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Bender M, Friedrich M, Voigtmann H, Haferkorn K, Uhl E, Stein M. Impact of Serum Lactate as an Early Serum Biomarker for Cardiopulmonary Parameters within the First 24 Hours of Intensive Care Unit Treatment in Patients with Isolated Traumatic Brain Injury. Diagnostics (Basel) 2023; 13:diagnostics13101777. [PMID: 37238261 DOI: 10.3390/diagnostics13101777] [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: 04/07/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Cardiopulmonary (CP) complications are well-known phenomena in patients with isolated traumatic brain injury (iTBI) that can lead to tissue hypoperfusion and hypoxia. Serum lactate level is a well-known biomarker, indicating these systemic dysregulations in various diseases, but this has not been investigated in iTBI patients so far. The current study evaluates the association between serum lactate levels upon admission and CP parameters within the first 24 h of intensive care unit (ICU) treatment in iTBI patients. PATIENTS AND METHODS 182 patients with iTBI who were admitted to our neurosurgical ICU between December 2014 and December 2016 were retrospectively evaluated. Serum lactate levels on admission, demographic, medical, and radiological data upon admission, as well as several CP parameters within the first 24 h of ICU treatment, were analyzed, as well as the functional outcome at discharge. The total study population was dichotomized into patients with an elevated serum lactate level (lactate-positive) and patients with a low serum lactate level (lactate-negative) upon admission. RESULTS 69 patients (37.9%) had an elevated serum lactate level upon admission, which was significantly associated with a lower Glasgow Coma Scale score (p = 0.04), a higher head AIS score (p = 0.03), and a higher Acute Physiology and Chronic Health Evaluation II score (p = 0.01) upon admission, as well as a higher modified Rankin Scale score (p = 0.002) and a lower Glasgow Outcome Scale score (p < 0.0001) at discharge. Furthermore, the lactate-positive group required a significantly higher norepinephrine application rate (NAR; p = 0.04) and a higher fraction of inspired oxygen (FiO2; p = 0.04) to maintain the defined CP parameters within the first 24 h. CONCLUSION ICU-admitted iTBI patients with elevated serum lactate levels upon admission required higher CP support within the first 24 h of ICU treatment after iTBI. Serum lactate may be a helpful biomarker for improving ICU treatment in the early stages.
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Affiliation(s)
- Michael Bender
- Department of Neurosurgery, Justus-Liebig-University, 35392 Gießen, Germany
| | - Michaela Friedrich
- Department of Neurosurgery, Hospital Aschaffenburg-Alzenau, 63739 Aschaffenburg, Germany
| | - Hans Voigtmann
- Department of Neurosurgery, Justus-Liebig-University, 35392 Gießen, Germany
| | - Kristin Haferkorn
- Department of Neurosurgery, Justus-Liebig-University, 35392 Gießen, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig-University, 35392 Gießen, Germany
| | - Marco Stein
- Department of Neurosurgery, Justus-Liebig-University, 35392 Gießen, Germany
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Al Houri HN, Jomaa S, Jabra M, Alhouri AN, Latifeh Y. Pathophysiology of stress cardiomyopathy: A comprehensive literature review. Ann Med Surg (Lond) 2022; 82:104671. [PMID: 36268377 PMCID: PMC9577654 DOI: 10.1016/j.amsu.2022.104671] [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: 07/16/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction Takotsubo cardiomyopathy is a transient type of acute heart failure with distinct wall motion abnormalities and unclear pathophysiology. This review focuses on the proposed pathophysiological mechanisms that could be involved in the occurrence takotsubo cardiomyopathy. Main body Acute stress and subsequent excessive activation of the sympathetic nervous system are major factors in the pathophysiology of takotsubo cardiomyopathy. The high levels of catecholamine work in a triggering manner, generate reactive oxygen species, release inflammatory cytokines, and induce endothelial injury. The incidence of Takotsubo cardiomyopathy has increased following COVID-19 infection and vaccination, which suggests that neurohormonal and psychological factors (i.e., fear and anxiety of infection or vaccination) may have an additional role in the pathophysiology. In addition, inflammatory state, cytokine storm, augmented sympathetic activity, and endothelial dysfunction during the acute phase of COVID-19 infection may participate in Takotsubo cardiomyopathy. Chronic stress is also linked to this complex mechanism by accelerating cripple of endocrinal hypothalamic-pituitary-adrenal axis activity, which influences the cortisol effect on releasing catecholamine, which is directly related to the pathogenesis of takotsubo cardiomyopathy. Conclusion The excessive activation of the sympathetic nervous system and subsequent high levels of catecholamines could initiate the process. The catecholamines, in turn, generate reactive oxygen species and release inflammatory cytokines (i.e., IL-1, IL-2, IL-6, IL-7, IL-8, CXCL1, TNF-α, and IFN-γ), which causes endothelial injury. The excessive activation of the sympathetic nervous system is the major drive for Stress Cardiomyopathy. Catecholamines are responsible for the subsequent endothelial injury. IL-1, IL-2, IL-6, IL-7, IL-8, CXCL1, TNF-α, and IFN-γ are the major cytokines involved in Stress Cardiomyopathy.
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Affiliation(s)
- Hasan Nabil Al Houri
- Internal Medicine Department, Damascus University, Damascus, Syria
- Faculty of Medicine, Syrian Private University, Damascus, Syria
- Corresponding author. Internal Medicine Department, Damascus University, Damascus, Syria.
| | - Sami Jomaa
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Massa Jabra
- Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Youssef Latifeh
- Department of Psychiatry, Faculty of Medicine, Damascus University, Damascus, Syria
- Department of Psychiatry, Faculty of Medicine, Al-Sham Private University, Damascus, Syria
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Henein MY, Vancheri S, Longo G, Vancheri F. The Impact of Mental Stress on Cardiovascular Health—Part II. J Clin Med 2022; 11:jcm11154405. [PMID: 35956022 PMCID: PMC9369438 DOI: 10.3390/jcm11154405] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
Endothelial dysfunction is one of the earliest manifestations of atherosclerosis, contributing to its development and progression. Mental stress induces endothelial dysfunction through increased activity of the sympathetic nervous system, release of corticotropin-releasing hormone from the hypothalamus, inhibition of nitric oxide (NO) synthesis by cortisol, and increased levels of pro-inflammatory cytokines. Mental-stress-induced increased output of the sympathetic nervous system and concomitant withdrawal of the parasympathetic inflammatory reflex results in systemic inflammation and activation of a neural–hematopoietic–arterial axis. This includes the brainstem and subcortical regions network, bone marrow activation, release of leukocytes into the circulation and their migration to the arterial wall and atherosclerotic plaques. Low-grade, sterile inflammation is involved in all steps of atherogenesis, from coronary plaque formation to destabilisation and rupture. Increased sympathetic tone may cause arterial smooth-muscle-cell proliferation, resulting in vascular hypertrophy, thus contributing to the development of hypertension. Emotional events also cause instability of cardiac repolarisation due to brain lateralised imbalance of cardiac autonomic nervous stimulation, which may lead to asymmetric repolarisation and arrhythmia. Acute emotional stress can also provoke severe catecholamine release, leading to direct myocyte injury due to calcium overload, known as myocytolysis, coronary microvascular vasoconstriction, and an increase in left ventricular afterload. These changes can trigger a heart failure syndrome mimicking acute myocardial infarction, characterised by transient left ventricular dysfunction and apical ballooning, known as stress (Takotsubo) cardiomyopathy. Women are more prone than men to develop mental-stress-induced myocardial ischemia (MSIMI), probably reflecting gender differences in brain activation patterns during mental stress. Although guidelines on CV prevention recognise psychosocial factors as risk modifiers to improve risk prediction and decision making, the evidence that their assessment and treatment will prevent CAD needs further evaluation.
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Affiliation(s)
- Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden;
- Brunel University, Middlesex, London UB8 3PH, UK
- St. George’s University, London SW17 0RE, UK
| | - Sergio Vancheri
- Radiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy;
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S. Elia Hospital, 93100 Caltanissetta, Italy;
| | - Federico Vancheri
- Department of Internal Medicine, S. Elia Hospital, 93100 Caltanissetta, Italy
- Correspondence:
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Fujiyoshi K, Ako J, Ishida K, Ishida M, Minami Y, Inomata T. Tako-tsubo-like left ventricular dysfunction in a patient with COVID-19 demonstrated by non-invasive multi-modality imaging. J Nucl Cardiol 2022; 29:863-865. [PMID: 33000408 PMCID: PMC7527244 DOI: 10.1007/s12350-020-02367-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Kazuhiro Fujiyoshi
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kohki Ishida
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan
| | - Miwa Ishida
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan.
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Suri JS, Paul S, Maindarkar MA, Puvvula A, Saxena S, Saba L, Turk M, Laird JR, Khanna NN, Viskovic K, Singh IM, Kalra M, Krishnan PR, Johri A, Paraskevas KI. Cardiovascular/Stroke Risk Stratification in Parkinson's Disease Patients Using Atherosclerosis Pathway and Artificial Intelligence Paradigm: A Systematic Review. Metabolites 2022; 12:metabo12040312. [PMID: 35448500 PMCID: PMC9033076 DOI: 10.3390/metabo12040312] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/20/2022] Open
Abstract
Parkinson’s disease (PD) is a severe, incurable, and costly condition leading to heart failure. The link between PD and cardiovascular disease (CVD) is not available, leading to controversies and poor prognosis. Artificial Intelligence (AI) has already shown promise for CVD/stroke risk stratification. However, due to a lack of sample size, comorbidity, insufficient validation, clinical examination, and a lack of big data configuration, there have been no well-explained bias-free AI investigations to establish the CVD/Stroke risk stratification in the PD framework. The study has two objectives: (i) to establish a solid link between PD and CVD/stroke; and (ii) to use the AI paradigm to examine a well-defined CVD/stroke risk stratification in the PD framework. The PRISMA search strategy selected 223 studies for CVD/stroke risk, of which 54 and 44 studies were related to the link between PD-CVD, and PD-stroke, respectively, 59 studies for joint PD-CVD-Stroke framework, and 66 studies were only for the early PD diagnosis without CVD/stroke link. Sequential biological links were used for establishing the hypothesis. For AI design, PD risk factors as covariates along with CVD/stroke as the gold standard were used for predicting the CVD/stroke risk. The most fundamental cause of CVD/stroke damage due to PD is cardiac autonomic dysfunction due to neurodegeneration that leads to heart failure and its edema, and this validated our hypothesis. Finally, we present the novel AI solutions for CVD/stroke risk prediction in the PD framework. The study also recommends strategies for removing the bias in AI for CVD/stroke risk prediction using the PD framework.
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Affiliation(s)
- Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (A.P.); (I.M.S.)
- Correspondence: ; Tel.: +1-(916)-749-5628
| | - Sudip Paul
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India; (S.P.); (M.A.M.)
| | - Maheshrao A. Maindarkar
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India; (S.P.); (M.A.M.)
| | - Anudeep Puvvula
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (A.P.); (I.M.S.)
- Annu’s Hospitals for Skin & Diabetes, Gudur 524101, India
| | - Sanjay Saxena
- Department of CSE, International Institute of Information Technology, Bhuneshwar 751003, India;
| | - Luca Saba
- Department of Radiology, University of Cagliari, 09121 Cagliari, Italy;
| | - Monika Turk
- Deparment of Neurology, University Medical Centre Maribor, 1262 Maribor, Slovenia;
| | - John R. Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St. Helena, CA 94574, USA;
| | - Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110001, India;
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, 10000 Zagreb, Croatia;
| | - Inder M. Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA; (A.P.); (I.M.S.)
| | - Mannudeep Kalra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
| | | | - Amer Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Kosmas I. Paraskevas
- Department of Vascular Surgery, Central Clinic of Athens, 106 80 Athens, Greece;
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Left Ventricular Function in the Initial Period After Severe Traumatic Brain Injury in Swine. Neurocrit Care 2022; 37:200-208. [PMID: 35314968 DOI: 10.1007/s12028-022-01468-5] [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: 09/21/2021] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiac dysfunction is common in the days after severe traumatic brain injury (TBI) and may contribute to hypotension episodes, leading to worse outcomes. Little is known about cardiac function in the minutes and hours immediately following TBI. By using fluid percussion TBI in a swine model, we aimed to characterize the immediate post injury cardiac function. METHODS Intubated, anesthetized immature (25.8 ± 1.5 kg) female swine were subjected to severe fluid percussion TBI (4.2 ± 0.2 atm). Beginning at 45 min, simulating hospital arrival, all animals were resuscitated with normal saline (NS), mannitol, and phenylephrine as needed to maintain a cerebral perfusion pressure more than 60 mm Hg and intracranial pressure (ICP) less than 20 mm Hg. Primary outcomes of cardiac function were cardiac output measured by thermodilution and transesophageal echo measurements of cardiac function recorded at prespecified time points and tested for trends over time using linear regression with spline at the time of resuscitation onset. Secondary outcomes included hemodynamic measurements, ICP, and cerebral perfusion pressure. RESULTS Eighteen animals were included. Post-TBI hemodynamic changes demonstrated an early decrease in mean arterial pressure and cerebral perfusion pressure with a corresponding increase in heart rate and ICP. Immediately after injury, there was a significant decrease in both left atrial area and tissue Doppler imaging e' of the LV lateral wall. In addition, there was a simultaneous increase in LV end diastolic diameter and increase in E/e' ratio of the lateral mitral annulus. All other transesophageal echo measurements demonstrated no significant changes throughout the duration of the experiment. CONCLUSIONS Traumatic brain injury is associated with cardiac dysfunction and increased mortality, however there is still a limited understanding of the hemodynamic and echocardiographic response associated with TBI. In this study we demonstrate the hemodynamic and echocardiographic changes in the early stages of TBI in swine. The authors hope that these results may help better understanding on the management of patients with severe head injury.
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Riordan P, Davis M. Anxiety and psychological management of heart disease and heart surgery. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:393-408. [PMID: 33632455 DOI: 10.1016/b978-0-12-819814-8.00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Anxiety is associated with many forms and facets of heart disease, and, by extension, neurologic manifestations of heart disease. Despite its seeming self-evidence, anxiety is challenging to consistently define, measure, and operationalize in the context of medical research. Various diagnostic nosologies have been defined and refined over time, but anxiety is also a universal human experience that may be "normal" in many circumstances, particularly in the face of major medical issues. For these and other reasons, the research on anxiety and heart disease is mixed, incomplete, and often characterized by challenging questions of causality. Nonetheless, a broad body of literature has established clear connections between anxiety and vascular risk factors, cardiac disease, and cardiac surgery. These relationships are often intuitive, with research suggesting, for example, that chronic activation of the sympathetic nervous system is associated with increased risk of heart disease. However, they are sometimes complexly reciprocal or even surprising (e.g., with high-anxiety individuals found to have better outcomes in some cardiac conditions by virtue of seeking evaluation and treatment earlier). This chapter reviews the construct of anxiety and its complexities, its associations with heart disease, and the established treatments for anxiety, concluding with questions about anxiety, heart disease, and their optimal management that still need to be answered.
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Affiliation(s)
- Patrick Riordan
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, United States.
| | - Matthew Davis
- Mental Health Service Line, Edward Hines Jr. VA Hospital, Hines, IL, United States
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Bender M, Stein M, Schoof B, Kolodziej MA, Uhl E, Schöller K. Troponin I as an early biomarker of cardiopulmonary parameters during the first 24 h of intensive care unit treatment in isolated traumatic brain injury patients. Injury 2020; 51:1189-1195. [PMID: 31926612 DOI: 10.1016/j.injury.2020.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/14/2019] [Accepted: 01/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Cardiopulmonary (CP) complications are well-known phenomena after an isolated traumatic brain injury (iTBI) and they may be associated with an elevated serum troponin I (TnI) value. However, the influence of an elevated TnI level on CP parameters within the first 24 h after an iTBI is still unknown. The current study was conducted to assess the associations between the initial TnI value on admission and CP parameters during the first 24 h of intensive care unit (ICU) treatment in iTBI patients. PATIENTS AND METHODS A total of 288 patients with iTBIs, who were admitted to our emergency department between January 2010 and November 2016 were retrospectively analyzed. Blood samples were taken on admission to determine TnI value. Each patient's demographic data, treatment regime, computed tomography results, and intra-hospital outcomes were evaluated, as well as several CP parameters, within the first 24 h of ICU treatment. The entire study population was stratified into patients with an initial TnI elevation (TnI positive) and without an initial TnI elevation (TnI negative). RESULTS Increased TnI values on admission were found in 59 (20.5%) patients. There were significant correlations between an initially elevated TnI value and a lower Glasgow Coma Scale score (p = 0.003), higher head Abbreviated Injury Scale score (p<0.0001), and higher Acute Physiology and Chronic Health Evaluation II score (p = 0.005) on admission, as well as a lower Glasgow Outcome Scale score (p = 0.0002) and higher modified Rankin Scale score (p = 0.0001) at discharge. In addition, a significantly higher norepinephrine application rate (NAR) (p<0.0001) and inspiratory oxygen fraction (FiO2) (p = 0.028) were needed in the TnI positive group. CONCLUSION Patients with elevated TnI values on admission require more circulation support (NAR and FiO2) within the first 24 h of ICU treatment after an iTBI. Therefore, the TnI may be a useful biomarker to improve ICU treatment of these patients.
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Affiliation(s)
- Michael Bender
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen 35392, Germany.
| | - Marco Stein
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen 35392, Germany
| | - Bennet Schoof
- Department of Trauma, Orthopedic and Reconstructive Surgery, Sana Klinikum Düsseldorf, Düsseldorf 40625, Germany
| | - Malgorzata Anna Kolodziej
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen 35392, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen 35392, Germany
| | - Karsten Schöller
- Department of Neurosurgery, Justus-Liebig-University Giessen, Klinikstrasse 33, Giessen 35392, Germany
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Fagundes N, Castro ML, Silva RA, De Lima MPA, Braga CS, Dos Santos EAR, Oliveira MA, Mattoso CRS, Pimenta ELM, Beier SL. Comparison of midazolam and butorphanol combined with ketamine or dexmedetomidine for chemical restraint in howler monkeys (Alouatta guariba clamitans) for vasectomy. J Med Primatol 2020; 49:179-187. [PMID: 32157703 DOI: 10.1111/jmp.12467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/06/2020] [Accepted: 02/19/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND This study evaluated and compared cardiorespiratory and blood gas parameters, as well as sedation, analgesia and recovery of two protocols: ketamine (10 mg/kg) or dexmedetomidine (10 μg/kg), with midazolam (0.5 mg/kg) and butorphanol (0.3 mg/kg), IM (KBM and DBM, respectively) in brown howler monkeys (Alouatta guariba clamitans). MATERIAL AND METHODS Twelve brown howler monkeys were selected in two groups and evaluated for cardiorespiratory parameters and sedation, from 5-30 minutes after latency. Blood gas and arterial lactate were taken at 5 and 30 minutes. In the end, time and quality of recovery were evaluated. RESULTS The HR in DBM group was significantly lower at all times. The sedation score was higher in DBM. Recovery in DBM was faster. All animals had moderate hypoxaemia. CONCLUSION Both protocols produce satisfactory anaesthesia and analgesia, but DBM provides deeper sedation with faster recovery. Oxygen supplementation is recommended in both due to hypoxaemia.
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Kim W, Choi KS, Lim T, Ahn C, Cho Y, Yi HJ, Lee SH. Prognostic Value of Echocardiography for Left Ventricular Dysfunction After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. World Neurosurg 2019; 126:e1099-e1111. [PMID: 30880203 DOI: 10.1016/j.wneu.2019.03.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Cardiac dysfunction may worsen outcomes after aneurysmal subarachnoid hemorrhage (SAH). This study quantitatively assessed the prognostic value of left ventricular dysfunction with respect to functional outcomes and mortality in patients with aneurysmal SAH. METHODS We searched MEDLINE and EMBASE databases to retrieve relevant studies evaluating echocardiographic left ventricular dysfunction following aneurysmal SAH. Fourteen relevant observational studies evaluating 2234 patients were finally included in this study. RESULTS Echocardiographic regional wall motion abnormalities (RWMA) and neurogenic cardiomyopathy (NCM) of the left ventricle occurring after SAH were significantly related to an increase of in-hospital mortality (in 8 studies for RWMA, odds ratio [OR] 2.37; 95% confidence interval [CI] 1.74-3.25 and in 5 studies for NCM, OR 2.82; 95% CI 1.2-6.6). Decreased ejection fraction on echocardiography was not associated with the increase of in-hospital mortality (in 4 studies, OR 1.76; 95% CI 0.86-3.61). The heterogeneities of decreased ejection fraction and NCM were significantly resolved by analyzing only the studies based on echocardiogram measurements obtained within 72 hours after admission. CONCLUSIONS The present meta-analysis suggests that the identification of echocardiographic left ventricular dysfunction identified by RWMA and NCM after SAH could provide better prognostic information for in-hospital mortality.
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Affiliation(s)
- Wonhee Kim
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Taeho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Youngsuk Cho
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seon-Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Republic of Korea.
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Takotsubo Cardiomyopathy and Neurogenic Pulmonary Edema After Carotid Endarterectomy. World Neurosurg 2019; 124:157-160. [PMID: 30660883 DOI: 10.1016/j.wneu.2018.12.206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/25/2018] [Accepted: 12/26/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TCM) and neurogenic pulmonary edema (NPE) are rare complications of an acute ischemic stroke. In particular, TCM and NPE following carotid endarterectomy (CEA) are extremely rare. In general, TCM- and NPE-associated ischemic strokes are caused by excess catecholamine release after sympathetic nervous stimulation following stroke onset, but the mechanism triggering this stimulation is still unknown. CASE DESCRIPTION An 88-year-old man underwent left CEA for symptomatic carotid artery stenosis (North American Symptomatic Carotid Endarterectomy Trial, 65%). After the surgery, his respiratory condition rapidly worsened, and chest radiography revealed an infiltrative shadow on both lung fields. Transthoracic echocardiography revealed left ventricular dysfunction, suggesting TCM. Postoperative magnetic resonance imaging revealed a small infarction in the left anterior insular cortex. Eventually, his respiratory and cardiac functions gradually improved. He was finally discharged on his own from the hospital on postoperative day 9. CONCLUSIONS We described a very rare case of TCM and NPE following CEA. The mechanisms of TCM and NPE involve excess catecholamine release after sympathetic nervous stimulation. Our findings suggest that surgery-associated transient ischemia and reperfusion injury to the left insular cortex stimulate sympathetic nerves.
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Ong SB, Lee WH, Shao NY, Ismail NI, Katwadi K, Lim MM, Kwek XY, Michel NA, Li J, Newson J, Tahmasebi S, Rehman J, Kodo K, Jang HR, Ong SG. Calpain Inhibition Restores Autophagy and Prevents Mitochondrial Fragmentation in a Human iPSC Model of Diabetic Endotheliopathy. Stem Cell Reports 2019; 12:597-610. [PMID: 30799273 PMCID: PMC6411483 DOI: 10.1016/j.stemcr.2019.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 02/09/2023] Open
Abstract
The relationship between diabetes and endothelial dysfunction remains unclear, particularly the association with pathological activation of calpain, an intracellular cysteine protease. Here, we used human induced pluripotent stem cells-derived endothelial cells (iPSC-ECs) to investigate the effects of diabetes on vascular health. Our results indicate that iPSC-ECs exposed to hyperglycemia had impaired autophagy, increased mitochondria fragmentation, and was associated with increased calpain activity. In addition, hyperglycemic iPSC-ECs had increased susceptibility to cell death when subjected to a secondary insult-simulated ischemia-reperfusion injury (sIRI). Importantly, calpain inhibition restored autophagy and reduced mitochondrial fragmentation, concurrent with maintenance of ATP production, normalized reactive oxygen species levels and reduced susceptibility to sIRI. Using a human iPSC model of diabetic endotheliopathy, we demonstrated that restoration of autophagy and prevention of mitochondrial fragmentation via calpain inhibition improves vascular integrity. Our human iPSC-EC model thus represents a valuable platform to explore biological mechanisms and new treatments for diabetes-induced endothelial dysfunction.
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Affiliation(s)
- Sang-Bing Ong
- Signature Research Program in Cardiovascular & Metabolic Disorders, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Won Hee Lee
- Department of Basic Medical Sciences, University of Arizona, Phoenix, AZ 85004, USA
| | - Ning-Yi Shao
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Nur Izzah Ismail
- Signature Research Program in Cardiovascular & Metabolic Disorders, Duke-NUS Medical School, Singapore 169857, Singapore; Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Khairunnisa Katwadi
- Signature Research Program in Cardiovascular & Metabolic Disorders, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Mim-Mim Lim
- Signature Research Program in Cardiovascular & Metabolic Disorders, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Xiu-Yi Kwek
- Signature Research Program in Cardiovascular & Metabolic Disorders, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Nathaly Anto Michel
- Signature Research Program in Cardiovascular & Metabolic Disorders, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Jiajun Li
- Department of Pharmacology, The University of Illinois College of Medicine, Chicago, IL 60612, USA
| | - Jordan Newson
- Department of Pharmacology, The University of Illinois College of Medicine, Chicago, IL 60612, USA
| | - Soroush Tahmasebi
- Department of Pharmacology, The University of Illinois College of Medicine, Chicago, IL 60612, USA
| | - Jalees Rehman
- Department of Pharmacology, The University of Illinois College of Medicine, Chicago, IL 60612, USA; Division of Cardiology, Department of Medicine, The University of Illinois College of Medicine, 909 S Wolcott Avenue, Chicago, IL 60612, USA
| | - Kazuki Kodo
- Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hye Ryoun Jang
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351 Republic of Korea.
| | - Sang-Ging Ong
- Department of Pharmacology, The University of Illinois College of Medicine, Chicago, IL 60612, USA; Division of Cardiology, Department of Medicine, The University of Illinois College of Medicine, 909 S Wolcott Avenue, Chicago, IL 60612, USA.
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13
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Rellini G, Piazza R, Loiudice E, Cassin M, Bernardi G, Pavan D, Cervesato E, Nicolosi GL. Heterogeneity of clinical presentation in Tako-Tsubo syndromes: the prevalence of normal segmental wall motion and normal ECG pattern. J Cardiovasc Med (Hagerstown) 2018; 19:717-724. [PMID: 30320724 DOI: 10.2459/jcm.0000000000000729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM The aim of this study is to report the heterogeneity of clinical presentation in Tako-Tsubo syndrome (TTS), including a significant prevalence of normal ECG and echocardiographic patterns in a series of consecutive patients from a single center. METHODS AND RESULTS From our database we selected a total of 168 cases of TTS. A total of 140 of these (Group A); 14 men (10%), mean age 60.3 years, range 39-87; 126 women (90%), mean age 66.1 years, range 43-93; matched the following reported criteria: typical stenocardic pain immediately following an emotional acute stress, or acute medical or surgical event within the preceding 12 h; acute rise and fall of troponin release; absence of significant coronary disease at coronary angiography. ECG findings at presentation ranged from T wave abnormalities (41 cases, 29.3%) to ST elevation (52 cases, 37.1%) and ST depression (11 cases, 7.9%), whereas in 36 cases (25.7%) the ECG was normal. Echocardiography at presentation showed akinesia of the total apical or medium-apical segments in 74 patients (53%), whereas it showed akinesia of left ventricular wall segments in other locations in 30 patients (21%) and even normal regional wall motion and thickening in 36 patients (26%). We described also a series of 13 female patients (mean age 70.2 years; age range 45-85 years) (Group B) who did not complain of chest pain at presentation, but showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography. Finally we selected 15 female patients (mean age 69.3 years; age range 49-89 years) (Group C) who formally did not report acute stress immediately preceding their presentation to the hospital for chest pain. They showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography and only one case of normal ECG pattern at presentation. CONCLUSION In this series of acute TTS, a wide variability of ECG and echocardiographic patterns are observed, ranging from ST elevation with coexisting segmental wall motion abnormalities of the typical TTS to a clinical presentation characterized by normal ECG and normal segmental wall motion pattern.
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Affiliation(s)
| | | | | | | | | | | | | | - Gian L Nicolosi
- Cardiology Department, ARC, Ospedale Civile.,Cardiology Clinic, Policlinico San Giorgio, Pordenone, Italy
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Khattak F, Khalid M, Murtaza G, Paul TK. Takotsubo Cardiomyopathy Mimicking Stent Thrombosis After Percutaneous Coronary Intervention. J Investig Med High Impact Case Rep 2018; 6:2324709618773793. [PMID: 29761112 PMCID: PMC5946348 DOI: 10.1177/2324709618773793] [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: 02/18/2018] [Revised: 03/25/2018] [Accepted: 04/05/2018] [Indexed: 11/30/2022] Open
Abstract
Takotsubo cardiomyopathy, also known as “broken heart syndrome,” is a transient left ventricular dysfunction associated with stress (usually emotional) induced myocardial injury and stunning. It often presents as myocardial infarction on surface electrocardiogram (EKG). Diagnosis is made by coronary angiography, which rules out coronary artery disease and shows pathognomonic apical ballooning. In this article, we present a case of a 72-year-old woman who initially presented with an ST segment elevation myocardial infarction on EKG. Coronary angiography showed severe left anterior descending artery and diagonal lesions requiring percutaneous coronary intervention. Post–percutaneous coronary intervention, EKG changes resolved. The next day, the patient developed recurrent chest pain and her EKG showed diffuse T-wave inversion in precordial leads with reemerging ST segment elevations concerning for stent thrombosis. The patient underwent repeat emergent coronary angiography, which showed patent stents and findings consistent with takotsubo cardiomyopathy.
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Affiliation(s)
- Furqan Khattak
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN, USA
| | - Muhammad Khalid
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN, USA
| | - Ghulam Murtaza
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN, USA
| | - Timir K Paul
- East Tennessee State University, Quillen College of Medicine, Johnson City, TN, USA
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15
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Taniguchi K, Takashima S, Iida R, Ota K, Nitta M, Sakane K, Fujisaka T, Ishizaka N, Umegaki O, Uchiyama K, Takasu A. Takotsubo cardiomyopathy caused by acute respiratory stress from extubation: A case report. Medicine (Baltimore) 2017; 96:e8946. [PMID: 29310390 PMCID: PMC5728791 DOI: 10.1097/md.0000000000008946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONAL Takotsubo cardiomyopathy (TCM) is a transient systolic dysfunction of the left ventricular apex without stenosis of coronary arteries and is induced by various psychological and physical factors. TCM sometimes causes lethal complications such as arrhythmia, thrombogenesis, and even cardiac rupture, and thus it should be diagnosed appropriately and managed carefully. Intensive care unit (ICU) patients are exposed to overstress during the treatment process and therefore can are at potential risk for TCM. PATIENT CONCERNS The patient was diagnosed as having pneumonia because of influenza A virus mixed with bacteria and underwent intensive care with intubation and mechanical ventilation in the ICU. His respiratory condition soon improved, and so extubation was carried out; however, redeterioration with pulmonary edema occurred at half of a day following extubation. DIAGNOSIS The chest x-ray revealed pulmonary edema. The electrocardiogram pattern significantly changed with time, and the echocardiogram showed weakness of wall motion around the left ventricular apex. Hence, to confirm the diagnosis, we performed cardiac catheterization immediately, with the results showing a Takotsubo-like form at the systolic phase without significant stenosis of the coronary arteries. INTERVENTION The patient was reintubated with administration of catecholamine for decreasing blood pressure caused by left ventricular dysfunction. Also, diuretics for pulmonary edema and anticoagulants for prevention of thrombogenesis were administered. OUTCOMES As the respiratory condition improved with stabilization of cardiovascular hemodynamics, reextubation was done at ICU day 11 and was discharged from the ICU at ICU day 15. The patient was subsequently treated for pneumonia after leaving the ICU but suffered from repetitive aspiration pneumonia and was finally transferred to another hospital at hospital day 111. LESSONS TCM should be considered especially under the situation of intensive care, and prompt diagnosis should be followed by appropriate management.
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Affiliation(s)
- Kohei Taniguchi
- Department of Emergency Medicine
- Department of General and Gastroenterological Surgery
| | | | - Ryo Iida
- Department of Emergency Medicine
- Department of General and Gastroenterological Surgery
| | | | | | | | | | | | - Osamu Umegaki
- Department of Critical Care Medicine, Osaka Medical College, Osaka, Japan
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16
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Takotsubo Cardiomyopathy vs. Acute Coronary Syndrome in the Emergency Department Setting: a Review of Diagnostic Criteria and Outcomes. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40138-017-0129-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Limongelli G, Masarone D, Maddaloni V, Rubino M, Fratta F, Cirillo A, Ludovica SB, Pacileo R, Fusco A, Coppola GR, Pisacane F, Bossone E, Calabrò P, Calabrò R, Russo MG, Pacileo G. Genetics of Takotsubo Syndrome. Heart Fail Clin 2017; 12:499-506. [PMID: 27638020 DOI: 10.1016/j.hfc.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Takotsubo syndrome (TTS) is an enigmatic disease with a multifactorial and still unresolved pathogenesis. A genetic predisposition has been suggested based on the few familial TTS cases. Conflicting results have been published regarding the role of functional polymorphisms in relevant candidate genes, such as α1-, β1-, and β2-adrenergic receptors; G protein-coupled receptor kinase 5; and estrogen receptors. Further research is required to help clarify the role of genetic susceptibility in TTS.
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Affiliation(s)
- Giuseppe Limongelli
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy.
| | - Daniele Masarone
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Valeria Maddaloni
- Genomic and Cellular Lab, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Marta Rubino
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Fiorella Fratta
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Annapaola Cirillo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Spinelli Barrile Ludovica
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Roberta Pacileo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Adelaide Fusco
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Guido Ronald Coppola
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Francesca Pisacane
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Eduardo Bossone
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy; Cardiology Division, Heart Department, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, via De Marinis, Cava de" Tirreni (SA) 84013, Italy
| | - Paolo Calabrò
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Raffaele Calabrò
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Maria Giovanna Russo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Monaldi Hospital, AORN dei Colli, Second University of Naples, Via L Bianchi, Naples 80100, Italy
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18
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The Role of Early Focused Cardiac Ultrasound in a Not-So-Typical Presentation of Takotsubo Cardiomyopathy: A Case Report. J Emerg Med 2017; 52:e169-e173. [PMID: 28268118 DOI: 10.1016/j.jemermed.2017.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/03/2017] [Accepted: 01/22/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Focused cardiac ultrasound (FoCUS) can be extremely helpful in identifying unexpected diagnoses that can significantly alter treatment options. The diagnosis of Takotsubo cardiomyopathy (TCM) may be difficult to identify. CASE REPORT We describe a 47-year-old woman who presented to the emergency department (ED) with atypical features of TCM. Her clinical features included being a premenopausal woman with mild chest pain with a lack of identifiable emotional or physical stressors or significant electrocardiographic changes. Initial findings on FoCUS were consistent with TCM, with these findings replicated on repeat bedside echo performed in the ED by the cardiology fellow. A subsequent comprehensive echo showed marked improvement of the TCM pattern within 24 hours. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TCM may present in younger women or men, without obvious preceding physical or emotional stressors and with nonspecific ECG findings. FoCUS performed in the ED may suggest a diagnosis of TCM in patients with chest pain or dyspnea of uncertain etiology. The performance of FoCUS, as highlighted by this case report, can lead to timely intervention and follow-up of a variety of cardiac conditions.
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19
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Efferth T, Banerjee M, Paul NW. Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact. Int J Cardiol 2017; 230:262-268. [PMID: 28041712 DOI: 10.1016/j.ijcard.2016.12.129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/29/2016] [Accepted: 12/16/2016] [Indexed: 11/25/2022]
Abstract
The cardiac impact of psychological stress historically and socially understood as boundary experiences of human life has long since become an icon. From the aching heart to the sudden death provoked by awe, horror, grief, anger, and humiliation on one side and extreme enchantment, enthusiasm, and excitement on the other, the broken heart has become a globally recognized and powerful metaphor present from folklore to popular culture to high literature and back to everyday communication. In medicine, the "broken heart syndrome" is described as a relatively new nosological entity that has been used synonymously with the term tako-tsubo or stress cardiomyopathy. Among those three terms, however, the broken heart most vividly draws the connection between conditions under which lived experience triggers cardiac damage and conversely, cardiovascular death occurs. According to Hassan and Yamasaki (2013) [1] and quite apart from the general perception medical notions of the broken heart indeed go back to at least 1967, when Rees and Lutkins studied the death rate among 903 relatives of patients who died in Wales. They found that 4.8% of bereaved close relatives died within a year of bereavement compared with 0.68% of a non-bereaved control group. Among widows and widowers, the mortality rate was even 10 times greater than that of the matched controls. After the first year of bereavement, however, mortality rates of relatives of a deceased person did not differ significantly from the control group Rees and Lutkins (1967) [2]. Similar findings were published by Parkes et al. (1969) [3] following up on 4486 widowers at the age of 55 for 9years following the death of their wives in 1957. During the first six months after the spouse had died, the mortality rate of the widowers was 40% above the rate of married men of the same age. While it seems plausible to accept the etiological role and pathogenic impact of personal loss, the pathogenic processes causing death remained relatively blurred. We will explain, why inaccurately stressing the fact that the broken heart and/or tako-tsubo syndrome would be a relatively new way of looking at stress-related cardiomyopathy as outlined by Yoshikawa (2015) [4] and why attaching stress-related cardiomyopathy to culturally powerful yet value-laden metaphors, might obstruct pathways to a better understanding, prevention and clinical management of the disease. By looking at narrative understandings and clinical representations of the broken heart, we aim to highlight the need for a more contextualised view of the broken heart syndrome in order to facilitate multi- and transdisciplinary approaches aiming at its prediction, prevention, and treatment.
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Affiliation(s)
- Thomas Efferth
- Department of Pharmaceutical Biology, Johannes Gutenberg University, Mainz, Germany.
| | - Mita Banerjee
- American Studies, Dept. of Philosophy and Philology, Johannes Gutenberg University, Mainz, Germany
| | - Norbert W Paul
- Institute for the History, Philosophy, and Ethics of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany
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20
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Successful treatment of inverted Takotsubo cardiomyopathy after severe traumatic brain injury with milrinone after dobutamine failure. Heart Lung 2016; 45:406-8. [DOI: 10.1016/j.hrtlng.2016.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 12/18/2022]
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
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22
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Christensen TE, Bang LE, Holmvang L, Skovgaard DC, Oturai DB, Søholm H, Thomsen JH, Andersson HB, Ghotbi AA, Ihlemann N, Kjaer A, Hasbak P. 123I-MIBG Scintigraphy in the Subacute State of Takotsubo Cardiomyopathy. JACC Cardiovasc Imaging 2016; 9:982-90. [DOI: 10.1016/j.jcmg.2016.01.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/30/2015] [Accepted: 01/07/2016] [Indexed: 01/26/2023]
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23
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Christensen TE, Bang LE, Holmvang L, Hasbak P, Kjær A, Bech P, Østergaard SD. Neuroticism, depression and anxiety in takotsubo cardiomyopathy. BMC Cardiovasc Disord 2016; 16:118. [PMID: 27246461 PMCID: PMC4888627 DOI: 10.1186/s12872-016-0277-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 05/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background Takotsubo cardiomypathy (TTC) causes acute reversible heart failure. Prior studies have indicated that the syndrome is associated with traits such as social inhibition, chronic psychological stress, and anxio-depressive disorders. The objective of this study was to further characterize key psychological/psychopathological traits of patients with TTC. Methods A survey of three groups was conducted: I) Female post-recovery TTC patients admitted between October 1st 2009 and December 10th 2014, II) Age, gender and geographically matched ST-elevation myocardial infarction (STEMI) patients, and III) Age, gender and geographically matched individuals from the background population. The following questionnaires were used in the survey: the WHO-5 Well-Being Index, Eysenck’s Neuroticism Scale, the Major Depression Inventory, and the anxiety subscale of Symptoms Checklist (SCL-90). Results In total, 173 of 230 invitees (75 %) participated in the study. In comparison to the background controls, TTC patients reported significantly less well-being, more neuroticism, more depression, and more anxiety. The levels of well-being, depression and neuroticism were comparable between TTC and STEMI patients, but the level of anxiety was higher in the TTC patients. There was a negative correlation between the time since TTC admission and the total scores on the psychopathology rating scales. Conclusions Patients with TTC reported significantly higher anxiety levels compared to both STEMI patients and background controls. However, unlike the STEMI patients, the TTC patients appeared to improve psychologically during the post-recovery phase. This may be a consolation for TTC patients in acute psychological distress.
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Affiliation(s)
- Thomas Emil Christensen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. .,Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Copenhagen University Hospital, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
| | - Lia E Bang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Copenhagen University Hospital, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Copenhagen University Hospital, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Per Bech
- Psychiatric Research Unit, Psychiatric Center North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Søren Dinesen Østergaard
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department P - Research, Aarhus University Hospital, Risskov, Denmark
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Belhaj A, Dewachter L, Rorive S, Remmelink M, Weynand B, Melot C, Galanti L, Hupkens E, Sprockeels T, Dewachter C, Creteur J, McEntee K, Naeije R, Rondelet B. Roles of inflammation and apoptosis in experimental brain death-induced right ventricular failure. J Heart Lung Transplant 2016; 35:1505-1518. [PMID: 27377219 DOI: 10.1016/j.healun.2016.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 04/26/2016] [Accepted: 05/12/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction remains the leading cause of early death after cardiac transplantation. Methylprednisolone is used to improve graft quality; however, evidence for that remains empirical. We sought to determine whether methylprednisolone, acting on inflammation and apoptosis, might prevent brain death-induced RV dysfunction. METHODS After randomization to placebo (n = 11) or to methylprednisolone (n = 8; 15 mg/kg), 19 pigs were assigned to a brain-death procedure. The animals underwent hemodynamic evaluation at 1 and 5 hours after Cushing reflex (i.e., hypertension and bradycardia). The animals euthanized, and myocardial tissue was sampled. This was repeated in a control group (n = 8). RESULTS At 5 hours after the Cushing reflex, brain death resulted in increased pulmonary artery pressure (27 ± 2 vs 18 ± 1 mm Hg) and in a 30% decreased ratio of end-systolic to pulmonary arterial elastances (Ees/Ea). Cardiac output and right atrial pressure did not change. This was prevented by methylprednisolone. Brain death-induced RV dysfunction was associated with increased RV expression of heme oxygenase-1, interleukin (IL)-6, IL-10, IL-1β, tumor necrosis factor (TNF)-α, IL-1 receptor-like (ST)-2, signal transducer and activator of transcription-3, intercellular adhesion molecules-1 and -2, vascular cell adhesion molecule-1, and neutrophil infiltration, whereas IL-33 expression decreased. RV apoptosis was confirmed by terminal deoxynucleotide transferase-mediated deoxy uridine triphosphate nick-end labeling staining. Methylprednisolone pre-treatment prevented RV-arterial uncoupling and decreased RV expression of TNF-α, IL-1 receptor-like-2, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and neutrophil infiltration. RV Ees/Ea was inversely correlated to RV TNF-α and IL-6 expression. CONCLUSIONS Brain death-induced RV dysfunction is associated with RV activation of inflammation and apoptosis and is partly limited by methylprednisolone.
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Affiliation(s)
- Asmae Belhaj
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur, Yvoir, Belgium; Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
| | - Laurence Dewachter
- Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Sandrine Rorive
- Department of Anatomopathology, Erasmus Academic Hospital, Brussels, Belgium; DIAPATH-Center for Microscopy and Molecular Imaging (CMMI), Gosselies, Belgium
| | - Myriam Remmelink
- Department of Anatomopathology, Erasmus Academic Hospital, Brussels, Belgium
| | - Birgit Weynand
- Department of Anatomopathology, Universitaire Ziekenhuizen (UZ) Leuven, Katholiek Universiteit Leuven, Brussels, Belgium
| | - Christian Melot
- Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Department of Emergency, Erasmus Academic Hospital, Brussels, Belgium
| | - Laurence Galanti
- Medical Laboratory, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Emeline Hupkens
- Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Sprockeels
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur, Yvoir, Belgium
| | - Céline Dewachter
- Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasmus Academic Hospital, Brussels, Belgium
| | - Kathleen McEntee
- Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Naeije
- Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Benoît Rondelet
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur, Yvoir, Belgium; Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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Sengupta S, Mungulmare K, Wadaskar N, Pande A. Inverted Takotsubo cardiomyopathy after attempted suicidal hanging--two cases. Indian Heart J 2016; 68 Suppl 1:S52-6. [PMID: 27056654 PMCID: PMC4824329 DOI: 10.1016/j.ihj.2015.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 06/07/2015] [Accepted: 06/16/2015] [Indexed: 11/19/2022] Open
Abstract
We report two cases of "Inverted Takotsubo cardiomyopathy" following attempted suicidal hanging. Both the patients presented with heart failure and had desaturation 8-12h after the suicidal attempt. Electrocardiography (ECG) showed ischemic changes. On echocardiography, the left ventricle (LV) showed ballooning and hypokinesia of the basal segments with apical sparing. Both patients underwent coronary angiograms considering the possibility of acute coronary syndrome. However, their coronary angiograms were normal. After 3-4 days of hospitalization, both recovered; their ECG had reversed and the LV contractility was normal on echocardiography.
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Koo N, Yoon BW, Song Y, Lee CK, Lee TY, Hong JY. Biventricular Takotsubo Cardiomyopathy Associated with Epilepsy. J Cardiovasc Ultrasound 2015; 23:262-5. [PMID: 26755936 PMCID: PMC4707313 DOI: 10.4250/jcu.2015.23.4.262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/17/2015] [Accepted: 11/18/2015] [Indexed: 02/06/2023] Open
Abstract
We describe a case of Takotsubo cardiomyopathy in an elderly woman after status epilepticus. In an emergency echocardiography, not only left ventricular apical ballooning but also right ventricular apical hypokinesia was observed. After a medical management, the patient's condition was improved and a follow-up echocardiography showed substantial recovery of left and right ventricular apical ballooning.
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Affiliation(s)
- Namho Koo
- Department of Internal Medicine, KEPCO Medical Center, Seoul, Korea
| | - Byung Woo Yoon
- Department of Internal Medicine, KEPCO Medical Center, Seoul, Korea
| | - Yonggeon Song
- Department of Internal Medicine, KEPCO Medical Center, Seoul, Korea
| | - Chang Kyun Lee
- Department of Internal Medicine, KEPCO Medical Center, Seoul, Korea
| | - Tae Yeon Lee
- Department of Internal Medicine, KEPCO Medical Center, Seoul, Korea
| | - Ji Yeon Hong
- Division of Cardiology, KEPCO Medical Center, Seoul, Korea
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Krishnamoorthy V, Prathep S, Sharma D, Fujita Y, Armstead W, Vavilala MS. Cardiac dysfunction following brain death after severe pediatric traumatic brain injury: A preliminary study of 32 children. Int J Crit Illn Inj Sci 2015; 5:103-7. [PMID: 26157654 PMCID: PMC4477386 DOI: 10.4103/2229-5151.158409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Cardiac dysfunction after brain death has been described in a variety of brain injury paradigms but is not well understood after severe pediatric traumatic brain injury (TBI). Cardiac dysfunction may have implications for organ donation in this patient population. Materials and Methods: We conducted a retrospective cohort study of pediatric patients with severe TBI, both with and without a diagnosis of brain death, who underwent echocardiography during the first 2 weeks after TBI, between the period of 2003–2011. We examined cardiac dysfunction in patients with and without a diagnosis of brain death. Results: In all, 32 (2.3%) of 1,413 severe pediatric TBI patients underwent echocardiogram evaluation. Most patients had head abbreviated injury score 5 (range 2–6) and subdural hematoma (34.4%). Ten patients with TBI had brain death compared with 22 severe TBI patients who did not have brain death. Four (40%) of 10 pediatric TBI patients with brain death had a low ejection fraction (EF) compared with 1 (4.5%) of 22 pediatric TBI patients without brain death who had low EF (OR = 14, P = 0.024). Conclusions: The incidence of cardiac dysfunction is higher among pediatric severe TBI patients with a diagnosis of brain death, as compared to patients without brain death. This finding may have implications for cardiac organ donation from this population and deserves further study.
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Affiliation(s)
- Vijay Krishnamoorthy
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Sumidtra Prathep
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Deepak Sharma
- Department of Anesthesiology and Pain Medicine, Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Yasuki Fujita
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - William Armstead
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, Pediatrics, Radiology, University of Washington, Seattle, Washington, USA
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Ghatak T, Azim A, Baronia AK. A case of "Tako-Tsubo syndrome" with postoperative shock. Anesth Essays Res 2015; 7:267-9. [PMID: 25885845 PMCID: PMC4173535 DOI: 10.4103/0259-1162.118974] [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] [Indexed: 11/20/2022] Open
Abstract
The “Tako-Tsubo syndrome” is a rare, transient, reversible hypokinesia of distal part of left ventricle, with normal coronary arteries. It was recently described and frequently associated with an extreme stressful event in postmenopausal women. We report a case of “Tako-Tsubo syndrome” following elective surgery for oesophageal malignancy with septic shock. Our report highlights the electrocardiographic changes with the progression of this syndrome and the challenges we faced in managing the case.
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Affiliation(s)
- Tanmoy Ghatak
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rai Bareilly Road, Lucknow, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rai Bareilly Road, Lucknow, Uttar Pradesh, India
| | - Arvind K Baronia
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rai Bareilly Road, Lucknow, Uttar Pradesh, India
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Jin U, Park JS, Min YG, Yang HM, Lim HS, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ, Shin JH. Hanging-associated left ventricular systolic dysfunction. Resuscitation 2014; 88:1-5. [PMID: 25513743 DOI: 10.1016/j.resuscitation.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUNDS Although hanging injury is infrequent, its clinical course is usually devastating. Hanging patients usually need cardiopulmonary resuscitation (CPR). However, hanging-associated cardiovascular damage has not been fully established. The aim of this study was to evaluate echocardiographic findings in patients with hanging injury. METHODS We enrolled 25 patients (nine males and 16 females with mean age of 33±15 years) with hanging injury. Echocardiography was performed within 2 weeks after admission. Clinical, demographic, and laboratory data as well as transthoracic echocardiographic findings were analyzed. RESULTS Of the 25 patients, eight (two males and six females with mean age of 34±13 years) showed left ventricular systolic dysfunction (LVSD). Mean LV ejection fraction was 34±16%. Global hypokinesia was present in one patient. Apical ballooning with sparing of the basal segment was present in two patients. Basal akinesia and apical hyperkinesia were present in one patient. Four patients showed regional wall motion abnormalities unmatched with coronary territories. The duration of suspension or CPR was not significantly different according to the presence of LVSD. CONCLUSION This study showed the echocardiographic findings in considerable numbers of patients with hanging injury for the first time. Variable patterns of LVSD were present in patients with hanging injury.
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Affiliation(s)
- Uram Jin
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Young-Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Hyoung-Mo Yang
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Byoung-Joo Choi
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - So-Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Myeong-Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea.
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Dvorakova MC, Kruzliak P, Rabkin SW. Role of neuropeptides in cardiomyopathies. Peptides 2014; 61:1-6. [PMID: 25149360 DOI: 10.1016/j.peptides.2014.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/09/2014] [Accepted: 08/11/2014] [Indexed: 01/19/2023]
Abstract
The role of neuropeptides in cardiomyopathy-associated heart failure has been garnering more attention. Several neuropeptides--Neuropeptide Y (NPY), vasoactive intestinal peptide (VIP), calcitonin gene related peptide (CGRP), substance P (SP) and their receptors have been studied in the various types of cardiomyopathies. The data indicate associations with the strength of the association varying depending on the kind of neuropeptide and the nature of the cardiomyopathy--diabetic, ischemic, inflammatory, stress-induced or restrictive cardiomyopathy. Several neuropeptides appear to alter regulation of genes involved in heart failure. Demonstration of an association is an essential first step in proving causality or establishing a role for a factor in a disease. Understanding the complexity of neuropeptide function should be helpful in establishing new or optimal therapeutic strategies for the treatment of heart failure in cardiomyopathies.
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Affiliation(s)
- Magdalena Chottova Dvorakova
- Department of Physiology, Charles University in Prague, Faculty of Medicine in Pilsen, Lidicka 1, 301 00 Pilsen, Czech Republic; Biomedical Centre, Faculty of Medicine in Pilsen, Charles University in Prague, Lidicka 1, 301 00 Pilsen, Czech Republic
| | - Peter Kruzliak
- Department of Cardiovascular Diseases, International Clinical Research Center, St. Anne's University Hospital and Masaryk University, Pekarska 53, 656 91 Brno, Czech Republic.
| | - Simon W Rabkin
- Department of Medicine Division of Cardiology, University of British Columbia, 2329W Mall, Vancouver, BC V6T 1Z4, Canada
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Wittekind SG, Yanay O, Johnson EM, Gibbons EF. Two pediatric cases of variant neurogenic stress cardiomyopathy after intracranial hemorrhage. Pediatrics 2014; 134:e1211-7. [PMID: 25201800 DOI: 10.1542/peds.2013-1881] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is an acquired form of left ventricular systolic dysfunction seen in the setting of physiologic stress and the absence of coronary artery disease. It is thought to be caused by excessive sympathetic stimulation. It is well described in the adult literature associated with subarachnoid hemorrhage where it is known as neurogenic stress cardiomyopathy (NSC), but few such pediatric cases have been reported. We describe our experience with 2 children (13- and 10-year-old girls) who presented with spontaneous intracranial hemorrhage followed by pulmonary edema and shock. Echocardiography revealed similar patterns of left ventricular wall motion abnormalities consistent with NSC, inverted Takotsubo variant. One child progressed to death, whereas the other made a remarkable recovery, including significant improvement in cardiac function over the course of 1 week. We argue that at least 1 of these cases represents true stress-induced cardiomyopathy. This report will alert pediatricians to this transient cardiomyopathy that is likely underdiagnosed in pediatric intensive care. We also highlight the challenges of managing both shock and elevated intracranial pressure in the setting of NSC.
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Affiliation(s)
| | - Ofer Yanay
- Division of Pediatric Critical Care, and
| | | | - Edward F Gibbons
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
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Krishnamoorthy V, Prathep S, Sharma D, Gibbons E, Vavilala MS. Association between electrocardiographic findings and cardiac dysfunction in adult isolated traumatic brain injury. Indian J Crit Care Med 2014; 18:570-4. [PMID: 25249741 PMCID: PMC4166872 DOI: 10.4103/0972-5229.140144] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: Abnormal electrocardiographic (ECG) findings can be seen in traumatic brain injury (TBI) patients. ECG may be an inexpensive tool to identify patients at high risk for developing cardiac dysfunction after TBI. The aim of this study was to examine abnormal ECG findings after isolated TBI and their association with true cardiac dysfunction, based on echocardiogram. Methods: Data from adult patients with isolated TBI between 2003 and 2010 was retrospectively examined. Inclusion criteria included the presence of a 12-lead ECG within 24 h of admission and a formal echocardiographic examination within 72 h of admission after TBI. Patients with preexisting cardiac disease were excluded. Baseline clinical characteristics, 12-lead ECG, and echocardiogram report were abstracted. Logistic regression was used to identify the relationship of specific ECG abnormalities with cardiac dysfunction. Results: We examined data from 59 patients with isolated TBI who underwent 12-lead ECG and echocardiographic evaluation. In this cohort, 13 (22%) patients had tachycardia (heart rate >100 bpm), 25 (42.4%) patients had a prolonged QTc, and 6 (10.2%) patients had morphologic end-repolarization abnormalities (MERA), with each having an association with abnormal echocardiographic findings: Odds ratios (and 95% confidence intervals) were 4.14 (1.02-17.05), 9.0 (1.74-46.65), and 5.63 (1.96-32.94), respectively. Ischemic-like ECG changes were not associated with echocardiographic abnormalities. Conclusions: Repolarization abnormalities (prolonged QTc and MERA), but not ischemic-like ECG changes, are associated with cardiac dysfunction after isolated TBI. 12-lead ECG may be an inexpensive screening tool to evaluate isolated TBI patients for cardiac dysfunction prior to more expensive or invasive studies.
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Affiliation(s)
- Vijay Krishnamoorthy
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Sumidtra Prathep
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Deepak Sharma
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA ; Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Edward Gibbons
- Department of Cardiology, University of Washington, Seattle, WA, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA ; Department of Neurological Surgery, University of Washington, Seattle, WA, USA ; Department of Pediatrics, University of Washington, Seattle, WA, USA ; Department of Radiology, University of Washington, Seattle, WA, USA
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Prunet B, Basely M, D'Aranda E, Cambefort P, Pons F, Cimarelli S, Dagain A, Desse N, Veyrieres JB, Jego C, Lacroix G, Esnault P, Boret H, Goutorbe P, Bussy E, Habib G, Meaudre E. Impairment of cardiac metabolism and sympathetic innervation after aneurysmal subarachnoid hemorrhage: a nuclear medicine imaging study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R131. [PMID: 24964817 PMCID: PMC4230019 DOI: 10.1186/cc13943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/13/2014] [Indexed: 12/11/2022]
Abstract
Introduction Although aneurysmal subarachnoid hemorrhage (SAH) is often complicated by myocardial injury, whether this neurogenic cardiomyopathy is associated with the modification of cardiac metabolism is unknown. This study sought to explore, by positron emission tomography/computed tomography, the presence of altered cardiac glucose metabolism after SAH. Methods During a 16-month period, 30 SAH acute phase patients underwent myocardial 18 F- fluorodesoxyglucose positron emission tomography (18F-FDGPET), 99mTc-tetrofosmin and 123I-meta-iodobenzylguanidine (123I-mIBG) scintigraphy, respectively, assessing glucose metabolism, cardiac perfusion, and sympathetic innervation. Patients with initial abnormalities were followed monthly for two months for 18F-FDG, and six months later for 123I-mIBG. Results In this SAH population, acute cardiac metabolic disturbance was observed in 83% of patients (n = 25), and sympathetic innervation disturbance affected 90% (n = 27). Myocardial perfusion was normal for all patients. The topography and extent of metabolic defects and innervation abnormalities largely overlapped. Follow-up showed rapid improvement of glucose metabolism in one or two months. Normalization of sympathetic innervation was slower; only 27% of patients (n = 8) exhibited normal 123I-mIBG scintigraphy after six months. Presence of initial altered cardiac metabolism was not associated with more unfavorable cardiac or neurological outcomes. Conclusions These findings support the hypothesis of neurogenic myocardial stunning after SAH. In hemodynamically stable acute phase SAH patients, cardiomyopathy is characterized by diffuse and heterogeneous 18F-FDG and 123I-mIBG uptake defect. Trial registration Clinicaltrials.gov NCT01218191. Registered 6 October 2010.
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Cardiac ⁹⁹mTc sestamibi SPECT and ¹⁸F FDG PET as viability markers in Takotsubo cardiomyopathy. Int J Cardiovasc Imaging 2014; 30:1407-16. [PMID: 24852336 DOI: 10.1007/s10554-014-0453-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/15/2014] [Indexed: 01/19/2023]
Abstract
In patients with heart failure (HF) due to coronary disease, a combined evaluation of perfusion and glucose metabolism by cardiac single photon emission computed tomography (SPECT)/positron emission tomography (PET) can be used to distinguish viable from non-viable myocardium, and current guidelines recommend cardiac SPECT and fluorodeoxyglucose (FDG) PET for viability assessment. Takotsubo cardiomyopathy (TTC) is a disease characterized by acute but reversible HF leaving no scarring. To explore how robust the semi-quantitative viability criteria used in cardiac SPECT and FDG PET stands their ground in a population with TTC. From 1 September 2009 to 1 October 2012, 24 patients suspected of TTC were enrolled in a multimodality cardiac imaging research project. Echocardiography, (99m)Tc SPECT, and (18)F FDG PET were performed during the acute admission and at follow-up 4 months later. Nineteen patients had a final diagnosis of TTC consistent with Mayo Clinic Diagnostic Criteria. Three of these patients were excluded from further analysis, since wall motion abnormalities were not persistent at the time of nuclear imaging. The remaining sixteen patients exhibited a distinct pattern with HF, "apical ballooning" and a perfusion-metabolism defect in the midventricular/apical region. When viability criteria were applied, they identified significant scarring/limited hibernation in the akinetic part of the left ventricle. However, full recovery was found in all TTC patients on follow-up. Using the current guideline-endorsed viability criteria for semiquantitative cardiac SPECT and FDG PET, these modalities failed to demonstrate the presence of viability in the acute state of TTC.
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Badovinac S, Korsic M, Cucevic B, Slivnjak V, Dugac AV, Jakopovic M. Stress cardiomyopathy following acute ischemic stroke during flexible bronchoscopy: a rare sequence of complications. J Bras Pneumol 2014; 39:525-8. [PMID: 24068278 PMCID: PMC4075863 DOI: 10.1590/s1806-37132013000400020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Sonja Badovinac
- University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Department of Respiratory Diseases, Zagreb, Croatia
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Síndrome de Tako-Tsubo. Discinesia transitoria del ventrículo izquierdo. Semergen 2014; 40:73-9. [DOI: 10.1016/j.semerg.2013.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/29/2013] [Accepted: 01/31/2013] [Indexed: 11/20/2022]
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Prathep S, Sharma D, Hallman M, Joffe A, Krishnamoorthy V, Mackensen GB, Vavilala MS. Preliminary report on cardiac dysfunction after isolated traumatic brain injury. Crit Care Med 2014; 42:142-7. [PMID: 23963125 PMCID: PMC3841242 DOI: 10.1097/ccm.0b013e318298a890] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this study was to examine cardiac dysfunction during the first 2 weeks after isolated traumatic brain injury and its association with in-hospital mortality. DESIGN Retrospective. SETTING Level 1 regional trauma center. PATIENTS Adult patients with severe traumatic brain injury. METHODS After institutional review board approval, data from adult patients with isolated traumatic brain injury who underwent echocardiography during the first 2 weeks after traumatic brain injury between 2003 and 2010 were examined. Patients with preexisting cardiac disease were excluded. Clinical characteristics and echocardiogram reports were abstracted. Cardiac dysfunction was defined as left ventricular ejection fraction less than 50% or presence of regional wall motion abnormality. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS We examined data from 139 patients with isolated traumatic brain injury who underwent echocardiographic evaluation. Patients were 58 ± 20 years old, 66% were male patients, and 62.6% had subdural hematoma; admission Glasgow Coma Scale score was 3 ± 1 (3-15) and head Abbreviated Injury Scale was 4 ± 1 (2-5). Of this cohort, 22.3% had abnormal echocardiogram: reduced left ventricular ejection fraction was documented in 12% (left ventricular ejection fraction, 43% ± 8%) and 17.5% of patients had a regional wall motion abnormality. Hospital day 1 was the most common day of echocardiographic exam. Abnormal echocardiogram was independently associated with all cause in-hospital mortality (9.6 [2.3-40.2]; p = 0.002). CONCLUSIONS Cardiac dysfunction in the setting of isolated traumatic brain injury occurs and is associated with increased in-hospital mortality. This finding raises the question as to whether there are uncharted opportunities for a more timely recognition of cardiac dysfunction and subsequent optimization of the hemodynamic management of these patients.
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Affiliation(s)
- Sumidtra Prathep
- Departments of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Deepak Sharma
- Departments of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
- Department of Neurological Surgery, University of Washington, Seattle, WA
| | - Matthew Hallman
- Departments of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Aaron Joffe
- Departments of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Vijay Krishnamoorthy
- Departments of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - G. Burkhard Mackensen
- Departments of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Monica S. Vavilala
- Departments of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
- Department of Radiology, University of Washington, Seattle, WA
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Myocardial dysfunction in acute traumatic brain injury relieved by surgical decompression. Case Rep Anesthesiol 2013; 2013:482596. [PMID: 23862078 PMCID: PMC3687721 DOI: 10.1155/2013/482596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/07/2013] [Indexed: 11/28/2022] Open
Abstract
Traumatic brain injury (TBI) is a major public health issue and is a leading cause of death in North America. After a primary TBI, secondary brain insults can predispose patients to a worse outcome. One of the earliest secondary insults encountered during the perioperative period is hypotension, which has been directly linked to both mortality and poor disposition after TBI. Despite this, it has been shown that hypotension commonly occurs during surgery for TBI. We present a case of intraoperative hypotension during surgery for TBI, where the use of transthoracic echocardiography had significant diagnostic and therapeutic implications for the management of our patient. We then discuss the issue of cardiac dysfunction after brain injury and the implications that echocardiography may have in the management of this vulnerable patient population.
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Arao K, Ako J, Momomura SI. Transient mid-ventricular ballooning: Insights from 123I-metaiodobenzylguanidine (MIBG) scintigraphy. Int J Cardiol 2013; 164:e15-6. [DOI: 10.1016/j.ijcard.2012.09.137] [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: 08/03/2012] [Accepted: 09/22/2012] [Indexed: 12/21/2022]
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Patankar GR, Choi JW, Schussler JM. Reverse takotsubo cardiomyopathy: two case reports and review of the literature. J Med Case Rep 2013; 7:84. [PMID: 23510078 PMCID: PMC3668300 DOI: 10.1186/1752-1947-7-84] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 01/16/2013] [Indexed: 11/29/2022] Open
Abstract
Introduction Reverse takotsubo cardiomyopathy is a rare variant of classic takotsubo cardiomyopathy that presents within a different patient profile and with its own hemodynamic considerations. Its recognition is important for prognostic, evaluation and treatment considerations. Case presentation Case 1: A 69-year-old Caucasian woman presented with substernal chest pain following a motor vehicle accident. During her evaluation, she was found to have positive results for cardiac enzymes and underwent left heart cardiac catheterization. The results of the catheterization demonstrated no significant coronary stenosis. However, her ventriculogram showed basal and anterior akinesis. Case 2: A 62-year-old Caucasian woman began having substernal chest pain that radiated to her shoulder blades. She was taken to a local area hospital where she was found to have elevated troponins. A left heart catheterization showed an ejection fraction of 35% with hypokinesis of the anterior and posterobasal walls of her heart, with 30% stenosis of her left anterior descending artery but no other significant coronary artery stenosis. Conclusion The cases in this report illustrate a lesser-known variant of takotsubo cardiomyopathy.
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Affiliation(s)
- Gautam R Patankar
- Baylor University Medical Center, 621 North Hall Street Suite 500, Dallas, Texas 75226, USA.
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Ishikura F, Takano Y, Ueyama T. Amlodipine has a preventive effect on temporal left ventricular hypokinesia after emotional stress compared with an angiotensin II receptor blocker. J Med Ultrason (2001) 2013; 40:3-7. [PMID: 27276918 DOI: 10.1007/s10396-012-0392-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 06/19/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE We previously reported that α- and β-blockers protected against emotional stress-induced cardiac dysfunction, but the protective effects of other antihypertensive drugs is unknown. The purpose of this study is to evaluate the ability of a calcium channel blocker, amlodipine, to prevent temporal left ventricular hypokinesia after emotional stress compared with an angiotensin II receptor blocker, olmesartan medoxomil. METHODS Rats premedicated with amlodipine (0.2 mg/kg), olmesartan (0.8 mg/kg), or vehicle were restrained for 30 min (immobilization stress: IMO) to reproduce emotional stress and then anesthetized to release stress. We measured the fractional area change (FAC) using echocardiography (SONOS5500) with a s12 probe (frequency 5-12 MHz, frame rate 120 Hz) and blood pressure and heart rate at the end of IMO and every 10 for 60 min after IMO. RESULTS During IMO, FAC in the amlodipine or the olmesartan group was as high as that in the vehicle group. At 20 min after IMO, FAC in the amlodipine group was significantly higher than in the other two groups (84 ± 8 vs. 60 ± 7 or 68 ± 15 %, p < 0.05). During IMO, blood pressure in the amlodipine or the olmesartan group was significantly lower than with vehicle (119 ± 6 and 110 ± 7 vs. 124 ± 5 mmHg, p < 0.05). After IMO, blood pressure in the olmesartan group was significantly lower than in the other two groups. CONCLUSION Acute administration of amlodipine could prevent a sudden drop in cardiac function after acute stress like IMO, but olmesartan did not. Amlodipine might have a protective effect on temporal left ventricular hypokinesia after emotional stress, which might not be related to decreased blood pressure.
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Affiliation(s)
- Fuminobu Ishikura
- School of Allied Health Sciences, Faculty of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yuri Takano
- School of Allied Health Sciences, Faculty of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Ueyama
- Department of Anatomy and Neurobiology, Wakayama Medical University, Wakayama, Japan
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Ishikura F, Takano Y, Ueyama T. Acute effects of beta-blocker with intrinsic sympathomimetic activity on stress-induced cardiac dysfunction in rats. J Cardiol 2012; 60:470-4. [DOI: 10.1016/j.jjcc.2012.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 06/06/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
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El-Sayed AM, Brinjikji W, Salka S. Demographic and co-morbid predictors of stress (takotsubo) cardiomyopathy. Am J Cardiol 2012; 110:1368-72. [PMID: 22819424 DOI: 10.1016/j.amjcard.2012.06.041] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/13/2012] [Accepted: 06/13/2012] [Indexed: 12/17/2022]
Abstract
Little is known about the epidemiology of stress (takotsubo) cardiomyopathy (SC). We used a 3-arm case-control study to assess differences in demographic and co-morbid predictors of SC compared to orthopedic controls and myocardial infarction (MI) controls to characterize (1) population-level predictors of SC generally and (2) differences and similarities in determinants of SC compared to MI. We included data on all discharges of patients diagnosed with SC from the 2008 to 2009 National Inpatient Samples and randomly selected 1-to-1 age-matched controls from patients hospitalized with MI and patients hospitalized with joint injuries after trauma. We used McNemar tests to assess differences in demographic characteristics and co-morbidities between patients with SC and controls. There were 24,701 patients with SC in our study. Of patients with SC, 89.0% were women compared to 38.9% of patients with MI and 55.7% of orthopedic controls. Patients with SC were more likely to be white and to reside in wealthier ZIP codes compared to MI and orthopedic controls. Patients with SC were less likely to have cardiovascular risk factors compared to MI and orthopedic controls but were more likely to have had histories of cerebrovascular accidents, drug abuse, anxiety disorders, mood disorders, malignancy, chronic liver disease, and sepsis. In conclusion, demographic and co-morbid predictors of SC differ substantially from those of MI and may be of interest to providers when diagnosing SC. Several co-morbid risk factors predictive of SC may operate by increased catecholamines.
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Takano Y, Ueyama T, Ishikura F. Azelnidipine, unique calcium channel blocker could prevent stress-induced cardiac dysfunction like α·β blocker. J Cardiol 2012; 60:18-22. [DOI: 10.1016/j.jjcc.2012.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 01/21/2012] [Accepted: 01/27/2012] [Indexed: 12/26/2022]
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Samardhi H, Raffel OC, Savage M, Sirisena T, Bett N, Pincus M, Small A, Walters DL. Takotsubo cardiomyopathy: an Australian single centre experience with medium term follow up. Intern Med J 2012; 42:35-42. [PMID: 21395961 DOI: 10.1111/j.1445-5994.2011.02474.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC) is increasingly recognised in patients presenting with features of acute coronary syndrome. We present a single centre experience of TC with medium term follow up. METHODS Fifty-two consecutive patients presenting with a diagnosis of TC were included. The clinical presentation, complications, baseline and follow-up echocardiograms and cardiac magnetic resonance imaging were analysed. RESULTS Fifty-one patients were female. A stressful event preceded presentation in 37 (71%) patients. Chest pain was the most common symptom (83%). Two patients presented with an out-of-hospital cardiac arrest. ST segment elevation (40%) and global T wave inversion (44%) were the most frequent electrocardiogram changes. Left ventricular assessment demonstrated typical apical ballooning in 41 patients and 11 patients demonstrated the mid-wall variant. In-hospital complications occurred in 11 patients (21%) and included acute pulmonary oedema (n = 2), cardiogenic shock (n = 5); two of whom had a significant left ventricular outflow gradient, atrial fibrillation (n = 1), left ventricular thrombus (n = 2) and a cerebrovascular event (n = 2). Left ventricular function at presentation and follow up was compared in 40 patients. The mean ejection fraction in this group at presentation was 47% (20-70%) compared with that at follow up of 63% (44-76%). There were no significant complications or recurrences at follow up. CONCLUSIONS While TC is a reversible condition with low rates of complications and recurrence at follow up it is, as demonstrated in our cohort, associated with significant in-hospital morbidity in a proportion of patients.
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Affiliation(s)
- H Samardhi
- Cardiology Program, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Abstract
Eating disorders are usually associated with an increased risk of premature death with a wide range of rates and causes of mortality. “Sudden death” has been defined as the abrupt and unexpected occurrence of fatality for which no satisfactory explanation of the cause can be ascertained. In many cases of sudden death, autopsies do not clarify the main cause. Cardiovascular complications are usually involved in these deaths. The purpose of this review was to report an update of the existing literature data on the main findings with respect to sudden death in eating disorders by means of a search conducted in PubMed. The most relevant conclusion of this review seems to be that the main causes of sudden death in eating disorders are those related to cardiovascular complications. The predictive value of the increased QT interval dispersion as a marker of sudden acute ventricular arrhythmia and death has been demonstrated. Eating disorder patients with severe cardiovascular symptoms should be hospitalized. In general, with respect to sudden death in eating disorders, some findings (eg, long-term eating disorders, chronic hypokalemia, chronically low plasma albumin, and QT intervals >600 milliseconds) must be taken into account, and it must be highlighted that during refeeding, the adverse effects of hypophosphatemia include cardiac failure. Monitoring vital signs and performing electrocardiograms and serial measurements of plasma potassium are relevant during the treatment of eating disorder patients.
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Acute global cardiac decompensation due to inverted takotsubo cardiomyopathy after skull–brain trauma—A case report. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.injury.2011.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lee W, Profitis K, Barlis P, Van Gaal WJ. Stroke and Takotsubo cardiomyopathy: Is there more than just cause and effect? Int J Cardiol 2011; 148:e37-9. [DOI: 10.1016/j.ijcard.2009.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 02/27/2009] [Indexed: 10/21/2022]
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Partial status epilepticus causing a transient left ventricular apical ballooning. Seizure 2011; 20:184-6. [DOI: 10.1016/j.seizure.2010.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 10/25/2010] [Accepted: 11/01/2010] [Indexed: 11/23/2022] Open
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