] [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: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Cardiotoxicity caused by adrenergic receptor agonists overdosing or stress-induced catecholamine release promotes cardiomyopathy, resembling Takotsubo cardiomyopathy (TC). TC is characterized by transient regional systolic dysfunction of the left ventricle. The animal models of TC and modalities for assessing regional wall motion abnormalities in animal models are lacking. We previously reported the protective role of a small noncoding microRNA-204-5p (miR-204) in cardiomyopathies, but its role in TC remains unknown. Here we compared the impact of miR-204 absence on phenylephrine (PE)-induced and transaortic constriction (TAC)-induced changes in cardiac muscle motion in the posterior and anterior apical, mid, and basal segments of the left ventricle using 2-dimensional speckle-tracking echocardiography (2-STE). Wildtype and miR-204-/- mice were subjected to cardiac stress in the form of PE for four weeks or TAC-induced pressure overload for five weeks. PE treatment increased longitudinal and radial motion in the apex of the left ventricle and shortened the peak motion time of all left ventricle segments. The TAC led to decreased longitudinal and radial motion in the left ventricle segments, and there was no difference in the peak motion time. Compared to wildtype mice, PE-induced peak cardiac muscle motion time in the anterior base of the left ventricle was significantly earlier in the miR-204-/- mice. There was no difference in TAC-induced peak cardiac muscle motion time between wildtype and miR-204-/- mice. Our findings demonstrate that PE and TAC induce regional wall motion abnormalities that 2-STE can detect. It also highlights the role of miR-204 in regulating cardiac muscle motion during catecholamine-induced cardiotoxicity.
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Affiliation(s)
- Ravinder Reddy Gaddam
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Veda Sudhir Amalkar
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Veeresh Kumar Sali
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Krishnamurthy Nakuluri
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Julie S Jacobs
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Young-Rae Kim
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Quixia Li
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Raman Bahal
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, CT-06269, USA
| | - Kaikobad Irani
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA, USA; Veterans Affairs Medical Center, Iowa City, IA, USA, Department of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - Ajit Vikram
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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17
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Amaro T, Sgarbi T, Vieira R, Santos RR, Matos P, Oliveira A. Incidental cerebral aneurysm after takotsubo cardiomyopathy: A case report. Clin Case Rep 2023; 11:e7998. [PMID: 37799569 PMCID: PMC10547853 DOI: 10.1002/ccr3.7998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
Takotsubo syndrome (TS) is an acute heart disease that mimics the typical features of acute coronary syndrome (ACS). TS is generally reported after subarachnoid hemorrhage (SAH) due to a ruptured aneurysm, and has an incidence rate of 0.8 (17%). Here, we report a rare case of TS with unruptured intracranial aneurism. A 54-year-old woman had a history of systemic arterial hypertension and migraine. She went to a secondary hospital 2 h after sudden-onset chest pain, which irradiated to the left upper limb and back. The initial electrocardiogram (ECG) was normal but showed a troponin curve, which led us to suspect acute non-ST elevation myocardial infarction. Serial ECG showed dynamic changes in ST-segment elevation in DIII, AvF, V5, and V6. Emergency cardiac catheterisation was performed and did not show any obstructive lesions. However, ventriculography revealed hypokinesia of the inferoapical wall. During hospitalization, the patient had a severe refractory headache. Computed tomography (CT) and CT angiography were performed, which identified "mirror" saccular aneurysms. A supraclinoid internal carotid artery aneurysm was embolized with two stents. The patient's condition progressed satisfactorily. The association between takotsubo syndrome and aneurysmal SAH with some populations has already been reported. Due to this prior knowledge, and severe headache, it was necessary to perform screening for SAH and the discovery of an unruptured aneurysm in this case report. The present case report differs from most reported cases of takotsubo syndrome described in the literature because it presents unruptured mirror aneurysms, while most cases are diagnosed after intracranial hemorrhage.
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Affiliation(s)
- Tânia Amaro
- Cardiology DepartmentClínica GirassolLuandaAngola
| | | | - Raísa Vieira
- Faculdade de Medicina da Universidade Estacio de Sá Campos Citta AméricaRio de JaneiroBrazil
| | | | - Priscila Matos
- Faculdade de Medicina da Universidade Estacio de Sá Campos Citta AméricaRio de JaneiroBrazil
| | - Adilson Oliveira
- Centro NeurociênciaClínica GirassolLuandaAngola
- Centro de Estudos Avançados em Formação e Educação Médica–CEDUMED–FMUANLuandaAngola
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18
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Munoz NR, Agwuegbo CC, Ghorbani A, Vincent Coralde JM, Abdelmalik R. Takotsubo Cardiomyopathy Induced by Stress From Amyotrophic Lateral Sclerosis and a Mechanical Fall. Cureus 2023; 15:e47068. [PMID: 38021968 PMCID: PMC10653622 DOI: 10.7759/cureus.47068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Named after the Japanese octopus trap, Takotsubo cardiomyopathy is an acute myocardial condition characterized by a reversible ventricular dysfunction with ballooning of the left ventricle (LV) during systole. A catecholamine surge is likely the primary mechanism responsible for myocardial damage in this condition. The association between amyotrophic lateral sclerosis (ALS) and Takotsubo cardiomyopathy has not been well established. We present a unique case of Takotsubo cardiomyopathy diagnosed in a patient with ALS who presented after a fall with shortness of breath, generalized weakness, and hypotension. She was found to have troponinemia, elevated brain natriuretic peptide, and Osborn waves without ST-segment changes noted on electrocardiography (EKG). The diagnosis of Takotsubo cardiomyopathy was confirmed via transthoracic echocardiography (TTE), which revealed reduced left ventricular ejection fraction, apical ballooning of the LV, akinesis of the ventricular apex, and hyperkinesis of the base of the heart. Coronary angiography revealed no coronary artery disease. She was managed medically and was hemodynamically stable at the time of discharge.
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Affiliation(s)
| | | | - Ali Ghorbani
- Internal Medicine, Southwest Healthcare, Temecula, USA
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19
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Krittanawong C, Khawaja M, Tamis‐Holland JE, Girotra S, Rao SV. Acute Myocardial Infarction: Etiologies and Mimickers in Young Patients. J Am Heart Assoc 2023; 12:e029971. [PMID: 37724944 PMCID: PMC10547302 DOI: 10.1161/jaha.123.029971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Acute myocardial infarction is an important cause of death worldwide. While it often affects patients of older age, acute myocardial infarction is garnering more attention as a significant cause of morbidity and mortality among young patients (<45 years of age). More specifically, there is a focus on recognizing the unique etiologies for myocardial infarction in these younger patients as nonatherosclerotic etiologies occur more frequently in this population. As such, there is a potential for delayed and inaccurate diagnoses and treatments that can carry serious clinical implications. The understanding of acute myocardial infarction manifestations in young patients is evolving, but there remains a significant need for better strategies to rapidly diagnose, risk stratify, and manage such patients. This comprehensive review explores the various etiologies for acute myocardial infarction in young adults and outlines the approach to efficient diagnosis and management for these unique patient phenotypes.
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Affiliation(s)
| | - Muzamil Khawaja
- Cardiology DivisionEmory University School of MedicineAtlantaGAUSA
| | | | - Saket Girotra
- Division of Cardiovascular MedicineUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Sunil V. Rao
- New York University Langone Health SystemNew YorkNYUSA
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20
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Bhanushali A, Kohli M, Prakash A, Sarvepalli SR, Pandey A, Odugbemi O, Reyaz N, Trambadia B, Reddy SA, Chauhan S, Desai R. Spontaneous coronary artery dissection-associated takotsubo syndrome: A systematic review of case reports. World J Cardiol 2023; 15:406-414. [PMID: 37771341 PMCID: PMC10523194 DOI: 10.4330/wjc.v15.i8.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/24/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is underdiagnosed and requires comprehensive angiographic findings. Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome (TTS) or exist simultaneously, making it challenging for clinicians to treat and manage. Case reports lack consolidated data. We examined SCAD-TTS case reports. AIM To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS. METHODS SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed, EMBASE, Scopus, and Google Scholar databases till January 2023. Case reports described demographics, comorbidities, imaging, management, and results. RESULTS Twelve articles about 20 female patients were analyzed. 30% of patients (n = 6, > 60 years) were elderly (mean age 56.2 ± 9.07 years, range 36-70 years). Canada has 9 cases, United States 3, Australia 3, Sweden 2, Japan, Denmark, and France 1. Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS. Nine had hypertension, 2 had hyperlipidemia, and 1 had prediabetes. 5 patients (25%) smoked. 10 (50%) troponin-positive myocardial infarction patients reported chest discomfort. 11 (55%) of 20 instances had TTS/SCAD. 12 (60%) of 20 patients exhibited ST elevation and 3 (15%) had T wave inversion on electrocardiogram. 19/20 patients had elevated troponin. 9 (45%) of 20 people had apical akinesis with TTS ballooning on cardiac imaging. All 20 exhibited echocardiographic wall motion abnormalities. 19 (95%) of 20 coronary angiography cases had SCAD. 10 of 19 SCAD patients had left anterior descending, 2 diagonal, and 2 left circumflex coronary artery involvement. 7 of 20 patients had left ventricular ejection fraction (LVEF) data. LVEF averaged 38.78 ± 7.35%. 5 (25%) of the 20 cases underwent dual antiplatelet therapy. Three (15%) of 20 cases experienced occasional ectopic ventricular complexes, Mobitz ll AV block, and paroxysmal atrial fibrillation. All 20 cases recovered and survived. CONCLUSION Given the clinical similarities and challenges in detecting TTS and SCAD, this subset needs more research to raise awareness and reduce morbidity.
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Affiliation(s)
- Aditi Bhanushali
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Muskan Kohli
- Department of Population Health & Leadership, University of New Haven, West Haven, CT 06516, United States
| | - Ananya Prakash
- Department of Medicine, Vydehi Institute of Medical Sciences and Research Center, Bangalore 560066, Karnataka, India
| | - Svaapnika Rao Sarvepalli
- Department of Population Health & Leadership, University of New Haven, West Haven, CT 06516, United States
| | - Anchal Pandey
- Department of Medicine, G.S.V.M. Medical College, Kanpur 208002, Uttar Pradesh, India
| | - Olufemi Odugbemi
- Department of Internal Medicine, Lincoln Medical and Mental Health Centre, Bronx, NY 10451, United States
| | - Nafisa Reyaz
- Department of Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh 202002, UP, India
| | - Bansi Trambadia
- Master of Public Health, Mount Sinai, New York, NY 10029, United States
| | | | - Shaylika Chauhan
- Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States.
| | - Rupak Desai
- Independent Researcher, Independent Researcher, Atlanta, GA 30079, United States
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21
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Oliveira GMMD, Almeida MCCD, Rassi DDC, Bragança ÉOV, Moura LZ, Arrais M, Campos MDSB, Lemke VG, Avila WS, Lucena AJGD, Almeida ALCD, Brandão AA, Ferreira ADDA, Biolo A, Macedo AVS, Falcão BDAA, Polanczyk CA, Lantieri CJB, Marques-Santos C, Freire CMV, Pellegrini D, Alexandre ERG, Braga FGM, Oliveira FMFD, Cintra FD, Costa IBSDS, Silva JSN, Carreira LTF, Magalhães LBNC, Matos LDNJD, Assad MHV, Barbosa MM, Silva MGD, Rivera MAM, Izar MCDO, Costa MENC, Paiva MSMDO, Castro MLD, Uellendahl M, Oliveira Junior MTD, Souza OFD, Costa RAD, Coutinho RQ, Silva SCTFD, Martins SM, Brandão SCS, Buglia S, Barbosa TMJDU, Nascimento TAD, Vieira T, Campagnucci VP, Chagas ACP. Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023. Arq Bras Cardiol 2023; 120:e20230303. [PMID: 37556656 PMCID: PMC10382148 DOI: 10.36660/abc.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Denise Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | - Fabiana Goulart Marcondes Braga
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Lara Terra F Carreira
- Cardiologia Nuclear de Curitiba, Curitiba, PR - Brasil
- Hospital Pilar, Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Marly Uellendahl
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | - Ricardo Quental Coutinho
- Faculdade de Ciências Médicas da Universidade de Pernambuco (UPE), Recife, PE - Brasil
- Hospital Universitário Osvaldo Cruz da Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | | | - Sílvia Marinho Martins
- Pronto Socorro Cardiológico de Pernambuco da Universidade de Pernambuco (PROCAPE/UPE), Recife, PE - Brasil
| | | | - Susimeire Buglia
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Thais Vieira
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Rede D'Or, Aracaju, SE - Brasil
- Hospital Universitário da Universidade Federal de Sergipe (UFS), Aracaju, SE - Brasil
| | | | - Antonio Carlos Palandri Chagas
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Centro Universitário Faculdade de Medicina ABC, Santo André, SP - Brasil
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22
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Nakajima T, Iba Y, Shibata T, Kawaharada N. A Case of Takotsubo Cardiomyopathy After Mitral Valvuloplasty. Cureus 2023; 15:e43175. [PMID: 37692607 PMCID: PMC10484754 DOI: 10.7759/cureus.43175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
We present a case of an 82-year-old male patient with a history of severe mitral regurgitation, severe aortic regurgitation, chronic atrial fibrillation, and suicide attempts due to depression. The patient underwent mitral valvuloplasty and aortic valve replacement for mitral valve regurgitation and aortic valve regurgitation. The patient was extubated on the morning of the sixth postoperative day, but he was reintubated in the evening because of hypotension and an unstable respiratory status. Echocardiography revealed Takotsubo cardiomyopathy development, and the patient was treated with intra-aortic balloon pump (IABP) implantation, which was removed on postoperative day 11.
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Affiliation(s)
| | - Yutaka Iba
- Cardiovascular Surgery, Sapporo Medical University, Sapporo, JPN
| | - Tsuyoshi Shibata
- Cardiovascular Surgery, Sapporo Medical University, Sapporo, JPN
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23
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Cimaroli S, Maniar Y, Ciancarelli J, Stright A, Joseph D. Takotsubo cardiomyopathy following blunt trauma: Early recognition and diagnosis. Trauma Case Rep 2023; 46:100855. [PMID: 37292438 PMCID: PMC10245330 DOI: 10.1016/j.tcr.2023.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
Background Takotsubo Cardiomyopathy (TTC) is characterized by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery disease. While TTC is usually preceded by an emotionally stressful event, physical trauma has been documented as a precipitating incident as well. Case summary An 82-year-old female with no past medical history, presented to the emergency department following a motor vehicle collision. Trauma workup was significant for an ulnar fracture, elevated cardiac enzymes, and ST-segment changes. Bedside echocardiogram revealed apical ballooning. She underwent cardiac catheterization, which failed to demonstrate significant coronary artery disease. The patient developed cardiogenic shock and required temporary vasopressor support after failing a trial of intra-aortic balloon pump. Conclusion Takotsubo Cardiomyopathy is a rare complication of trauma, which presents with signs and symptoms similar to acute coronary syndrome (ACS) but without evidence of obstructive coronary artery disease. Following trauma, signs of ACS in elderly women should raise provider's suspicion for TTC and prompting bedside echocardiography, which can assist with early diagnosis.
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24
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Limper U, Keipke D, Lindenbeck L, Lanz F, Kramer C, Meissner A, Wappler F, Annecke T. A case of recurring perioperative circulatory arrest: mind the autonomic nervous system. Clin Auton Res 2023; 33:543-547. [PMID: 37285112 PMCID: PMC10439036 DOI: 10.1007/s10286-023-00953-x] [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: 04/04/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023]
Abstract
We report the case of an elderly woman who developed recurring episodes of unexplained cardiocirculatory arrest. The index event appeared during surgery to fix a fracture of the ankle and consisted of bradypnea, hypotension and asystole, coherent with a Bezold-Jarisch-like cardioprotective reflex. Classical signs of acute myocardial infarction were absent. Yet, occlusion of the right coronary artery (RCA) was observed and successfully revascularized, whereupon circulatory arrests vanished. We discuss several differential diagnoses. Unexplainable circulatory failure, with sinus bradycardia and arterial hypotension, despite lack of ECG signs of ischemia or significant troponin levels, suggest the action of cardioprotective reflexes of the autonomic nervous system. Coronary artery disease is a common source. Attention to cardioprotective reflexes should be taken in the case of unexplained cardiac arrest without overt reasons. We recommend performing coronary angiography to exclude significant coronary stenosis.
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Affiliation(s)
- Ulrich Limper
- Department of Anaesthesiology and Critical Care Medicine, Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Straße 200, 51109, Cologne, Germany.
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.
| | - Dorothee Keipke
- Department of Anaesthesiology and Critical Care Medicine, Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Straße 200, 51109, Cologne, Germany
| | - Lars Lindenbeck
- Department of Anaesthesiology and Critical Care Medicine, Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Straße 200, 51109, Cologne, Germany
| | - Friederike Lanz
- Department of Cardiology, Merheim Medical Center, Cologne, Germany
| | - Claudia Kramer
- Department of Cardiology, Merheim Medical Center, Cologne, Germany
| | - Axel Meissner
- Department of Cardiology, Merheim Medical Center, Cologne, Germany
| | - Frank Wappler
- Department of Anaesthesiology and Critical Care Medicine, Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Straße 200, 51109, Cologne, Germany
| | - Thorsten Annecke
- Department of Anaesthesiology and Critical Care Medicine, Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Straße 200, 51109, Cologne, Germany
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25
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Szatko A, Glinicki P, Gietka-Czernel M. Pheochromocytoma/paraganglioma-associated cardiomyopathy. Front Endocrinol (Lausanne) 2023; 14:1204851. [PMID: 37522121 PMCID: PMC10374018 DOI: 10.3389/fendo.2023.1204851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Pheochromocytoma/paraganglioma (PPGL) are neuroendocrine tumors that frequently produce and release catecholamines. Catecholamine excess can manifest in several cardiovascular syndromes, including cardiomyopathy. PPGL-induced cardiomyopathies occur in up to 11% of cases and are most often associated with an adrenal pheochromocytoma (90%) and rarely with a paraganglioma derived from the sympathetic ganglia (10%). PPGL-associated cardiomyopathies can be chronic or acute, with takotsubo cardiomyopathy being the most often reported. These two types of PPGL-induced cardiomyopathy seem to have different pathophysiological backgrounds. Acute catecholaminergic stress inundates myocardial β-adrenoceptors and leads to left ventricle stunning and slight histological apoptosis. In chronic cardiomyopathy, prolonged catecholamine exposure leads to extended myocardial fibrosis, inflammation, and necrosis, and ultimately it causes dilated cardiomyopathy with a low ejection fraction. Sometimes, especially in cases associated with hypertension, hypertrophic cardiomyopathy can develop. The prognosis appears to be worse in chronic cases with a higher hospital mortality rate, higher cardiogenic shock rate at initial presentation, and lower left ventricular recovery rate after surgery. Therefore, establishing the correct diagnosis at an early stage of a PPGL is essential. This mini-review summarizes current data on pathophysiological pathways of cardiac damage caused by catecholamines, the clinical presentation of PPGL-induced cardiomyopathies, and discusses treatment options.
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Affiliation(s)
- Alicja Szatko
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
- EndoLab Laboratory, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Glinicki
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
- EndoLab Laboratory, Centre of Postgraduate Medical Education, Warsaw, Poland
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Kigure R, Akiyama G, Tosa M, Ogawa R. A Case of Takotsubo Cardiomyopathy after Dermal Burn on the Face and Hands. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5099. [PMID: 37427154 PMCID: PMC10325743 DOI: 10.1097/gox.0000000000005099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023]
Abstract
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or broken heart syndrome, generally has a good prognosis but occasionally causes serious complications. It is often triggered by physical and emotional stressors. Burns have been associated with takotsubo cardiomyopathy in six cases in the literature. We report here the seventh case. The patient, an 86-year-old woman with burn injuries to her face and hands due to a fire in her home, developed takotsubo cardiomyopathy. The condition was suspected soon after presentation due to precautionary electrocardiogram and then laboratory findings of elevated myocardial biomarkers. The diagnosis was then confirmed by left ventriculography. The cardiomyopathy resolved spontaneously without complications. The burn in our patient affected only 5% of total body surface area, but its impact may have been augmented by emotional stress caused by the patient losing her home in the fire. Our review of the six burn-related takotsubo cardiomyopathy cases in the literature showed that two of the cases also had small burns in combination with severe emotional stress. Since all six cases developed serious complications, the possibility of takotsubo cardiomyopathy should be suspected, even with small burns.
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Affiliation(s)
- Ryuta Kigure
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Goh Akiyama
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Mamiko Tosa
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Rei Ogawa
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Kan CFK, Rich B, Brown N, Janes S, Grudziak J. Takotsubo Cardiomyopathy (TCM) After Uncomplicated Paraesophageal Hernia Repair: A Case Report and Review on Postoperative TCM. Cureus 2023; 15:e41770. [PMID: 37575796 PMCID: PMC10416749 DOI: 10.7759/cureus.41770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a rare stress-induced condition that appears rarely in suspected acute myocardial infarction cases. It causes unexplained left ventricular failure, but most cases are reversible with supportive treatment. In this report, we present the case of a 70-year-old female who developed acute hypotension after a laparoscopic Toupet fundoplication on postoperative day one, requiring care in the surgical intensive care unit. Following consultation with the cardiology service and further imaging and tests, she was diagnosed with TCM. This report outlines the potential mechanisms and management of TCM in the intensive care unit, emphasizing the importance of prompt diagnosis and treatment.
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Affiliation(s)
| | - Bianca Rich
- Anesthesiology, University of Utah School of Medicine, Salt Lake City, USA
| | - Noah Brown
- General Surgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Sophia Janes
- Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, USA
| | - Joanna Grudziak
- General Surgery, University of Utah School of Medicine, Salt Lake City, USA
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Gharaibeh K, Hegde P, Malaiyandi D. Takotsubo cardiomyopathy associated with Herpes simplex encephalitis: A case report and literature review. J Neuroimmunol 2023; 381:578138. [PMID: 37393852 DOI: 10.1016/j.jneuroim.2023.578138] [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: 05/08/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy characterized by transient left ventricular dysfunction. It can be triggered by various central nervous system pathologies including status epilepticus (SE) and N-methyl-d-aspartate receptor (NMDAr) encephalitis. Herpex simplex encephalitis (HSE) is a life-threatening, sporadic, encephalitis associated with focal or global cerebral dysfunction caused by herpes simplex viruses type 1(HSV-1), or less commonly, type 2(HSV-2). While approximately 20% of patients with HSE develop NMDAr antibodies, not all manifest with encephalitis clinically. We present here a 77-year-old woman admitted with HSV-1 encephalitis who presented with acute encephalopathy and seizure-like activity. Continuous EEG monitoring (cEEG) showed periodic lateralized epileptiform discharges (PLEDs) involving the left parietotemporal region but no evidence of electrographic seizures. Her early hospital course was complicated by TCM which subsequently resolved on repeat TTE. She demonstrated initial neurological improvement. However, five weeks later her mental status declined. Again, no seizures were appreciated on cEEG. Unfortunately, repeat studies including lumbar puncture and magnetic resonance imaging (MRI) of the brain were consistent with NMDAr encephalitis. She was treated with immunosuppression and immunomodulation therapies. To our knowledge we report the first case of TCM secondary to HSE without comorbid status epilepticus. However, further studies are needed to better understand the correlation between, and underlying pathophysiology of HSE and TCM, as well as any potential association with this presentation and subsequent development of NMDAr encephalitis.
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Affiliation(s)
- Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine, Toledo, OH, United States of America.
| | - Prajwal Hegde
- Department of Neurology, University of Toledo College of Medicine, Toledo, OH, United States of America.
| | - Deepa Malaiyandi
- Division of Neurocritical Care, Department of Neurology, University of Toledo College of Medicine, Toledo, OH, United States of America.
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Candreva A, Templin C. Is Takotsubo syndrome just the tip of the iceberg in the clinical spectrum of coronary microvascular dysfunction? Eur Heart J 2023:7176241. [PMID: 37220394 DOI: 10.1093/eurheartj/ehad264] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Alessandro Candreva
- Department of Cardiology, University Heart Center, Zurich University Hospital, Raemistr. 100, CH-8044 Zurich, Switzerland
- PoliToBIO Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Christian Templin
- Department of Cardiology, University Heart Center, Zurich University Hospital, Raemistr. 100, CH-8044 Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Almalouf C, Hakobyan N, Yadav V, Gandhi A, Yadav R. Cardiac Arrest (CA) as the Initial Presentation of Cocaine-Induced Takotsubo Cardiomyopathy (TCM): A Case Report and Review of Literature. Cureus 2023; 15:e38525. [PMID: 37273300 PMCID: PMC10239072 DOI: 10.7759/cureus.38525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Cocaine is used as an illicit substance responsible for the most common cause of drug-related death. It is a stimulant that acts on the sympathetic nervous system and cardiovascular system leading to exaggerated, prolonged sympathetic activity due to the accumulation of neurotransmitters. Cardiovascular side effects of cocaine are coronary artery spasms, myocarditis, arrhythmias, and congestive heart failure. Takotsubo cardiomyopathy (TCM) is characterized by transient hypokinesis, akinesis, or dyskinesis of the left ventricle (LV) wall with or without apical involvement in the absence of obstructive coronary artery disease. Cocaine-induced TCM is an extremely rare condition emphasizing the need of its prompt diagnosis by the physicians. We present a case report of a 54-year-old male, brought to the emergency department (ED) after an out-of-hospital cardiac arrest (CA), found to have TCM in the setting of cocaine use. Clinicians need to understand the association between cocaine use and the development of TCM as cardiomyopathy of this type can result in complete remission after discontinuing the offending agent.
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Affiliation(s)
- Catherina Almalouf
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
- Internal Medicine, St. George's University School of Medicine, Brooklyn, USA
| | - Narek Hakobyan
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Vivek Yadav
- Pulmonary and Critical Care, State University of New York Downstate Health Sciences University, New York, USA
| | - Anjula Gandhi
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Ruchi Yadav
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
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Truter N, Malan L, Essop MF. Glial cell activity in cardiovascular diseases and risk of acute myocardial infarction. Am J Physiol Heart Circ Physiol 2023; 324:H373-H390. [PMID: 36662577 DOI: 10.1152/ajpheart.00332.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Growing evidence indicates that the pathophysiological link between the brain and heart underlies cardiovascular diseases, specifically acute myocardial infarction (AMI). Astrocytes are the most abundant glial cells in the central nervous system and provide support/protection for neurons. Astrocytes and peripheral glial cells are emerging as key modulators of the brain-heart axis in AMI, by affecting sympathetic nervous system activity (centrally and peripherally). This review, therefore, aimed to gain an improved understanding of glial cell activity and AMI risk. This includes discussions on the potential role of contributing factors in AMI risk, i.e., autonomic nervous system dysfunction, glial-neurotrophic and ischemic risk markers [glial cell line-derived neurotrophic factor (GDNF), astrocytic S100 calcium-binding protein B (S100B), silent myocardial ischemia, and cardiac troponin T (cTnT)]. Consideration of glial cell activity and related contributing factors in certain brain-heart disorders, namely, blood-brain barrier dysfunction, myocardial ischemia, and chronic psychological stress, may improve our understanding regarding the pathological role that glial dysfunction can play in the development/onset of AMI. Here, findings demonstrated perturbations in glial cell activity and contributing factors (especially sympathetic activity). Moreover, emerging AMI risk included sympathovagal imbalance, low GDNF levels reflecting prothrombic risk, hypertension, and increased ischemia due to perfusion deficits (indicated by S100B and cTnT levels). Such perturbations impacted blood-barrier function and perfusion that were exacerbated during psychological stress. Thus, greater insights and consideration regarding such biomarkers may help drive future studies investigating brain-heart axis pathologies to gain a deeper understanding of astrocytic glial cell contributions and unlock potential novel therapies for AMI.
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Affiliation(s)
- Nina Truter
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leoné Malan
- Technology Transfer and Innovation-Support Office, North-West University, Potchefstroom, South Africa
| | - M Faadiel Essop
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Ghobrial M, Karan A, Omar M, Velarde G. The Stressed Heart: A Case Report of Takotsubo Cardiomyopathy in a Patient With Known Coronary Artery Disease. Cureus 2023; 15:e36277. [PMID: 37073186 PMCID: PMC10106009 DOI: 10.7759/cureus.36277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Takotsubo cardiomyopathy and acute coronary syndrome are often clinically indistinguishable, making their differentiation challenging for physicians. We present a case of a 65-year-old female who presented with acute chest pain, shortness of breath, and a recent psychosocial stressor. This is a unique case in which our patient, with known history of coronary artery disease and recent percutaneous intervention, favored a misleading initial diagnosis of non-ST elevation myocardial infarction.
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Shabbir T, Kal S, Gupta S, Hunsucker R, Siddiqui D. An Incidental Finding of Takotsubo Cardiomyopathy in a Trauma Case. Cureus 2023; 15:e35106. [PMID: 36938217 PMCID: PMC10023098 DOI: 10.7759/cureus.35106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
Takotsubo cardiomyopathy (TC) is a transient condition characterized by left ventricular wall motion abnormalities, ventricular systolic dysfunction, and apical ballooning. When initially presented, the pathology is often erroneously attributed to acute coronary syndrome (ACS) or acute-onset heart failure due to similar symptoms and electrocardiogram (ECG) findings. However, upon further review of imaging, coronary arteries are often void of disease. The highest prevalence of Takotsubo cardiomyopathy is noted in elderly, postmenopausal women who recently experienced an emotionally or physically triggering event. Although the true underlying pathophysiology of Takotsubo cardiomyopathy remains poorly elucidated, a few leading concepts suggest that stress-induced sympathetic responses may lead to catecholamine-induced cardiotoxicity. Other ideologies implicate poor coronary perfusion, neurogenic myocardial stunning, and coronary artery vasospasms. As features of TC are transient, it has an excellent prognosis, and patients see improvement in ventricular function and symptoms within weeks after the initiation of therapy. In this paper, we discuss a case of TC noted incidentally on imaging in a middle-aged female presenting with encephalopathy after a motor vehicle accident.
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Affiliation(s)
- Talha Shabbir
- Research, California University of Science and Medicine, Colton, USA
| | - Sarala Kal
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Saloni Gupta
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Rachel Hunsucker
- Internal Medicine, California University of Science and Medicine, Colton, USA
| | - Danish Siddiqui
- Cardiology, Loma Linda University Medical Center, Loma Linda, USA
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Visclosky T, Klekowski N, Sikavitsas A. Pediatric Takotsubo cardiomyopathy resulting from clonidine overdose. Am J Emerg Med 2023; 63:179.e1-179.e4. [PMID: 36216626 DOI: 10.1016/j.ajem.2022.09.037] [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: 04/13/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 12/13/2022] Open
Abstract
Takotsubo cardiomyopathy is a syndrome characterized by localized apical dysfunction of the left ventricle. It is rarely seen in pediatric patients, but can carry significant morbidity and mortality. While most commonly associated with psychosocial stressors or physical exertion, a growing number of cases are being attributed to medications. We describe a case of a six-month-old male diagnosed with Takotsubo cardiomyopathy in the setting of an accidental clonidine overdose. The patient presented with altered mental status and hypertension. In the course of his broad workup, cardiac dysfunction was indicated by bedside ultrasound in the Emergency Department. The classic apical dyskinesis was seen on a follow-up, cardiology-based echocardiogram. The patient responded to high-dose naloxone and only briefly required an epinephrine infusion. His symptoms resolved in a few days and serial echocardiograms showed a return to normal LV function. Rates of pediatric clonidine overdoses are increasing in the setting of changing prescribing practices. Our case illustrates some key features of the clinical presentation, as well as demonstrates a rare sequelae to this common toxic exposure. To our knowledge, this is the first reported pediatric case of Takotsubo cardiomyopathy secondary to a clonidine overdose.
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Affiliation(s)
- Timothy Visclosky
- Department of Emergency Medicine, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109-4260, United States of America.
| | - Nicole Klekowski
- Department of Emergency Medicine, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109-4260, United States of America
| | - Athina Sikavitsas
- Department of Emergency Medicine, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109-4260, United States of America; Department of Pediatrics, University of Michigan, Medical Professional Building, 1522 Simpson Road East, Ann Arbor, MI 48109-5718, United States of America
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Singh H, Ahmed O, Allen E, Othman H. A Case of Stress Cardiomyopathy With Nab-Paclitaxel Infusion. J Investig Med High Impact Case Rep 2023; 11:23247096231209554. [PMID: 37919938 PMCID: PMC10623926 DOI: 10.1177/23247096231209554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023] Open
Abstract
Stress cardiomyopathy is a transient left ventricular dysfunction caused by physiologic or pathologic stressors. Anaphylaxis is a hypersensitivity disorder that can lead to a rapid life-threatening respiratory collapse. It happens due to exposure to allergens including medications. During anaphylaxis, there is a compensatory release of catecholamines that can lead to stress cardiomyopathy. In this case, nab-paclitaxel infusion led to anaphylaxis with respiratory failure. Echocardiogram showed features of diffuse hypokinesis with preserved basal segment contractility, and cardiac catheterization did not show any evidence of obstructive coronary artery disease. The overall clinical picture suggested stress cardiomyopathy. The patient was treated with guideline-directed medical therapy which resulted in normalization of the ejection fraction with no symptoms of congestive heart failure at any point. The patient was thereafter resumed on a reduced dose of nab-paclitaxel. This case report adds to the spectrum of infusion-related reactions associated with paclitaxel and demonstrates the course of events in the management of anaphylaxis and stress cardiomyopathy in this scenario.
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Affiliation(s)
| | - Omair Ahmed
- Henry Ford Allegiance Health, Jackson, MI, USA
| | - Erin Allen
- Henry Ford Allegiance Health, Jackson, MI, USA
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Sethi Y, Murli H, Kaiwan O, Vora V, Agarwal P, Chopra H, Padda I, Kanithi M, Popoviciu MS, Cavalu S. Broken Heart Syndrome: Evolving Molecular Mechanisms and Principles of Management. J Clin Med 2022; 12:jcm12010125. [PMID: 36614928 PMCID: PMC9821117 DOI: 10.3390/jcm12010125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Broken Heart Syndrome, also known as Takotsubo Syndrome (TS), is sudden and transient dysfunction of the left and/or right ventricle which often mimics Acute Coronary Syndrome (ACS). Japan was the first country to describe this syndrome in the 1990s, and since then it has received a lot of attention from researchers all around the world. Although TS was once thought to be a harmless condition, recent evidence suggests that it may be linked to serious complications and mortality on par with Acute Coronary Syndrome (ACS). The understanding of TS has evolved over the past few years. However, its exact etiology is still poorly understood. It can be classified into two main types: Primary and Secondary TS. Primary TS occurs when the symptoms of myocardial damage, which is typically preceded by emotional stress, are the reason for hospitalization. Secondary TS is seen in patients hospitalized for some other medical, surgical, obstetric, anesthetic, or psychiatric conditions, and the dysfunction develops as a secondary complication due to the activation of the sympathetic nervous system and the release of catecholamines. The etiopathogenesis is now proposed to include adrenergic hormones/stress, decreased estrogen levels, altered microcirculation, endothelial dysfunction, altered inflammatory response via cardiac macrophages, and disturbances in the brain-heart axis. The role of genetics in disease progression is becoming the focus of several upcoming studies. This review focuses on potential pathophysiological mechanisms for reversible myocardial dysfunction observed in TS, and comprehensively describes its epidemiology, clinical presentation, novel diagnostic biomarkers, and evolving principles of management. We advocate for more research into molecular mechanisms and promote the application of current evidence for precise individualized treatment.
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Affiliation(s)
- Yashendra Sethi
- PearResearch, Dehradun 248001, India
- Department of Medicine, Government Doon Medical College, Dehradun 248001, India
- Correspondence: (Y.S.); (M.S.P.)
| | - Hamsa Murli
- PearResearch, Dehradun 248001, India
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai 400022, India
| | - Oroshay Kaiwan
- PearResearch, Dehradun 248001, India
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Vidhi Vora
- PearResearch, Dehradun 248001, India
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai 400022, India
| | - Pratik Agarwal
- PearResearch, Dehradun 248001, India
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai 400022, India
| | - Hitesh Chopra
- College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India
| | - Inderbir Padda
- Richmond University Medical Center, Staten Island, NY 10310, USA
| | - Manasa Kanithi
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Mihaela Simona Popoviciu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
- Correspondence: (Y.S.); (M.S.P.)
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
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Wang T, Xiong T, Yang Y, Zuo B, Chen X, Wang D. Metabolic remodeling in takotsubo syndrome. Front Cardiovasc Med 2022; 9:1060070. [PMID: 36505375 PMCID: PMC9729286 DOI: 10.3389/fcvm.2022.1060070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
The heart requires a large and constant supply of energy that is mainly the result of an efficient metabolic machinery that converges on mitochondrial oxidative metabolism to maintain its continuous mechanical work. Perturbations in these metabolic processes may therefore affect energy generation and contractile function directly. Metabolism characteristics in takotsubo syndrome (TTS) reveals several metabolic alterations called metabolic remodeling, including the hyperactivity of sympathetic metabolism, derangements of substrate utilization, effector subcellular dysfunction and systemic metabolic disorders, ultimately contributing to the progression of the disease and the development of a persistent and long-term heart failure (HF) phenotype. In this review, we explore the current literature investigating the pathological metabolic alterations in TTS. Although the metabolic dysfunction in takotsubo hearts is initially recognized as a myocardial metabolic inflexibility, we suggest that the widespread alterations of systemic metabolism with complex interplay between the heart and peripheral tissues rather than just cardiometabolic disorders per se account for long-term maladaptive metabolic, functional and structural impairment under this condition. Therapeutic strategies with the recent evidence from small clinical and animal researches, especially for targeting substrate utilization and/or oxidative stress, might be promising tools to improve the outcome of patients with TTS beyond that achieved with traditional sympathetic inhibition and symptomatic therapies.
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Affiliation(s)
- Ti Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Ting Xiong
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuxue Yang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Bangyun Zuo
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Xiwei Chen
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Daxin Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China,*Correspondence: Daxin Wang, ,
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38
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Wang ZH, Fan JR, Zhang GY, Li XL, Li L. Atypical Takotsubo cardiomyopathy presenting as acute coronary syndrome: A case report. World J Clin Cases 2022; 10:10772-10778. [PMID: 36312483 PMCID: PMC9602209 DOI: 10.12998/wjcc.v10.i29.10772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/22/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TS) is a rare acute cardiac disease with clinical features, symptoms, and electrocardiographic manifestations similar to those of acute myocardial infarction. We present the case of a patient with TS caused by a pheochromocytoma, which was confirmed by the postoperative pathology. Furthermore, we present the patient's subsequent management, treatment, and outcome.
CASE SUMMARY A 64-year-old woman was admitted to the hospital with episodic chest pain and palpitations, electrocardiogram (ECG) findings suggestive of high lateral wall myocardial infarction, echocardiogram showing left ventricular wall segmental motion abnormalities, and elevated levels of the myocardial marker troponin. The patient underwent coronary angiography, which revealed unobstructed blood flow without obvious stenosis. During their hospitalization, the patient had paroxysmal elevation of blood pressure accompanied by palpitations and profuse sweating, with elevated blood catecholamine levels during seizures. Subsequent computerized tomography of the adrenal glands revealed the presence of a nodule in the right adrenal, which was resected and determined to be an adrenal pheochromocytoma. Therefore, the diagnosis of pheochromocytoma-induced atypical TS was made. The patient had an uneventful postoperative recovery.
CONCLUSION Cardiologists should consider pheochromocytoma in patients with TS. Early detection allows timely intervention, benefiting patients.
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Affiliation(s)
- Zi-Han Wang
- Beijing University of Chinese Medicine, Graduate School, Beijing 100029, Chaoyang District, China
| | - Jia-Rong Fan
- Beijing University of Chinese Medicine, Graduate School, Beijing 100029, Chaoyang District, China
| | - Gao-Yu Zhang
- Beijing University of Chinese Medicine, Graduate School, Beijing 100029, Chaoyang District, China
| | - Xian-Lun Li
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing 100029, Chaoyang District, China
| | - Lin Li
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing 100029, Chaoyang District, China
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Yang K, Li X, Xie P, Zhong X, Zhang Y, Xiao C, Yao X, Cai J, Lin M. Takostubo syndrome combined with ventricular septal perforation: a case report. BMC Cardiovasc Disord 2022; 22:402. [PMID: 36076178 PMCID: PMC9461131 DOI: 10.1186/s12872-022-02834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background The precise clinical features and etiologic basis of Takotsubo syndrome remain unclear, although an association with emotional or stressful triggers has been recognized. Ventricular septal perforation is a very rare life-threatening complication. Case presentation A 77-year-old female patient presented to the hospital with unrelieved chest tightness and shortness of breath. Three months ago, the patient's electrocardiogram revealed ischemic T wave inversion of the anterior wall, along with an increase in myocardial injury markers. There was no evidence of a ventricular septal defect on echocardiography. The patient was admitted to the respiratory department to treat lung lesions. The electrocardiogram demonstrated dynamic changes following admission, and the myocardial markers returned to normal, but the echocardiography revealed a ventricular septal defect. The initial diagnosis was ventricular septal perforation because of myocardial infarction with acute anterior ST-segment elevation. Coronary angiography revealed no abnormalities, but left ventricular angiography revealed an enlarged apex and VSD, with a right ventricular shunt bundle. Later, cardiac MRI revealed an apical ventricular septal defect. Further inquiry of the patient's medical history revealed that her husband died unexpectedly three months ago, and her daughter was seriously injured in a car accident, causing the patient severe emotional distress. Takotsubo syndrome was then determined in conjunction with the patient's medical history, symptoms, signs, and pertinent examinations. Without using a catheter or a surgical procedure, we managed the patient's medical condition. Two weeks later, the patient was discharged with symptoms improved. Conclusions Takotsubo syndrome is comparable to an acute myocardial infarction on clinical and electrocardiographic examination in the absence of significant coronary disease. Although ventricular septal perforation is most commonly associated with acute myocardial infarction, it can also happen following Takotsubo syndrome. Takotsubo syndrome complicated by ventricular septal perforation is easily misdiagnosed. The early recognition and management of this condition can avoid or reduce morbidity and mortality.
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Affiliation(s)
- Kexin Yang
- Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Xinghui Li
- Lanzhou University, Lanzhou, 730000, Gansu, China. .,Department of Cardiology, Gansu Provincial People's Hospital, Lanzhou, 730000, Gansu, China.
| | - Ping Xie
- Department of Cardiology, Gansu Provincial People's Hospital, Lanzhou, 730000, Gansu, China
| | - Xiang Zhong
- Department of Cardiology, Gansu Provincial People's Hospital, Lanzhou, 730000, Gansu, China
| | - Yifan Zhang
- Department of Cardiology, Gansu Provincial People's Hospital, Lanzhou, 730000, Gansu, China
| | | | - Xiaotao Yao
- Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Jia Cai
- Ningxia Medical University, Yinchuan, 750000, Ningxia, China
| | - Meng Lin
- Ningxia Medical University, Yinchuan, 750000, Ningxia, China
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To M, Zhang Y, Tompkins A, Chen R, Patankar K, Sangodkar S. A Broken Heart After Witnessing a Dying Heart: A Case of Takotsubo Cardiomyopathy. Cureus 2022; 14:e28752. [PMID: 36211117 PMCID: PMC9529233 DOI: 10.7759/cureus.28752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/28/2022] Open
Abstract
Takotsubo cardiomyopathy is a form of non-ischemic cardiomyopathy characterized by transient systolic dysfunction. The prevalence of Takotsubo cardiomyopathy has been estimated to be about 2% overall but about 10% amongst women presenting with clinical manifestations of acute coronary syndrome. The overall mechanism of the disease still remains unclear. However, treatment of Takotsubo cardiomyopathy appears to be similar to congestive heart failure (CHF) medical management. This case highlights the classic presentation exhibited very similar to acute coronary syndrome and diagnostic criteria for Takotsubo (stress-induced) cardiomyopathy.
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The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management. J Pers Med 2022; 12:jpm12081244. [PMID: 36013193 PMCID: PMC9410002 DOI: 10.3390/jpm12081244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy mimicking an acute coronary syndrome, usually observed in response to acute stress situations. The association between acute ischemic stroke and TC is already known, since it has been previously reported that ischemic stroke can be both a consequence and a potential cause of TC. However, the precise pathophysiological mechanism linking the two conditions is still poorly understood. The aim of our review is to expand insights regarding the genetic susceptibility and available specific biomarkers of TC and to investigate the clinical profile and outcomes of patients with TC and stroke. Since evidence and trials on TC and stroke are currently lacking, this paper aims to fill a substantial gap in the literature about the relationship between these pathologies.
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Shang Z, Zhao M, Cai J, Wu C, Xu Y, Zeng L, Cai H, Xu M, Fan Y, Li Y, Gao W, Xu W, Zu L. Peri-operative Takotsubo syndrome after non-cardiac surgery: a retrospective nested case-control study. ESC Heart Fail 2022; 9:3149-3159. [PMID: 35757924 DOI: 10.1002/ehf2.14015] [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: 12/19/2021] [Revised: 05/09/2022] [Accepted: 06/03/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Takotsubo syndrome (TTS) is an acute reversible cardiac dysfunction that may occur during the peri-operative period and among patients with serious illness. We aimed to evaluate the clinical characteristics, peri-operative management, and prognosis of peri-operative TTS (pTTS) and explore the factors associated with pTTS. METHODS We conducted a retrospective nested case-control study using the database of patients who underwent in-hospital non-cardiac surgeries between January 2017 and December 2020 in Peking University Third hospital. Cases were adult patients diagnosed TTS at discharge who were matched with four controls based on operative types. Multivariable conditional logistic regression was used to identified the factors associated with pTTS. The area under the curve (AUC) was used to evaluate the diagnostic efficacy. RESULTS Among the 128 536 patients underwent non-cardiac surgery, 20 patients with pTTS and 80 patients without were enrolled in this study. The incidence of pTTS was about 0.016% in our centre. The median age of patients with pTTS was 52.5 (38.25, 76.25) years, although 90% of them were female. Fifty per cent (9 cases) of female patients were pre-menopausal. Caesarean section has the highest proportion of pTTS (30% of the pTTS cases) with the incidence of caesarean section-related pTTS of 0.06% in our centre. A high prevalence of non-apical ballooning pattern of regional wall motion abnormality (seven cases, 35%) and a high mortality (two cases, 10%) were observed. Left ventricular ejection fraction (LVEF) of patients with pTTS was significantly decreased (41.7 ± 8.8%). In the acute phase, supportive treatments aiming to reduce life-threatening complications were main treatment strategies. After receiving systematic treatment, significant improvements were observed in LVEF (63.1 ± 13.5%), with median recovery time of LVEF of 7.48 days. Leucocyte count [odds ratio (OR): 4.59; 95% confidence interval (CI): 1.10-19.15], haemoglobin (HGB) (OR: 10.52; 95% CI: 1.04-106.36), and the revised cardiac risk index (RCRI) score (OR: 6.30; 95% CI: 1.05-37.88) were the factors significantly associated with pTTS. The RCRI score performed poorly in the prediction of pTTS (AUC: 0.630; 95% CI: 0.525-0.735). After adding leucocyte count and HGB into the RCRI score, the AUC was significantly improved (AUC: 0.768; 95% CI: 0.671-0.865; P = 0.001). CONCLUSIONS Patients with pTTS have some differences compared with common TTS, including higher proportion of pre-menopausal female, higher prevalence during caesarean section, higher prevalence of non-apical ballooning pattern of regional wall motion abnormality, and higher mortality. The RCRI score performed poorly in the evaluation of pTTS. Adding HGB and leucocyte count into the RCRI score could significantly improve its predictive performance.
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Affiliation(s)
- Zhi Shang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Menglin Zhao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Jiageng Cai
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Cencen Wu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yuan Xu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Hong Cai
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Mao Xu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yuanyuan Fan
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yanguang Li
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Wei Gao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Weixian Xu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Lingyun Zu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
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Topf A, Mirna M, Paar V, Motloch LJ, Bacher N, Franz M, Hoppe UC, Kretzschmar D, Lichtenauer M. Differential Diagnosis between Takotsubo Syndrome and Acute Coronary Syndrome—A Prospective Analysis of Novel Cardiovascular Biomarkers for a More Selective Triage. J Clin Med 2022; 11:jcm11112974. [PMID: 35683362 PMCID: PMC9180967 DOI: 10.3390/jcm11112974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction: Takotsubo syndrome (TTS) is clinically indistinguishable from an ACS. Despite the implementation of clinical scoring systems and novel biomarkers, coronary angiography currently remains necessary for differential diagnosis. Methods: 93 patients with chest pain and the suspicion of TTS were enrolled in two study centers. Fetuin-A, IGFBP-2, Galectin-3, and TNF α were determined in serum samples, collected within 24 h after the onset of symptoms. Serum levels of biomarkers were analyzed for the differential diagnostic value between TTS and ACS. Results: Compared to TTS, patients with ACS had significantly lower serum levels of Fetuin-A and IGFBP-2. The cut-off value of Fetuin-A for the identification of TTS compared to ACS was 55.74 μg/mL (sensitivity: 100.0%, specificity: 82.6%, PPV: 63.2%, NPV: 100.0%). An optimal cut-off value for IGFBP-2 for the differential diagnosis between TTS and ACS was determined as 171.77 ng/mL (sensitivity: 76.0%, specificity: 82.6%, PPV: 76.4%, NPV 72.7%). Conclusion: Fetuin-A and IGFBP-2 might facilitate the triage between TTS and ACS and could be therefore of great benefit for the guidance of treatment.
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Affiliation(s)
- Albert Topf
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
- Correspondence: ; Tel.: +43-(0)-57-57418; Fax: +43-(0)-57255-4111
| | - Moritz Mirna
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
| | - Vera Paar
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
| | - Lukas J. Motloch
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
| | - Nina Bacher
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07743 Jena, Germany; (M.F.); (D.K.)
| | - Uta C. Hoppe
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07743 Jena, Germany; (M.F.); (D.K.)
| | - Michael Lichtenauer
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
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Reverse Takotsubo cardiomyopathy after orthotopic liver transplantation. A case report. J Crit Care Med (Targu Mures) 2022; 8:117-122. [PMID: 35950160 PMCID: PMC9097646 DOI: 10.2478/jccm-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/19/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Takotsubo cardiomyopathy is a rare reversible type of heart failure, often precipitated by emotional stress; other risk factors include intracranial bleeding, ischemic stroke, sepsis, major surgery, pheochromocytoma. The clinical, electrical and blood sample analysis features resemble those of a myocardial infarction- however, they occur in the absence of angiographic coronary filling defects. Case presentation A 61-year-old male patient, 71 kg, 175 cm, underwent liver transplantation for Child-Pugh B cirrhosis secondary to mixed viral hepatitis (B and D). His medical records revealed mild mitral, aortic, and tricuspid insufficiencies and heart failure with preserved ejection fraction. An initially uneventful perioperative stage was succeeded by cardiogenic shock (cardiac index – 1.2 l/min/ sqm), which the patient developed 24 hours after the intervention. Elevated cardiac markers and ECG abnormalities showing ST-T changes in the V2-V5 leads were additionally noted. Transesophageal echocardiography (TEE) revealed an acute onset reduction in the left ventricular systolic function secondary to basal hypokinesia. No coronary obstruction was detected by percutaneous angiography. The above findings lead to the diagnosis of reverseTakotsubo cardiomyopathy. Further, the patient developed acute kidney injury and liver graft failure, succumbing within 48 hours after the surgical procedure. Conclusions We report a rare case of reverse Takotsubo cardiomyopathy in a male patient after orthotopic liver transplant.
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Jabri A, Detuch Z, Butt MU, Haddadin F, Madanat L, Al-Abdouh A, Mhanna M, Masri MKA, Nasser F, Kondapaneni M. Independent risk factors for thromboembolic events in high-risk patients with Takotsubo cardiomyopathy. Curr Probl Cardiol 2022:101242. [DOI: 10.1016/j.cpcardiol.2022.101242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 12/01/2022]
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Karnati S, Guntas G, Rajendran R, Shityakov S, Höring M, Liebisch G, Kosanovic D, Ergün S, Nagai M, Förster CY. Quantitative Lipidomic Analysis of Takotsubo Syndrome Patients' Serum. Front Cardiovasc Med 2022; 9:797154. [PMID: 35514439 PMCID: PMC9062978 DOI: 10.3389/fcvm.2022.797154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Takotsubo syndrome (TTS), also known as the transient left ventricular apical ballooning syndrome, is in contemporary times known as novel acute cardiac syndrome. It is characterized by transient left ventricular apical akinesis and hyperkinesis of the basal left ventricular portions. Although the precise etiology of TTS is unknown, events like the sudden release of stress hormones, such as the catecholamines and the increased inflammatory status might be plausible causes leading to the cardiovascular pathologies. Recent studies have highlighted that an imbalance in lipid accumulation might promote a deviant immune response as observed in TTS. However, there is no information on comprehensive profiling of serum lipids of TTS patients. Therefore, we investigated a detailed quantitative lipid analysis of TTS patients using ES-MSI. Our results showed significant differences in the majority of lipid species composition in the TTS patients compared to the control group. Furthermore, the computational analyses presented was able to link the altered lipids to the pro-inflammatory cytokines and disseminate possible mechanistic pathways involving TNFα and IL-6. Taken together, our study provides an extensive quantitative lipidome of TTS patients, which may provide a valuable Pre-diagnostic tool. This would facilitate the elucidation of the underlying mechanisms of the disease and to prevent the development of TTS in the future.
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Affiliation(s)
- Srikanth Karnati
- University of Würzburg, Institute of Anatomy and Cell Biology, Würzburg, Germany
- *Correspondence: Srikanth Karnati
| | - Gulcan Guntas
- Department of Biochemistry, Medical Faculty, Atilim University, Ankara, Turkey
| | - Ranjithkumar Rajendran
- Experimental Neurology, Department of Neurology, Justus Liebig University, Giessen, Germany
| | - Sergey Shityakov
- Infochemistry Scientific Center, Laboratory of Chemoinformatics, ITMO University, Saint-Petersburg, Russia
| | - Marcus Höring
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Gerhard Liebisch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Djuro Kosanovic
- Department of Pulmonology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Süleyman Ergün
- University of Würzburg, Institute of Anatomy and Cell Biology, Würzburg, Germany
| | - Michiaki Nagai
- Hiroshima City Asa Hospital, Department of Cardiology, Hiroshima, Japan
| | - Carola Y. Förster
- University of Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
- Carola Y. Förster
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Wu Z, Ma Y. Takotsubo syndrome caused by sclerotherapy for varicose vein: A case report. Asian J Surg 2022; 45:1889-1890. [PMID: 35440384 DOI: 10.1016/j.asjsur.2022.03.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/31/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, 37 GuoXue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yukui Ma
- Department of Vascular Surgery, West China Hospital, 37 GuoXue Alley, Chengdu, 610041, Sichuan Province, China.
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Meng LP, Zhang P. Takotsubo cardiomyopathy misdiagnosed as acute myocardial infarction under the Chest Pain Center model: A case report. World J Clin Cases 2022; 10:2616-2621. [PMID: 35434081 PMCID: PMC8968609 DOI: 10.12998/wjcc.v10.i8.2616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/15/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the spread and establishment of the Chest Pain Center in China, adhering to the idea that “time is myocardial cell and time is life”, many hospitals have set up a standardized process that ensures that patients with acute myocardial infarction (AMI) who meet emergency percutaneous coronary intervention (PCI) guidelines are sent directly to the DSA room by the prehospital emergency doctor, saving the time spent on queuing, registration, payment, re-examination by the emergency doctor, and obtaining consent for surgery after arriving at the hospital. Takotsubo cardiomyopathy is an acute disease that is triggered by intense emotional or physical stress and must be promptly differentiated from AMI for its appropriate management.
CASE SUMMARY A 52-year-old female patient was taken directly to the catheterization room to perform PCI due to 4 h of continuous thoracalgia and elevation of the ST segment in the V3–V5 lead, without being transferred to the emergency department according to the Chest Pain Center model. Loading doses of aspirin, clopidogrel and statins were administered and informed consent for PCI was signed in the ambulance. On first look, the patient looked nervous in the DSA room. Coronary angiography showed no obvious stenosis. Left ventricular angiography showed that the contraction of the left ventricular apex was weakened, and the systolic period was ballooning out, showing a typical “octopus trap” change. The patient was diagnosed with Takotsubo cardiomyopathy. Five days later, the patient had no symptoms of thoracalgia, and the serological indicators returned to normal. She was discharged with a prescription of medication.
CONCLUSION Under the Chest Pain Center model for the treatment of patients with chest pain showing ST segment elevation, despite the urgency of time, Takotsubo cardiomyopathy must be promptly differentiated from AMI for its appropriate management.
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Affiliation(s)
- Li-Ping Meng
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
| | - Peng Zhang
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
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Waqar A, Jain A, Joseph C, Srivastava K, Ochuba O, Alkayyali T, Poudel S. Cardioprotective Role of Estrogen in Takotsubo Cardiomyopathy. Cureus 2022; 14:e22845. [PMID: 35382214 PMCID: PMC8977075 DOI: 10.7759/cureus.22845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/04/2022] [Indexed: 11/21/2022] Open
Abstract
Takotsubo cardiomyopathy (TC) is a rare, reversible cause of left ventricular wall motion abnormality (LVWMA) that mimics the presentation of acute myocardial infarction (AMI). TC is usually preceded by an emotional or physical stressor and appears to be more common in postmenopausal women. Various pathophysiological hypotheses of TC have been proposed, but the exact mechanism of action remains elusive. Elevated levels of catecholamines leading to cardiac dysfunction are the most prevalent hypothesis. The protective role of estrogen in the development of cardiomyopathies has been studied extensively. International Takotsubo Diagnostic Criteria (InterTAK) and Mayo clinic diagnostic criteria both have the stipulation stating prevalence of TC is higher in postmenopausal women which hints towards the protective role of estrogen in the development of TC. To review the protective role of estrogen in the mechanism of this novel pathology, we searched Pubmed and Google scholar for the relevant articles by using keywords such as: “takotsubo cardiomyopathy”, “apical ballooning”, “broken heart syndrome”, “stress cardiomyopathy”, “left ventricle wall motion abnormality”, “estrogen”, “estradiol” and “sex hormones”. Our research revealed that although the prevalence of TC is greater in postmenopausal women as compared to men, the prognosis is worse in men. It also revealed the involvement of multiple cellular pathways under the influence of estrogen that could explain the cardioprotective effect of estrogen. Most of the articles found were based on animal studies, thus, there is an emphasis on future human studies. However, we strongly suggest evaluating estrogen levels as part of the initial workup for any patient presenting with signs and symptoms of cardiac pathology.
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Brain-heart communication in health and diseases. Brain Res Bull 2022; 183:27-37. [PMID: 35217133 DOI: 10.1016/j.brainresbull.2022.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/19/2022]
Abstract
Tight connections between the brain and heart have attracted a considerable amount of attention. This review focuses on the anatomical (extrinsic cardiac autonomic nervous system and intrinsic cardiac autonomic nervous system) and functional (neuroendocrine-heart axis and neuroimmune-heart axis) connections between the brain and heart, the linkage between central nervous system diseases and cardiovascular diseases, the harm of sympathetic hyperactivity to the heart, and current neuromodulation therapies. Depression is a comorbidity of cardiovascular diseases, and the two are causally related. This review summarizes the mechanisms and treatment of depression and cardiovascular diseases, providing theoretical evidence for basic research and clinical studies to improve treatment options.
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