1
|
Denicolai M, Morello M, Del Buono MG, Sanna T, Agatiello CR, Abbate A. Cardiac rupture as a life-threatening outcome of Takotsubo syndrome: A systematic review. Int J Cardiol 2024; 412:132336. [PMID: 38964548 DOI: 10.1016/j.ijcard.2024.132336] [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: 05/14/2024] [Revised: 06/17/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Takotsubo syndrome (TS) is a reversible cause of heart failure; however, a minority of patients can develop serious complications, including cardiac rupture (CR). OBJECTIVES Analyze case reports of CR related to TS, detailing patient characteristics to uncover risk factors and prognosis for this severe complication. METHODS We conducted a systematic search of MEDLINE and Embase databases to identify case reports of patients with TS complicated by CR, from inception to October 2023. RESULTS We included 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and an apical ballooning pattern was observed in all cases (100%). ST-segment elevation was reported in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery was attempted in 16 (36%) cases, and 28 (64%) patients did not survive. CONCLUSIONS CR related to TS is a rare complication associated with high mortality and affecting elderly females, specially from White/Caucasian or East Asian/Japanese descent, presenting with anterior or lateral ST-segment elevation, and an apical ballooning pattern. Although data is limited and additional prospective studies are needed, the awareness of this life-threatening complication is crucial to early identify high-risk patients. CONDENSED ABSTRACT Cardiac rupture is a rare complication of Takotsubo syndrome. We conducted a systematic review of cases complicated by cardiac rupture, and we identified 44 subjects (40 females and 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity, all with an apical ballooning pattern (100%). The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.
Collapse
Affiliation(s)
- Martin Denicolai
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States; Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Matteo Morello
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
| | - Marco G Del Buono
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carla R Agatiello
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States; Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, United States
| |
Collapse
|
2
|
Hassanabad AF, Sembo T, Kidd WT, Har B. Takotsubo cardiomyopathy associated with free wall rupture and ventricular septal defect: a case report. Future Cardiol 2024:1-4. [PMID: 39101463 DOI: 10.1080/14796678.2024.2382541] [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: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 08/06/2024] Open
Abstract
Takotsubo cardiomyopathy is a rare cardiac presentation. It can be associated with severe complications such as hemodynamically significant ventricular septal defect and cardiac free wall rupture. In cases of mechanical complications, surgical repair is often indicated. Despite best medical and surgical efforts, patients with Takotsubo cardiomyopathy and mechanical complications carry significant mortality risk. Herein, we present an unusual presentation of Takotsubo cardiomyopathy that was associated with a mechanical complication. Although the patient underwent a successful surgical repair, she passed away from multiorgan failure during the postoperative period.
Collapse
Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Canada
| | - Toshiro Sembo
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Canada
| | - William T Kidd
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Canada
| | - Bryan Har
- Section of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Canada
| |
Collapse
|
3
|
Yasumura H, Tao K, Imada R, Yamashita Y, Tateishi N, Kinjo T. Successful sutureless repair of multiple left ventricular free wall ruptures due to Takotsubo cardiomyopathy: a case report. Surg Case Rep 2024; 10:47. [PMID: 38393421 PMCID: PMC10891034 DOI: 10.1186/s40792-024-01848-3] [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: 12/26/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TCM) is a temporary and reversible systolic abnormality of the left ventricular apical area resembling a myocardial infarction. Cardiac rupture due to TCM is a rare but fatal complication. Without cardiac surgery, 94% of patients with left ventricular free wall rupture (LVFWR) due to TCM die. Furthermore, successful surgical cases are rare. We report herein the successful treatment of multiple LVFWRs due to TCM using a sutureless repair. CASE PRESENTATION An 80-year-old man quarreled with his daughter and had a sudden onset of chest pain. He was transferred to our hospital in shock. Electrocardiography showed ST elevation and contrast-enhanced computed tomography revealed a bloody pericardial effusion. Emergent coronary angiography showed no significant stenosis. Cardiac arrest ensued because of cardiac tamponade. Emergent surgery was undertaken and three oozing lacerations on the lateral and inferior walls were noted. A sutureless repair was performed using TachoSil® patches. We also applied Surgicel Nu-Knit® absorbable hemostat with Hydrofit® where TachoSil® failed to completely adhere because of hematoma formation and achieved complete hemostasis. We diagnosed the ruptures due to TCM according to the Mayo criteria. The patient was discharged on postoperative day 71. CONCLUSIONS A sutureless repair using TachoSil® patches and Surgicel® with Hydrofit® is a minimally invasive and effective method for the treatment of multiple LVFWRs due to TCM.
Collapse
Affiliation(s)
- Hiroto Yasumura
- Department of Cardiovascular Surgery, National Hospital Organization Kagoshima Medical Center, 8-1, Shiroyamacho, Kagoshima, Kagoshima, 892-0853, Japan.
| | - Koji Tao
- Department of Cardiovascular Surgery, National Hospital Organization Kagoshima Medical Center, 8-1, Shiroyamacho, Kagoshima, Kagoshima, 892-0853, Japan
| | - Ryo Imada
- Department of Cardiovascular Surgery, National Hospital Organization Kagoshima Medical Center, 8-1, Shiroyamacho, Kagoshima, Kagoshima, 892-0853, Japan
| | - Yushi Yamashita
- Department of Cardiovascular Surgery, National Hospital Organization Kagoshima Medical Center, 8-1, Shiroyamacho, Kagoshima, Kagoshima, 892-0853, Japan
| | - Naoki Tateishi
- Department of Cardiovascular Surgery, National Hospital Organization Kagoshima Medical Center, 8-1, Shiroyamacho, Kagoshima, Kagoshima, 892-0853, Japan
| | - Tamahiro Kinjo
- Department of Cardiovascular Surgery, National Hospital Organization Kagoshima Medical Center, 8-1, Shiroyamacho, Kagoshima, Kagoshima, 892-0853, Japan
| |
Collapse
|
4
|
Gill JR, Tashjian R, Duncanson E. Autopsy Histopathologic Cardiac Findings in Two Adolescents Following the Second COVID-19 Vaccine Dose. Arch Pathol Lab Med 2022; 146:925-929. [PMID: 35157759 DOI: 10.5858/arpa.2021-0435-sa] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT - Myocarditis in adolescents has been diagnosed clinically following the administration of the second dose of an mRNA vaccine for coronavirus disease 2019 (COVID-19). OBJECTIVE - To examine the autopsy microscopic cardiac findings in adolescent deaths that occurred shortly following administration of the second Pfizer-BioNTech COVID-19 dose to determine if the "myocarditis" described in these instances has the typical histopathology of myocarditis. DESIGN - Clinical and autopsy investigation of two teenage boys who died shortly following administration of the second Pfizer-BioNTech COVID-19 dose. RESULTS - The microscopic examination revealed features resembling a catecholamine-induced injury, not typical myocarditis pathology. CONCLUSIONS - The myocardial injury seen in these post-vaccine hearts is different from typical myocarditis and has an appearance most closely resembling a catecholamine-mediated stress (toxic) cardiomyopathy. Understanding that these instances are different from typical myocarditis and that cytokine storm has a known feedback loop with catecholamines may help guide screening and therapy.
Collapse
Affiliation(s)
- James R Gill
- Connecticut Office of the Chief Medical Examiner, Farmington, Connecticut, (Gill).,Department of Pathology, Yale School of Medicine, New Haven, Connecticut (Gill)
| | - Randy Tashjian
- Wayne County Medical Examiners' Office, Detroit, Michigan (Tashijan).,Department of Pathology, University of Michigan, Ann Arbor, Michigan (Tashijan)
| | - Emily Duncanson
- Jesse E. Edwards Registry of Cardiovascular Disease, St. Paul, MN (Duncanson)
| |
Collapse
|
5
|
Zalewska-Adamiec M, Bachórzewska-Gajewska H, Dobrzycki S. Cardiac Rupture-The Most Serious Complication of Takotsubo Syndrome: A Series of Five Cases and a Systematic Review. J Clin Med 2021; 10:jcm10051066. [PMID: 33806583 PMCID: PMC7962024 DOI: 10.3390/jcm10051066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 01/19/2023] Open
Abstract
Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).
Collapse
Affiliation(s)
- Małgorzata Zalewska-Adamiec
- Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (H.B.-G.); (S.D.)
- Correspondence: ; Tel.: +48-(85)-8318496
| | - Hanna Bachórzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (H.B.-G.); (S.D.)
- Department of Clinical Medicine, Medical University of Bialystok, 15-295 Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland; (H.B.-G.); (S.D.)
| |
Collapse
|
6
|
Singh A, Sturzoiu T, Vallabhaneni S, Shirani J. Stress cardiomyopathy induced during dobutamine stress echocardiography. Int J Crit Illn Inj Sci 2020; 10:43-48. [PMID: 33376690 PMCID: PMC7759070 DOI: 10.4103/ijciis.ijciis_86_19] [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: 10/14/2019] [Revised: 01/18/2019] [Accepted: 01/20/2020] [Indexed: 11/04/2022] Open
Abstract
Background Catecholamines play a central role in pathogenesis of stress cardiomyopathy (SC). We aimed to review the clinical characteristics, procedural details and outcomes of patients with SC during dobutamine stress echocardiography (DSE). Methods/Results A total of 20 adults [age 64±15 years, 80% women, 67% hypertension, 20% diabetes, 33% hypercholesterolemia, 19% chronic kidney disease, 13% known anxiety disorder] with SC during DSE were identified from local digital archives of our laboratory (n=3) or reports in English literature (n=17). Indication for DSE was suspected coronary artery disease (CAD) in all patients. Left ventricular (LV) ejection fraction was normal at baseline. SC developed at a blood pressure of 154±47/86±24 mmHg, heart rate of 130±17 bpm (88±10% predicted maximum) and peak rate-pressure product of 20559±3898 mmHg*bpm. ST segment elevation was seen in 65%. SC occurred at peak dobutamine infusion rate of 38±6 μg/kg/min in 85% and during recovery in 15%. Atropine [0.7±0.6 (0.25-2) mg] was given to 7 patients. LV ejection fraction dropped to 30±6% with apical (40%), apical and mid (45%) or basal and mid (10%) circumferential LV ballooning. One patient (5%) had a mixed pattern of wall motion abnormality. LV outflow tract obstruction developed in 15%. Major adverse cardiac events occurred in 7 (35%) and included death (n=1), congestive heart failure (n=2), hypotension (n=3) and atrial fibrillation with heart failure (n=1). At a mean follow up duration of 19±19 days, complete or partial recovery of LV wall motion abnormality was seen in 18 and 1 patient, respectively. Conclusion SC uncommonly occurs during DSE. However, death and other adverse events (hypotension, heart failure and atrial fibrillation) may occur and require urgent attention. Once managed, complete recovery is expected in most patients.
Collapse
Affiliation(s)
- Amitoj Singh
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Tudor Sturzoiu
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | | | - Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| |
Collapse
|
7
|
Jalloul Y, Refaat MM. Left ventricular apical thinning. J Cardiovasc Electrophysiol 2020; 31:921-923. [DOI: 10.1111/jce.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Youssef Jalloul
- Division of Cardiology, Department of Biochemistry and Molecular Genetics, Faculty of Medicine and Medical CenterAmerican University of Beirut Beirut Lebanon
| | - Marwan M. Refaat
- Division of Cardiology, Department of Biochemistry and Molecular Genetics, Faculty of Medicine and Medical CenterAmerican University of Beirut Beirut Lebanon
| |
Collapse
|
8
|
Toni C, Iannaccone F, Chella P, Basolo F, Pucci A. Sudden death in a case of recurrent Takotsubo syndrome. Forensic Sci Med Pathol 2019; 15:10.1007/s12024-019-00163-w. [PMID: 31707601 DOI: 10.1007/s12024-019-00163-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2019] [Indexed: 01/30/2023]
Abstract
Herein we report an unusual case of sudden death occurring in a 65 year old woman during a minor oral surgery. The subject, who had a medically treated anxiety, had a history of two reversible left ventricle dysfunction episodes consistent with recurrent Takotsubo Syndrome that had occurred seven and six years before, respectively. She also suffered from moderate, well treated post-menopausal systemic hypertension. Post-mortem examination showed apical biventricular ballooning of the heart with no cardiac rupture, coronary artery lesion or other cardiac/extra-cardiac disease. Toxicological tests and forensic investigations excluded unnatural causes of death, including pharmacological or iatrogenic causes related to medical malpractice. Only non-specific contraction bands and mild hypertrophy were observed by histology in the left ventricle myocytes. Takotsubo syndrome is usually an acute and reversible heart failure syndrome with acute left ventricle apex ballooning, no coronary artery disease or other macroscopic or microscopic cardiac changes; physical or emotional stress are well known triggering factors. Nevertheless, recurrent forms, major cardiac adverse events and even sudden death may occur in a minority of cases, meaning that a diagnosis of Takotsubo syndrome must be considered in cases of sudden death and in forensic investigations.
Collapse
Affiliation(s)
- Chiara Toni
- Forensic Medicine Department, Pisa University Hospital, Pisa, Italy
| | | | | | - Fulvio Basolo
- Histopathology Department, Pisa University Hospital, Pisa, Italy
| | - Angela Pucci
- Histopathology Department, Pisa University Hospital, Pisa, Italy.
| |
Collapse
|
9
|
Zhukova NS, Merkulova IN, Shakhnovich RM, Merkulov EV, Osiev AG, Pevzner DV, Sukhinina TS, Staroverov II. [Endovascular closure of a ventricular septal defect from Takotsubo Syndrome]. TERAPEVT ARKH 2019; 91:115-123. [PMID: 32598822 DOI: 10.26442/00403660.2019.09.000363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 01/18/2023]
Abstract
Takotsubo Syndrome is a transient condition characterized by left ventricular systolic dysfunction. Although the prognosis is excellent in most cases, rare cases of serious complications can occur. We present a case of a 81-year - old woman with Takotsubo Syndrome complicated by ventricular septal rupture that was successfully closed with an occluder Occlutech with good immediate and long - term outcomes.
Collapse
Affiliation(s)
- N S Zhukova
- National Medical Research Center of Cardiology
| | | | | | | | - A G Osiev
- National Medical Research Center of Cardiology
| | - D V Pevzner
- National Medical Research Center of Cardiology
| | | | | |
Collapse
|
10
|
A Rare Case of Sudden Death in a Patient with Takotsubo Cardiomyopathy Secondary to Cardiac Rupture. Case Rep Cardiol 2019; 2019:5404365. [PMID: 31428481 PMCID: PMC6683796 DOI: 10.1155/2019/5404365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/18/2019] [Accepted: 07/04/2019] [Indexed: 12/03/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM), also known as broken heart syndrome or stress-induced cardiomyopathy, is a rare condition with an estimated incidence of 0.02% of all hospitalizations in United States and 2% of all acute coronary syndrome presentations. TCM predominately presents as a transient wall motion abnormality of the left ventricular apex due to emotional or physical stress. Cardiac rupture in the setting of TCM is an extremely rare phenomenon with limited published case reports. We present a case of a 75-year-old female who had cardiac rupture secondary to TCM and performed a literature review using Ovid MEDLINE for published cases showing this association. After the literature review, we found 20 cases showing this association, which are listed in a tabular fashion.
Collapse
|
11
|
Hůlka J, Soukup J. Rupture of free wall of left ventricle in a patient with takotsubo cardiomyopathy. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
12
|
Iskander M, Abugroun A, Shehata K, Iskander F, Iskander A. Takotsubo Cardiomyopathy-Induced Cardiac Free Wall Rupture: A Case Report and Review of Literature. Cardiol Res 2018; 9:244-249. [PMID: 30116453 PMCID: PMC6089471 DOI: 10.14740/cr728w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/07/2018] [Indexed: 12/22/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is an acquired form of cardiomyopathy that is commonly seen among post-menopausal women. It is characterized by left ventricular apical ballooning, electrocardiographic changes and mild elevation of cardiac enzymes in the absence of significant coronary artery stenosis. TCM usually has benign course. However, on rare instance, it can result in life-threatening and fatal complications including acute cardiogenic shock, ventricular arrhythmias and ventricular wall rupture. We herein report a case of a 77-year-old female who developed TCM complicated with massive pericardial effusion and cardiac arrest. The patient died and autopsy revealed normal coronaries with a slit-like rupture on the antero-apical surface of the heart extending into the papillary muscle. The clinical course, labs and angiographic findings preceding the cardiac rupture will be outlined. A thorough literature review including review of 14 previously reported case reports of TCM complicated with cardiac rupture will be included.
Collapse
Affiliation(s)
- Mina Iskander
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA
| | - Ashraf Abugroun
- Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Kerolus Shehata
- St. Joseph’s Hospital Health Center, Heart Journal 301 Prospect Ave, Syracuse, NY 13203, USA
| | - Fady Iskander
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA
| | - Ayman Iskander
- SJH Cardiology Associates, 4820 West Taft Road, Suite 209, Liverpool, NY 13088, USA
| |
Collapse
|
13
|
Mitchell A, Marquis F. Can takotsubo cardiomyopathy be diagnosed by autopsy? Report of a presumed case presenting as cardiac rupture. BMC Clin Pathol 2017; 17:4. [PMID: 28396614 PMCID: PMC5382367 DOI: 10.1186/s12907-017-0045-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 03/29/2017] [Indexed: 01/01/2023] Open
Abstract
Background Takostsubo (stress) cardiomyopathy (TC) is a clinical syndrome featuring transient left ventricular dysfunction and wall-motion abnormalities, usually following emotional or physical stress. The diagnosis of TC depends on fulfillment of multiple clinical criteria. Although the pathogenesis has not been firmly established, myocardial cathecholamine toxicity is thought to represent a primary mechanism. The vast majority of patients with TC survive. However, a rare cause of death in TC is myocardial rupture. All documented cases of rupture have followed known, recently diagnosed or suspected TC. However, in this report we propose that an initial diagnosis of TC with myocardial rupture can be made by autopsy when supported by a compelling clinical history and appropriate histologic changes in the myocardium. Case presentation An 82 year-old female underwent elective craniotomy for a recently discovered craniopharyngioma. The surgery was uneventful; the initial postoperative course featured diabetes insipidus and delirium. With no prior warning, on the third postoperative day she was found unresponsive in bed. Two prolonged cardiopulmonary resuscitations were successful, however, during a third arrest maneuvers were stopped at the request of the family. An autopsy was conducted which revealed hemopericardium due to cardiac rupture. Coronary artery atherosclerosis, valve disease, and renal and extra-renal pheochromocytoma were absent. Microscopy of the myocardium showed a recent, localized, transmural myocardial infarction and diffuse changes (all four ventricles) typical of cathecholamine cardiomyopathy. The findings were considered compatible with TC with secondary myocardial rupture. Conclusion An initial diagnosis of TC with myocardial rupture can be reasonably made by autopsy in the context of an appropriate clinical history and the presence of the characteristic microscopic features of cathecholamine excess in the myocardium.
Collapse
Affiliation(s)
- Andrew Mitchell
- Department of Anatomic Pathology and Cytology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L'Assomption, Montreal, Quebec H1T 2M4 Canada
| | - François Marquis
- Departments of Medicine, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L'Assomption, Montreal, Quebec H1T 2M4 Canada
| |
Collapse
|
14
|
Abstract
Deaths which occur in association with agricultural electric fences are very rare. In fact, electric fences have undoubtedly saved numerous human and animal lives by safely and reliably keeping livestock confined to their fields and enclosures and thus preventing motor vehicle incidents when livestock get onto roads and highways. Accidental and intentional human contact with electric fences occurs regularly and causes little more than transient discomfort, however, on exceptional occasions, contact with electric fences appears to be directly related to the death of the individual. The precise pathophysiological cause of these deaths is unclear. We present two cases of deaths associated with electric fences, discuss the possible pathophysiological mechanisms in these cases, and suggest a universal approach to the medico-legal investigation and documentation of these deaths.
Collapse
|
15
|
Weiner MM, Asher DI, Augoustides JG, Evans AS, Patel PA, Gutsche JT, Mookadam F, Ramakrishna H. Takotsubo Cardiomyopathy: A Clinical Update for the Cardiovascular Anesthesiologist. J Cardiothorac Vasc Anesth 2017; 31:334-344. [DOI: 10.1053/j.jvca.2016.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Indexed: 12/20/2022]
|
16
|
Y-Hassan S, De Palma R. Contemporary review on the pathogenesis of takotsubo syndrome: The heart shedding tears: Norepinephrine churn and foam at the cardiac sympathetic nerve terminals. Int J Cardiol 2016; 228:528-536. [PMID: 27875730 DOI: 10.1016/j.ijcard.2016.11.086] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/06/2016] [Indexed: 12/14/2022]
Abstract
Takotsubo syndrome (TS), an increasingly recognized acute cardiac disease entity, is characterized by a unique pattern of circumferential and typically regional left ventricular wall motion abnormality resulting in a conspicuous transient ballooning of the left ventricle during systole. The mechanism of the disease remains elusive. However, the sudden onset of acute myocardial stunning in a systematic pattern extending beyond a coronary artery territory; the history of a preceding emotional or physical stress factor in two thirds of cases; the signs of sympathetic denervation at the regions of left ventricular dysfunction on sympathetic scintigraphy; the finding of myocardial edema and other signs consistent with (catecholamine-induced) myocarditis shown by cardiac magnetic resonance imaging; and the contraction band necrosis on histopathological examination all argue strongly for the involvement of the cardiac sympathetic nervous system in the pathogenesis of TS. In this narrative review, extensive evidence in support of local cardiac sympathetic nerve hyperactivation, disruption and norepinephrine spillover causing TS in predisposed patients is provided.
Collapse
Affiliation(s)
- Shams Y-Hassan
- Karolinska Institute at Karolinska University Hospital, Department of Cardiology, Sweden.
| | - Rodney De Palma
- Karolinska Institute at Karolinska University Hospital, Department of Cardiology, Sweden
| |
Collapse
|
17
|
Indorato F, Bartoloni G. Post-mortem Takotsubo cardiomyopathy diagnosis: the challenge is open! Forensic Sci Med Pathol 2016; 12:227-8. [DOI: 10.1007/s12024-016-9759-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 11/24/2022]
|
18
|
Do pathologists agree on how to diagnose takotsubo cardiomyopathy? Forensic Sci Med Pathol 2016; 12:226. [PMID: 26820282 DOI: 10.1007/s12024-015-9739-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
|