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Gu H, Yang L. Transesophageal echocardiography combined with ProAQT/PulsioFlex hemodynamic monitoring in anesthetic management of a patient with septic shock associated with septic cardiomyopathy: A case report. Clin Case Rep 2023; 11:e8266. [PMID: 38033696 PMCID: PMC10682247 DOI: 10.1002/ccr3.8266] [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: 08/07/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023] Open
Abstract
Patients with septic shock complicated by septic cardiomyopathy (SCM) can be extremely ill and at high risk for mortality. If early assessment of cardiac function is neglected during treatment, sepsis may be further exacerbated. We report a 77-year-old male patient with severe septic shock who underwent intraoperative transesophageal echocardiography (TEE) because of progressive circulatory instability, SCM was diagnosed. Further perioperative treatment to support the circulation was successfully adjusted based on TEE and pulse index continuous cardiac output (CO) by ProAQT/PulsioFlex hemodynamic monitoring. We should consider a diagnosis of SCM in the perioperative period and perform ultrasonography routinely. The use of TEE with ProAQT/PulsioFlex offers a new option for anesthetic management.
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Affiliation(s)
- Hui Gu
- Department of AnesthesiologyWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Lei Yang
- Department of AnesthesiologyWest China Hospital of Sichuan UniversityChengduSichuanChina
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Muacevic A, Adler JR, Rajkanna J. Acute Pulmonary Edema as a Cardiovascular Manifestation of Pheochromocytoma. Cureus 2023; 15:e33675. [PMID: 36788877 PMCID: PMC9918853 DOI: 10.7759/cureus.33675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
Pheochromocytoma most commonly presents with the triad of paroxysms of headache, palpitations, and diaphoresis. Pheochromocytoma crisis, caused by a supra-physiological surge of catecholamine release, is an endocrine emergency that can present with various clinical manifestations. Acute pulmonary edema is one of the manifestations of pheochromocytoma crisis and can be either cardiogenic or non-cardiogenic. Here, we report cases of acute pulmonary edema of each type, related to pheochromocytoma crisis, which were presented to our district general hospital in 2020.
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Ochi S, Sano N, Iga J, Ueno S. Takotsubo cardiomyopathy associated with pneumatosis cystoides intestinalis and postprandial hypoglycemia of anorexia nervosa. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e33. [PMID: 38868681 PMCID: PMC11114407 DOI: 10.1002/pcn5.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/17/2022] [Accepted: 06/26/2022] [Indexed: 06/14/2024]
Abstract
Hypoglycemia is not rare in anorexia nervosa (AN). Takotsubo cardiomyopathy (TCM) is characterized by extensive akinesis of the apical region with hypercontraction of the basal segment of the ventricle in the absence of coronary artery disease. Its mechanism is not fully understood, but hypoglycemia is considered one of the physical factors. Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by multiple gaseous cysts in the intestinal wall. PCI sometimes causes an absorption defect. The case of a 48-year-old woman with AN with PCI and TCM that developed after a postprandial hypoglycemic coma is reported. When the patient was admitted to our hospital, her abdominal X-ray showed a confluent image of grapes, and computed tomography showed gaseous cysts in the intestinal wall from the ascending colon to the transverse colon. PCI was then diagnosed. About 7 days after admission, she developed hypoglycemic coma. However, she recovered from the coma and on the next day she became suddenly hypotensive, with the electrocardiogram showing T-wave inversion. Echocardiography then showed akinesis around the apex and hypercontraction of the basal segments, and TCM was diagnosed. Severe AN with PCI may cause more severe hypoglycemia, resulting in TCM.
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Affiliation(s)
- Shinichiro Ochi
- Department of NeuropsychiatryEhime University Graduate School of Medicine, ToonEhimeJapan
- Present address:
Department of NeuropsychiatryEhime University Graduate School of Medicine, ShitsukawaToonEhimeJapan
| | | | - Jun‐ichi Iga
- Department of NeuropsychiatryEhime University Graduate School of Medicine, ToonEhimeJapan
| | - Shu‐ichi Ueno
- Department of NeuropsychiatryEhime University Graduate School of Medicine, ToonEhimeJapan
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Ishii M, Seki T, Kaikita K, Sakamoto K, Nakai M, Sumita Y, Nishimura K, Miyamoto Y, Noguchi T, Yasuda S, Tsutsui H, Komuro I, Saito Y, Ogawa H, Tsujita K, Kawakami K. Short-term exposure to desert dust and the risk of acute myocardial infarction in Japan: a time-stratified case-crossover study. Eur J Epidemiol 2020; 35:455-464. [PMID: 31950372 DOI: 10.1007/s10654-020-00601-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/08/2020] [Indexed: 01/19/2023]
Abstract
Particulate matter from natural sources such as desert dust causes harmful effects for health. Asian dust (AD) increases the risk of acute myocardial infarction (AMI). However, little is known about the risk of myocardial infarction with nonobstructive coronary arteries (MINOCA), compared to myocardial infarction with coronary artery disease (MI-CAD). Using a time-stratified case-crossover design and conditional logistic regression models, the association between short-term exposure to AD whereby decreased visibility (< 10 km) observed at each monitoring station nearest to the hospitals was used for exposure measurements and admission for AMI in the spring was investigated using a nationwide administrative database between April 2012 and March 2016. According to presence of revascularization and coronary atherosclerosis, AMI patients (n = 30,435) were divided into 2 subtypes: MI-CAD (n = 27,202) or MINOCA (n = 3233). The single lag day-2 was used in AD exposure based on the lag effect analysis. The average level of meteorological variables and co-pollutants on the 3 days prior to the case/control days were used as covariates. The occurrence of AD events 2 days before the admission was associated with admission for MINOCA after adjustment for meteorological variables [odds ratio 1.65; 95% confidence interval (CI) 1.18-2.29], while the association was not observed in MI-CAD. The absolute risk difference of MINOCA admission was 1.79 (95% CI 1.21-2.38) per 100,000 person-year. These associations between AD exposure and the admission for MINOCA remained unchanged in two-pollutant models. This study provides evidence that short-term exposure to AD is associated with a higher risk of MINOCA, but not MI-CAD.
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Affiliation(s)
- Masanobu Ishii
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Pharmacoepidemiology, Graduate School of Medical and Public Health, Kyoto University, Yoshida, Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.,National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomotsugu Seki
- Department of Pharmacoepidemiology, Graduate School of Medical and Public Health, Kyoto University, Yoshida, Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Koichi Kaikita
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenji Sakamoto
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Yoko Sumita
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | - Teruo Noguchi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Issei Komuro
- Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshihiko Saito
- School of Medicine, Nara Medical University, Kashihara, Japan
| | - Hisao Ogawa
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Tsujita
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medical and Public Health, Kyoto University, Yoshida, Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Lal S, Pemberton J, Wilkins GT. Cough-Induced Takotsubo (Stress) Cardiomyopathy. CASE 2018; 2:240-242. [PMID: 30582081 PMCID: PMC6301975 DOI: 10.1016/j.case.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This case demonstrates cough as an extremely rare but notable cause of TC. Plausible mechanisms include catecholamine surge, impaired cardiac microvascular and metabolic function, and extreme haemodynamic stress during cough. Cough should be considered as a potential aetiology in differential diagnosis of TC. There could be severe as well as subclinical cases of cough induced TC that goes unidentified.
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Alteration of β-Adrenoceptor Signaling in Left Ventricle of Acute Phase Takotsubo Syndrome: a Human Study. Sci Rep 2018; 8:12731. [PMID: 30143703 PMCID: PMC6109068 DOI: 10.1038/s41598-018-31034-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 08/09/2018] [Indexed: 12/11/2022] Open
Abstract
Accumulating evidence indicates alteration of the β-adrenoceptor (AR), such as desensitization and subtype switching of its coupling G protein, plays a role in the protection against catecholamine toxicity in heart failure. However, in human takotsubo syndrome (TTS), which is associated with a surge of circulating catecholamine in the acute phase, there is no histologic evidence of β-AR alteration. The purpose of this study was to investigate the involvement of alteration of β-AR signaling in the mechanism of TTS development. Left ventricular (LV) biopsied samples from 26 patients with TTS, 19 with normal LV function, and 26 with dilated cardiomyopathy (DCM) were studied. G protein-coupled receptor kinase 2 (GRK2) and β-arrestin2, which initiate the alteration of β-AR signaling, were more abundantly expressed in the myocardium in acute-phase TTS than in those of DCM and normal control as indicated by immunohistochemistry. The percentage of cardiomyocytes that showed positive membrane staining for GRK2 and β-arrestin2 was also significantly higher in acute-phase TTS. Sequential biopsies in the recovery-phase for two patients with TTS revealed that membrane expression of GRK2 and β-arrestin2 faded over time. This study provided the first histologic evidence of the involvement of alteration of β-ARs in the development of TTS.
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Jung YJ, Kim SW, Choi JH. Takotsubo Syndrome Resulting from Traumatic Multiple Rib Fractures. JOURNAL OF ACUTE CARE SURGERY 2018. [DOI: 10.17479/jacs.2018.8.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yoo Jin Jung
- JeJu National University School of Medicine, Jeju, Korea
| | - Su Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Joon Hyouk Choi
- Department of Cardiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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Chang SC, Ren S, Rau CD, Wang JJ. Isoproterenol-Induced Heart Failure Mouse Model Using Osmotic Pump Implantation. Methods Mol Biol 2018; 1816:207-220. [PMID: 29987822 DOI: 10.1007/978-1-4939-8597-5_16] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Isoproterenol is used widely for inducing heart failure in mice. Isoproterenol is a nonselective beta-adrenergic agonist. The acute model mimics stress-induced cardiomyopathy. The chronic model mimics advanced heart failure in humans. In this chapter, we describe a protocol that we used to induce heart failure in 100+ strains of inbred mice. Techniques on surgical pump implantation and echocardiography are described in detail. We also discuss the impact of drug dosage, duration, mortality, age, gender, and strain on cardiac remodeling responses. The success of model creation may be assessed by echocardiogram or molecular markers. This chapter may be relevant to those who are interested in using this heart failure model.
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Affiliation(s)
- Sunny C Chang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shuxun Ren
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christoph D Rau
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jessica J Wang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Ventricular Septal Defect from Takotsubo Syndrome. Case Rep Cardiol 2016; 2016:2693062. [PMID: 27563471 PMCID: PMC4987479 DOI: 10.1155/2016/2693062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/25/2016] [Accepted: 07/10/2016] [Indexed: 11/17/2022] Open
Abstract
Takotsubo Syndrome is a transient condition characterized by left ventricular systolic dysfunction with apical akinesis/dyskinesis and ballooning. Although the prognosis with medical management is excellent in most cases, rare cases of serious complications can occur. We present here a case of a 71-year-old woman presenting with acute decompensated heart failure with initial findings consistent with a myocardial infarction, who was found instead to have an acute ventricular septal defect as a complication of Takotsubo Syndrome.
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Abstract
With each successive year, the number of Emergency Department (ED) visits related to illicit drug abuse has progressively increased. Cocaine is the most common illegal drug to cause a visit to the ED. Cocaine use results in a variety of pathophysiological changes with regards to the cardiovascular system, such as constriction of coronary vessels, dysfunction of vascular endothelium, decreased aortic elasticity, hemodynamic disruptions, a hypercoagulable state, and direct toxicity to myocardial and vascular tissue. The clinical course of patients with cocaine-induced chest pain (CCP) is often challenging, and electrocardiographic findings can be potentially misleading in terms of diagnosing a myocardial infarction. In addition, there is no current satisfactory study regarding outcomes of use of various pharmacological drug therapies to manage CCP. At present, calcium-channel blockers and nitroglycerin are two pharmacological agents that are advocated as first-line drugs for CCP management, although the role of labetalol has been controversial and warrants further investigation. We performed an extensive search of available literature through a large number of scholarly articles previously published and listed on Index Medicus. In this review, we put forward a concise summary of the current approach to a patient presenting to the ED with CCP and management of the clinical scenario. The purpose of this review is to summarize the understanding of cocaine's cardiovascular pathophysiology and to examine the current approach for proper evaluation and management of CCP.
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De Gennaro L, Brunetti ND, Buquicchio F, Tota F, Locuratolo N, Santoro F, Guaricci AI, Di Biase M, Caldarola P. Takotsubo cardiomyopathy induced by acute inhalation of hypochlorite drain gel exhalations. Int J Cardiol 2015; 180:216-7. [DOI: 10.1016/j.ijcard.2014.11.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/22/2014] [Indexed: 10/24/2022]
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Strande JL. Haploinsufficiency MYBPC3 mutations: another stress induced cardiomyopathy? Let's take a look! J Mol Cell Cardiol 2014; 79:284-6. [PMID: 25524041 DOI: 10.1016/j.yjmcc.2014.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 01/18/2023]
Affiliation(s)
- Jennifer L Strande
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA.
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Abstract
Since Takotsubo cardiomyopathy was first described by Sato in 1990, multiple cases have been reported, but only few in children, among whom this type of cardiomyopathy is to some extent underappreciated. A series of children with this syndrome were therefore reviewed, drawing comparison with cases reported by others. The review addresses the current challenges in diagnosis, presentation, triggers, clinical course, management, and possible pathogenic mechanisms of the entity.
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