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Simões JLB, Braga GDC, Coiado JV, Scaramussa AB, Rodrigues APB, Bagatini MD. Takotsubo syndrome as an outcome of the use of checkpoint inhibitor therapy in patients with COVID-19. Biochem Pharmacol 2024; 226:116388. [PMID: 38914315 DOI: 10.1016/j.bcp.2024.116388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/11/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024]
Abstract
Takotsubo Syndrome (TS) is a heart disease caused by extreme exposure of the body to physical or psychological stress. In the context of COVID-19, the virus can be a significant source of stress, with particular attention being paid to the cytokine storm as a cause of damage to the body. New research shows that the production of specific cytokines is linked to the activation of immune checkpoint proteins such as PD-1, PD-L1, and CTLA-4 on T cells. Although initially beneficial in combating infections, it can suppress defense and aid in disease progression. Therefore, checkpoint inhibitor therapy has been highlighted beyond oncological therapies, given its effectiveness in strengthening the immune system. However, this treatment can lead to excessive immune responses, inflammation, and stress on the heart, which can cause Takotsubo Syndrome in patients. Several studies investigate the direct link between this therapy and cardiac injuries in these patients, which can trigger TS. From this perspective, we must delve deeper into this treatment and consider its effects on the prognosis against SARS-CoV-2 infection.
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Affiliation(s)
| | | | - João Victor Coiado
- Medical School, Federal University of Fronteira Sul, Chapecó, SC, Brazil
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2
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Simões JLB, Braga GDC, Mittelmann TH, Bagatini MD. Current Pharmacology and Modulation of the Purinergic System in Takotsubo Syndrome Triggered by Cytokine Storm. Curr Probl Cardiol 2024; 49:102019. [PMID: 37544631 DOI: 10.1016/j.cpcardiol.2023.102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Studies show that with the COVID-19 pandemic, the world's population went through multiple stress and anxiety factors, generating serious psychological problems, in addition, the virus also caused damage and physical stress to those contaminated. In this way, the intense emotional experiences and stressful effects on the body caused by SARS-CoV-2 are capable of triggering the excessive release of catecholamines in the body. Thus, the framework of Takotsubo Syndrome is characterized by myocardial dysfunction as a response of cardiac receptors to the spillage of such hormones in an unregulated way in the human body. The purinergic system plays a central role in this process, as it actively participates in actions responsible for the syndromic cascade, such as the stress generated by the cytokine storm triggered by the virus and the stimulation of deregulated catecholamine release. Therefore, further pharmacological studies on the role of purines in this pathology should be developed in order to avoid the evolution of the syndrome and to modulate its P1 and P2 receptors aiming at developing means of reversing or treating the Takotsubo Syndrome.
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3
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Hwang EH, Koo JH, Lee YH, Song JH, Lim YC. Neurogenic pulmonary edema and Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2023; 165:3677-3684. [PMID: 37924360 DOI: 10.1007/s00701-023-05824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Neurogenic pulmonary edema (NPE) combined with Takotsubo cardiomyopathy (TCM) is a rare condition associated with aneurysmal subarachnoid hemorrhage (aSAH). Although several mechanisms have been proposed, the pathophysiology and management strategies are not yet fully established. We aimed to determine the radiological and clinical outcomes of patients with NPE and with TCM after aSAH to propose management strategies. METHODS We analyzed the data of 564 patients with aSAH recorded at a single medical center from February 2015 to July 2022. This study retrospectively investigated the incidence and demographics of SAH combined with both NPE and TCM and the clinical outcomes of the patients. Correlating factors, independently associated with NPE-TCM, were also investigated. RESULTS During the 7 years, 11 (2.0%) of 564 patients had NPE complicated with TCM after aSAH. Seven of 11 (63.6%) patients had poor-grade SAH (Hunt-Hess Grade 4 to 5). Three of 11 patients had a posterior circulation in the NPE-TCM group. The most prevalent treatment option was endovascular coil embolization, except for one case of clip. Long-term outcomes were favorable in 6 of 11 patients, and there was one case of mortality. Age, troponin I level, and alveolar-arterial oxygen gradient were correlating factors of NPE-TCM. CONCLUSION Although NPE-TCM represents a rare complication associated with aSAH, achieving active resolution of underlying neurological causes through early and appropriate treatment may contribute to a favorable prognosis. Considering the limited incidence of SAH complicated with NPE-TCM, a multi-center study may be needed.
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Affiliation(s)
- Eui-Hyun Hwang
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ja Ho Koo
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yeon Hu Lee
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ji Hye Song
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
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4
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Sultana SS, Nisar S, Kumar FM, Khan H, Saeed H, Ahmed G, Malik J. Role of Positive Emotions in Takotsubo Cardiomyopathy. Curr Probl Cardiol 2023; 48:101997. [PMID: 37506960 DOI: 10.1016/j.cpcardiol.2023.101997] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Takotsubo Cardiomyopathy, also known as "broken heart syndrome," is a transient cardiac condition characterized by sudden left ventricular dysfunction, often triggered by emotional stress or significant life events. While research has predominantly focused on the impact of negative emotions and emotional stressors, there is a growing interest in understanding the role of positive emotions in this unique cardiac syndrome. This narrative review explores the emerging research on positive emotions and Takotsubo Cardiomyopathy. It provides an overview of studies investigating the relationship between positive emotions and the condition, highlighting key findings and observations. Positive emotions, such as joy, happiness, gratitude, and optimism, have been associated with improved emotional well-being, better-coping mechanisms, and potential cardiovascular protection. Some studies suggest that individuals experiencing higher levels of positive emotions may have a reduced risk of developing Takotsubo Cardiomyopathy. However, the research in this area is still limited, with small sample sizes and challenges in quantifying positive emotions. Additionally, the interplay between positive and negative emotions requires further exploration to fully understand their impact on cardiovascular health. Despite these limitations, harnessing positive emotions in cardiac care holds promise for enhancing patient outcomes and emotional well-being. Integrating positive psychology into clinical practice and cardiac rehabilitation may lead to more holistic and patient-centered approaches to cardiovascular care. Further longitudinal studies, interventional trials, and mechanistic investigations are needed to strengthen the evidence base and identify potential therapeutic perspectives. As research progresses, addressing these gaps will provide valuable insights into the complex relationship between emotions and cardiovascular health, benefiting patients affected by Takotsubo Cardiomyopathy and other cardiovascular conditions.
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Affiliation(s)
- Syeda S Sultana
- Department of Medicine, Southern Medical College, Chittagong, Bangladesh
| | - Sibtain Nisar
- Department of Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - Fnu Manoj Kumar
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Haysum Khan
- Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | - Hamayle Saeed
- Department of Medicine, Fatima Memorial Hospital, Lahore, Pakistan
| | - Gulfam Ahmed
- Department of Medicine, Muhammad Hospital, Lahore, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan.
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5
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Shao H, Li S. A new perspective on HIV: effects of HIV on brain-heart axis. Front Cardiovasc Med 2023; 10:1226782. [PMID: 37600062 PMCID: PMC10436320 DOI: 10.3389/fcvm.2023.1226782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
The human immunodeficiency virus (HIV) infection can cause damage to multiple systems within the body, and the interaction among these various organ systems means that pathological changes in one system can have repercussions on the functions of other systems. However, the current focus of treatment and research on HIV predominantly centers around individual systems without considering the comprehensive relationship among them. The central nervous system (CNS) and cardiovascular system play crucial roles in supporting human life, and their functions are closely intertwined. In this review, we examine the effects of HIV on the CNS, the resulting impact on the cardiovascular system, and the direct damage caused by HIV to the cardiovascular system to provide new perspectives on HIV treatment.
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Affiliation(s)
| | - Sijun Li
- Department of Internal Medicine, The Fourth People's Hospital of Nanning, Nanning, China
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6
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Truter N, Malan L, Essop MF. Glial cell activity in cardiovascular diseases and risk of acute myocardial infarction. Am J Physiol Heart Circ Physiol 2023; 324:H373-H390. [PMID: 36662577 DOI: 10.1152/ajpheart.00332.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Growing evidence indicates that the pathophysiological link between the brain and heart underlies cardiovascular diseases, specifically acute myocardial infarction (AMI). Astrocytes are the most abundant glial cells in the central nervous system and provide support/protection for neurons. Astrocytes and peripheral glial cells are emerging as key modulators of the brain-heart axis in AMI, by affecting sympathetic nervous system activity (centrally and peripherally). This review, therefore, aimed to gain an improved understanding of glial cell activity and AMI risk. This includes discussions on the potential role of contributing factors in AMI risk, i.e., autonomic nervous system dysfunction, glial-neurotrophic and ischemic risk markers [glial cell line-derived neurotrophic factor (GDNF), astrocytic S100 calcium-binding protein B (S100B), silent myocardial ischemia, and cardiac troponin T (cTnT)]. Consideration of glial cell activity and related contributing factors in certain brain-heart disorders, namely, blood-brain barrier dysfunction, myocardial ischemia, and chronic psychological stress, may improve our understanding regarding the pathological role that glial dysfunction can play in the development/onset of AMI. Here, findings demonstrated perturbations in glial cell activity and contributing factors (especially sympathetic activity). Moreover, emerging AMI risk included sympathovagal imbalance, low GDNF levels reflecting prothrombic risk, hypertension, and increased ischemia due to perfusion deficits (indicated by S100B and cTnT levels). Such perturbations impacted blood-barrier function and perfusion that were exacerbated during psychological stress. Thus, greater insights and consideration regarding such biomarkers may help drive future studies investigating brain-heart axis pathologies to gain a deeper understanding of astrocytic glial cell contributions and unlock potential novel therapies for AMI.
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Affiliation(s)
- Nina Truter
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leoné Malan
- Technology Transfer and Innovation-Support Office, North-West University, Potchefstroom, South Africa
| | - M Faadiel Essop
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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7
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Bairashevskaia AV, Belogubova SY, Kondratiuk MR, Rudnova DS, Sologova SS, Tereshkina OI, Avakyan EI. Update of Takotsubo cardiomyopathy: Present experience and outlook for the future. IJC HEART & VASCULATURE 2022; 39:100990. [PMID: 35281752 PMCID: PMC8913320 DOI: 10.1016/j.ijcha.2022.100990] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/21/2022]
Abstract
Takotsubo cardiomyopathy (TTS) has become a recognised clinical entity since the Japanese scientist Sato first described it in 1990. Despite an increasing number of confirmed cases, especially during the COVID-19 pandemic, its pathophysiology remains incompletely understood, and decision-making differs in the diagnosis and treatment. In addition, it is not evident whether a significant increase in TTS is due to better understanding among practitioners and widespread access to coronary angiography, or if it is a reflection of an actual increase in incidence. We analysed a series of international research studies from 1990 to 2021. Beyond epidemiology and clinical presentation, we evaluated and summarised fundamental knowledge about various predisposing factors, with particular attention to the iatrogenic impact of certain drugs, namely antidepressants, chemotherapy, and antiarrhythmics. Furthermore, we highlighted the main pathophysiological theories to date. In addition, based on published studies and clinical cases, we investigated the role of numerous diagnostic approaches in the differential diagnosis of TTS and identified predictors of TTS complications, such as cardiogenic shock, ventricular fibrillation, and left ventricular thrombi. Accordingly, we sought to propose a diagnostic algorithm and further treatment management of TTS under the presence of possible complications to help practitioners make more informed decisions, as the initial presentation continues to pose a challenge due to its close similarity to acute coronary syndrome with ST-elevation. In conclusion, this article examines Takotsubo cardiomyopathy from different perspectives and, along with future systematic reviews and meta-analyses, can be of particular interest to practising cardiologists and researchers in developing clinical guidelines.
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Affiliation(s)
- Anastasiia V. Bairashevskaia
- Department of Paediatrics, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Sofiya Y. Belogubova
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
| | - Mikhail R. Kondratiuk
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Daria S. Rudnova
- International School “Medicine of the Future”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Susanna S. Sologova
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Olga I. Tereshkina
- Department of Pharmacology, Institute of Pharmacy, Sechenov First Moscow State Medical University (Sechenov University), 119571 Moscow, Russia
| | - Esma I. Avakyan
- Department of Faculty Therapy, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- AMEE International Networking Centre, Sechenov First Moscow State Medical University (Sechenov University), 123242 Moscow, Russia
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8
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Review of multi-modality imaging update and diagnostic work up of Takotsubo cardiomyopathy. Clin Imaging 2021; 80:334-347. [PMID: 34500146 DOI: 10.1016/j.clinimag.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/30/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022]
Abstract
Takotsubo cardiomyopathy (TC) is an acute but reversible non-ischemic heart failure syndrome. It is characterized by a transient form of ventricular dysfunction typically manifesting as basal hyperkinesis with hypokinesia and ballooning of left ventricle mid-cavity and apex. Imaging helps in both diagnosis and follow up. Echocardiogram is the first-line modality to assess the typical contractile dysfunction in suspected patients with catheter angiography showing normal coronary arteries. Cardiac MRI is currently the modality of choice for the non-invasive initial assessment of TC and for follow up imaging. The current review focusses on historical background of TC, its pathophysiology, diagnostic work up and differential diagnosis and provides multimodality imaging work up of TC including role of echocardiogram, invasive catheterization, nuclear imaging, cardiac computed tomography and cardiac MRI including basic and advanced MRI sequences.
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9
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Fridlund B, Bruteig E, Dahlviken RM, Fålun N, Norekvål TM. Women's Initial Experiences and up to a Year in Retrospect of Their Life Situation With a Confirmed Takotsubo Syndrome Diagnosis: A Single Case Study Literature Review. J Holist Nurs 2021; 40:146-156. [PMID: 34029129 PMCID: PMC9121527 DOI: 10.1177/08980101211018343] [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] [Indexed: 11/20/2022]
Abstract
Purpose: To describe women's initial experiences and up to a year in
retrospect of their life situation with a confirmed Takotsubo syndrome (TS) diagnosis.
Method: A single case study literature review based on nine articles
published by nurses was analyzed deductively using a nursing life dimension model.
Results: All but one case was conducted on the North American continent and
TS had largely affected women with previous cardiac history and had been triggered by one
or two stressful life events. The biophysical life dimension manifested in distinct and
troublesome inconvenience and in retrospect in fretting and grievous ailments. The
emotional dimension manifested in pronounced ways and attitude-related sensations,
feelings or moods while the intellectual dimension manifested in an unmanageable world of
thought. The spiritual–existential dimension manifested in a life-denying view of life and
the socio-cultural dimension manifested in an asocial life. Conclusions: With
TS best practice in mind and a person-centered care and holistic approach, comprehensive
descriptions are needed of how women identify, interpret, and use knowledge to manage
their life situation. Cardiac nurses need further comprehensive descriptions to implement
actions. Prior to implementation of such programs, this knowledge needs to be disseminated
among cardiac nurses and evaluated in international randomized controlled trials.
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Affiliation(s)
| | | | | | | | - Tone M Norekvål
- 1658University of Bergen.,60498Haukeland University Hospital
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10
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Maier T, Kugelmann M, Rhee DS, Brill S, Gündel H, Friemert B, Becker HP, Waller C, Rappel M. Structural Equation Modeling of a Global Stress Index in Healthy Soldiers. J Clin Med 2021; 10:jcm10081799. [PMID: 33924268 PMCID: PMC8074902 DOI: 10.3390/jcm10081799] [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: 02/04/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Accumulation of stress is a prognostic trigger for cardiovascular disease. Classical scores for cardiovascular risk estimation typically do not consider psychosocial stress. The aim of this study was to develop a global stress index (GSI) from healthy participants by combining individual measures of acute and chronic stress from childhood to adult life. One-hundred and ninety-two female and male soldiers completed the Perceived Stress Scale (PSS4), Trier Inventory for Chronic Stress (TICS), Hospital Anxiety and Depression Scale (HADS), Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale Checklist (PDS), and the Deployment Risk and Resilience Inventory (DRRI-2). The underlying structure for the GSI was examined through structural equation modeling. The final hierarchical multilevel model revealed fair fit by taking modification indices into account. The highest order had a g-factor called the GSI. On a second level the latent variables stress, HADS and CTQ were directly loading on the GSI. A third level with the six CTQ subscales was implemented. On the lowest hierarchical level all manifest variables and the DRRI-2/PDS sum scores were located. The presented GSI serves as a valuable and individual stress profile for soldiers and could potentially complement classical cardiovascular risk factors.
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Affiliation(s)
- Tanja Maier
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
- Correspondence:
| | - Melanie Kugelmann
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
| | - Dae-Sup Rhee
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
| | | | - Harald Gündel
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
| | | | | | - Christiane Waller
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
- Department of Psychosomatics and Psychotherapeutic Medicine, Paracelsus Medical University of Nueremberg, 90419 Nueremberg, Germany
| | - Manuela Rappel
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany; (M.K.); (D.-S.R.); (H.G.); (C.W.); (M.R.)
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11
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Sahdev N, Oji O, Babu A, Dutta Roy S. Case report of Takotsubo syndrome following seizures in a patient with pyruvate carboxylase deficiency. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab011. [PMID: 34109288 PMCID: PMC8183661 DOI: 10.1093/ehjcr/ytab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/15/2020] [Accepted: 01/07/2021] [Indexed: 12/01/2022]
Abstract
Background Takotsubo syndrome (TS) is defined as transient left ventricular dysfunction, which is often related to an emotional or physically stressful event. We describe a case of TS in a lady with pyruvate carboxylase deficiency (PCD). Pyruvate carboxylase deficiency is rare condition with the majority of those affected demonstrating signs of failure to thrive, recurrent seizures, and metabolic acidosis. To our knowledge, this is the first documented case of TS in an individual with PCD. Case summary This 28-year-old female presented to the emergency department after a tonic-clonic seizure. For 4 days prior to the presentation, she had been suffering from cough and pyrexia. On Day 2, she developed abdominal pain associated with tachycardia and hypotension, and an elevated troponin (791 ng/L). The echocardiogram showed a severely impaired left ventricular systolic function, regional wall motion abnormalities (RWMAs), and a visually estimated left ventricular ejection fraction of 25–30%. Eight days following admission her clinical state significantly improved, with a reduction troponin to 60 ng/L. A repeat echocardiogram on Day 9 showed complete resolution of cardiac function with no RWMAs. Following this, she was discharged from hospital the next day with a diagnosis of TS. Discussion This is the first case report of TS in a patient with PCD. In this case, multiple aetiologies of TS such as emotional and physical stress, seizures, and acute infection were considered. This case also highlights that TS should be an important differential diagnosis in patients presenting with cardiac symptoms.
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Affiliation(s)
- Nikhil Sahdev
- Cardiology Department, Homerton University Hospital, Homerton Row, Clapton, London E9 6SR, UK
| | - Onyedikachi Oji
- Cardiology Department, Homerton University Hospital, Homerton Row, Clapton, London E9 6SR, UK
| | - Aswin Babu
- Cardiology Department, Homerton University Hospital, Homerton Row, Clapton, London E9 6SR, UK
| | - Smita Dutta Roy
- Cardiology Department, Homerton University Hospital, Homerton Row, Clapton, London E9 6SR, UK
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12
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Sun H, Ji Y, Li S, Dong H. Current strategies with sensing technologies to eliminate stress cardiomyopathy. Biotechnol Appl Biochem 2021; 69:576-586. [PMID: 33619791 DOI: 10.1002/bab.2134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/09/2021] [Indexed: 11/09/2022]
Abstract
Stress cardiomyopathy refers weakening of heart muscle due to the continuous stress. Generally, the severe status of stress cardiomyopathy has been revealed after damaging the muscles and measured by the physical changes in the heart system. To overcome this issue, biosensor can be used, which could eliminate the late identification stress cardiomyopathy. With biosensors, different stress markers such as epinephrine, dopamine, catecholamine, α-amylase, norepinephrine, serotonin and cortisol have been identified by a wide range of developments. These biosensors are available from laboratory to industry at the ranges of nano to macrodevices. To merge with the identification of stress cardiomyopathy, the above strategies might be utilized properly and can aid to reduce the stress-related problems. This overview gleaned the currently available biosensing methods and the associated biomarkers at various stages of the developments and implementations of stress cardiomyopathy.
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Affiliation(s)
- Hao Sun
- Department of Cardiovascular Medicine, Dezhou People's Hospital, Dezhou City, Shandong Province, People's Republic of China
| | - Yongjian Ji
- Department of Cardiovascular Medicine, Dezhou People's Hospital, Dezhou City, Shandong Province, People's Republic of China
| | - Shuang Li
- Department of Cardiovascular Medicine, Dezhou People's Hospital, Dezhou City, Shandong Province, People's Republic of China
| | - Hongwei Dong
- Department of Cardiovascular Medicine, Dezhou People's Hospital, Dezhou City, Shandong Province, People's Republic of China
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13
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Oladunjoye OO, Oladiran O, Oladunjoye AO, Reddy R. A 62-Year-Old Man with Acute Alcohol Withdrawal and Stress-Induced Cardiomyopathy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928518. [PMID: 33566795 PMCID: PMC7883938 DOI: 10.12659/ajcr.928518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Stress-induced cardiomyopathy is also known as takotsubo cardiomyopathy, broken heart syndrome, and left ventricular apical ballooning syndrome. Patients may present with chest pain and electrocardiogram (EKG) changes, but without coronary artery occlusion, and a reduced ejection fraction that may undergo spontaneous reversal if the patient receives appropriate hemodynamic support. This is a case report of stress-induced cardiomyopathy associated with alcohol withdrawal in a 62-year-old man. CASE REPORT We present the case of 62-year-old man who came to the emergency room on account of nausea and vomiting after a reduction in the daily intake of alcohol. He had no chest pain or shortness of breath but had new T wave inversions in anterolateral leads on EKG, elevated troponin, and apical wall hypokinesis with ejection fraction 40% on echocardiography. He subsequently developed active symptoms of alcohol withdrawal and was managed with intravenous Lorazepam and chlordiazepoxide. With the improvement in his mental state over the next couple of days, he had a coronary angiogram which showed no coronary disease. He was diagnosed with stress-induced cardiomyopathy or takotsubo cardiomyopathy due to alcohol withdrawal. CONCLUSIONS This report describes a case of takotsubo cardiomyopathy, or stress-induced cardiomyopathy, that was believed to be associated with acute alcohol withdrawal, with spontaneous improvement in the reduced left ventricular ejection fraction following medical support.
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Affiliation(s)
- Olubunmi O Oladunjoye
- Department of Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | - Oreoluwa Oladiran
- Cardiovascular Division, Department of Medicine, Tower Health Medical Group, Reading Hospital, West Reading, PA, USA
| | - Adeolu O Oladunjoye
- Division of Medical Critical Care, Boston Children's Hospital, Boston, PA, USA
| | - Rajesh Reddy
- Cardiovascular Division, Department of Medicine, Tower Health Medical Group, Reading Hospital, West Reading, PA, USA
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14
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Zhang Z, Kong H, Zhang SY, Guan TT. Takotsubo syndrome triggered by change in position in a patient with thoracic vertebral fracture: A case report. Medicine (Baltimore) 2021; 100:e24088. [PMID: 33466170 PMCID: PMC10545422 DOI: 10.1097/md.0000000000024088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/26/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Takotsubo syndrome (TTS) is characterized by recovery of wall motion abnormalities and acute left ventricular dysfunction, which are often caused by acute physical or emotional stressors. It is rarely reported that TTS can be precipitated by change in position in the patient in the operating room. We report a case of a patient with a thoracic vertebral fracture who presented with TTS precipitated by changing from a supine to a prone position before percutaneous kyphoplasty (PKP) under local anesthesia. PATIENT CONCERNS A 76-year-old man who was diagnosed with a fracture in a thoracic vertebra was sent to the operating room to undergo PKP under local anesthesia. Approximately 5 minutes after changing from a supine to a prone position, which is necessary for PKP, the patient experienced chest pain, headache, and sweating. DIAGNOSIS A fracture in a thoracic vertebra; TTS. INTERVENTIONS As a result of 12-lead electrocardiography, echocardiography, left ventriculogram, and cardiac catheterization, the diagnosis of TTS was retained, and supportive therapy was initiated. OUTCOMES Two hours later, the patient's symptoms mitigated significantly and the ST segment returned to baseline. Four days later, echocardiography showed normal systolic function without wall motion abnormalities and the patient returned to the orthopedics ward for further treatment. LESSONS It is necessary for anesthetists to recognize TTS which is life-threatening during monitored anesthetic care (MAC). We highlight the importance of being alerted to the possibility of TTS when managing patients with thoracic vertebral fractures undergoing surgery under local anesthesia.
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Affiliation(s)
| | | | - Si-Yu Zhang
- Department of Cardiac Surgery, Peking University First Hospital, Beijing, China
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Agarwal S, Sanghvi C, Odo N, Castresana MR. Perioperative takotsubo cardiomyopathy: Implications for anesthesiologist. Ann Card Anaesth 2020; 22:309-315. [PMID: 31274495 PMCID: PMC6639891 DOI: 10.4103/aca.aca_71_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by transient ventricular dysfunction in the absence of obstructive coronary artery disease that may be triggered by an acute medical illness or intense physical or emotional stress. TCM is often confused with acute myocardial infarction given the similar electrocardiographic changes, cardiac enzymes, hemodynamic perturbations, and myocardial wall motion abnormalities. In the perioperative setting, the clinical picture may be more confusing because of the effect of anesthesia as well as hemodynamic changes related to the surgery itself. However, awareness of various other diagnostic modalities may enable clinicians to distinguish between the two, more systematically and with greater certainty. Despite the large body of literature, there still seems to be an overall paucity in our understanding of the etiopathogenesis, clinical characteristics, natural history, and management of this syndrome, especially in the perioperative setting. This narrative review seeks to present and synthesize the most recent literature on TCM and to identify gaps in current knowledge which can become the basis for future research.
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Affiliation(s)
- Shvetank Agarwal
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Chinar Sanghvi
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nadine Odo
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Manuel R Castresana
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Finkel-Oron A, Olchowski J, Jotkowitz A, Barski L. Takotsubo cardiomyopathy triggered by wasabi consumption: can sushi break your heart? BMJ Case Rep 2019; 12:12/9/e230065. [PMID: 31540920 DOI: 10.1136/bcr-2019-230065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Takotsubo cardiomyopathy is a left ventricular dysfunction that typically occurs after sudden intense emotional or physical stress and mimics myocardial infarction. We describe a case of a 60-year-old woman that presented to the emergency department with chest pain after she attended a wedding and ate a large amount of wasabi, assuming it to be an avocado. To the best of our knowledge, this is the first report of takotsubo cardiomyopathy triggered by wasabi consumption.
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Affiliation(s)
- Alona Finkel-Oron
- Internal Medicine Ward F, Soroka University Medical Center, Beer Sheva, Israel
| | - Judith Olchowski
- Internal Medicine Ward F, Soroka University Medical Center, Beer Sheva, Israel
| | - Alan Jotkowitz
- Internal Medicine Ward F, Soroka University Medical Center, Beer Sheva, Israel
| | - Leonid Barski
- Internal Medicine Ward F, Soroka University Medical Center, Beer Sheva, Israel
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Buchmann SJ, Lehmann D, Stevens CE. Takotsubo Cardiomyopathy-Acute Cardiac Dysfunction Associated With Neurological and Psychiatric Disorders. Front Neurol 2019; 10:917. [PMID: 31507520 PMCID: PMC6714036 DOI: 10.3389/fneur.2019.00917] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 08/07/2019] [Indexed: 12/12/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC) is an acute and reversible cardiac wall motion abnormality of the left myocardium. Although many studies focused on etiology, diagnostic and treatment of TTC, precise clinical guidelines on TTC are not available. Research revealed emotional and physical triggering factors of TTC and emphasized the association of TTC with psychiatric and particularly acute neurological disorders. Similar clinical presentation of acute coronary syndrome (ACS) and TTC patients, makes an anamnestic screening for TTC risk factors necessary. In psychiatric anamnesis affective disorders and chronic anxiety disorders are presumably for TTC. Subarachnoid hemorrhages and status epilepticus are typical acute neurological associated with a higher risk for TTC. Moreover, magnetic resonance imaging (MRI) studies reveled brain alterations of the limbic system and reduced connectivity of central autonomic nervous system structures. Diagnosis of TTC is made by elevation of cardiac enzymes, electrocardiogram (ECG) and visualization of myocardial wall motion. Major differential diagnoses like acute coronary syndrome and myocarditis are hereby in synopsis with anamnesis with respect of possible emotional and physical triggering factors of TTC ruled out. In most cases the TTC typical wall motion abnormalities resolve in weeks and therapy is only necessary in hemodynamic instable patients and if rare complications, like cardiac wall ruptures occur. Recently, the two-parted International expert consensus document on Takotsubo syndrome was published, providing a detailed characterization of TTC and allows clinicians to understand this cardiac dysfunction with a multidisciplinary view.
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Affiliation(s)
- Sylvia J Buchmann
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dana Lehmann
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christin E Stevens
- Department of Neurology, Augustahospital Anholt, Isselburg-Anholt, Germany
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Jha S, Zeijlon R, Enabtawi I, Espinosa AS, Chamat J, Omerovic E, Redfors B. Electrocardiographic predictors of adverse in-hospital outcomes in the Takotsubo syndrome. Int J Cardiol 2019; 299:43-48. [PMID: 31279663 DOI: 10.1016/j.ijcard.2019.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Takotsubo syndrome (TS) is a life-threatening acute heart failure syndrome. However, little is known about risk factors for worse outcomes in TS and no high-risk ECG criteria have been defined. We sought to identify ECG predictors of life-threatening in-hospital complications in TS. METHOD AND RESULT Using the nationwide Swedish Angiography and Angioplasty Registry (SCAAR) we obtained data on all consecutive patients undergoing coronary angiography at Sahlgrenska University Hospital between June 2008 and February 2019. For all patients with TS we conducted in-depth chart reviews to confirm the TS diagnosis. For those with confirmed TS we then evaluated all ECGs obtained during the index hospitalization. The primary endpoint was the occurrence of in-hospital major adverse cardiac event (MACE), defined as the composite of death, ventricular tachycardia or fibrillation (VT/VF), or atrioventricular block ≥2 or asystole ≫10 s. We identified 215 patients with TS (mean age 69 ± 13 years; 93% women). MACE occurred in 34 patients (16%), of whom 20 had VT/VF (9,3%). Patients with MACE were less likely than those without MACE to have sinus rhythm (85% versus 96%, p = 0.025) or T-wave inversion (29% versus 51%, p = 0.025). After propensity score adjustment T-wave inversion was independently associated with lower MACE risk (adjusted odds ratio [AdjOR] 0.28, 95% confidence interval [CI] 0.10-0.76, p = 0.012) and VT/VF (AdjOR 0.24, 95% CI 0.06-0.94, p = 0.041). CONCLUSION T-wave inversion is common in TS and is associated with lower risk of MACE, driven by a lower risk of VT/VF.
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Affiliation(s)
- Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden; Department of Internal medicine, Kungälv Hospital, Kungälv, Sweden.
| | - Rickard Zeijlon
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden; Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Israa Enabtawi
- Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden
| | | | - Jasmina Chamat
- Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Gothenburg University, Gothenburg, Sweden
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Zhang AN, Sacchi T, Altschul R, Guss D, Mohanty SR, Notar-Francesco V. A case of esophagogastroduodenoscopy induced Takotsubo cardiomyopathy with complete heart block. Clin J Gastroenterol 2019; 12:296-300. [PMID: 30904984 DOI: 10.1007/s12328-019-00967-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/31/2019] [Indexed: 12/27/2022]
Abstract
Takotsubo cardiomyopathy (TC) describes a reversible left ventricular dysfunction characterized by apical ballooning and basal hyperkinesis, commonly triggered by emotional or physical distress. TC associated with an esophagogastroduodenoscopy (EGD) has rarely been reported. We report a case of TC with complete heart block (CHB) in a patient receiving an EGD, who had no underlying cardiac disease, had previously tolerated both local and general anesthesia, and who had previously undergone similar endoscopic procedures without complications. The concurrence of both TC and CHB is unique in this case pertaining to a patient with no significant risk factors. The incidence, mechanism and prognosis of TC-associated arrhythmias are also reviewed.
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Affiliation(s)
- Allison Naiquan Zhang
- Division of Gastroenterology and Hepatobiliary Diseases, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA.
| | - Terrence Sacchi
- Division of Cardiovascular Diseases, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215, USA
| | - Rebecca Altschul
- Division of Cardiovascular Diseases, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215, USA
| | - Debra Guss
- Division of Gastroenterology and Hepatobiliary Diseases, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA
| | - Smruti Ranjan Mohanty
- Division of Gastroenterology and Hepatobiliary Diseases, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA
| | - Vincent Notar-Francesco
- Division of Gastroenterology and Hepatobiliary Diseases, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA
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Oindi FM, Sequeira E, Sequeira HR, Mutiso SK. Takotsubo cardiomyopathy in pregnancy: a case report and literature review. BMC Pregnancy Childbirth 2019; 19:89. [PMID: 30866848 PMCID: PMC6416971 DOI: 10.1186/s12884-019-2233-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy is rare in pregnancy and is characterized by left ventricular dysfunction with apical ballooning. This transient cardiac dysfunction may affect women of childbearing age in the antepartum, intrapartum or postpartum period. Most patients respond well to medical management with resolution of cardiac dysfunction within weeks. CASE PRESENTATION A 35-year-old female in her second pregnancy presented with severe preeclampsia at 31 weeks of gestation. She subsequently developed severe substernal chest pain and workup showed a stress induced cardiomyopathy prior to her delivery via caesarean section. She had full recovery of her cardiac function by 12 weeks postpartum after medical management. CONCLUSIONS Stress induced cardiomyopathy, though rare, should be considered after acute myocardial infarction has been ruled out in gravid females presenting with acute chest pain. Management should involve a multidisciplinary team. Cardiac function recovery is common within 4 weeks although some patients may require long term heart failure management.
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Affiliation(s)
- Felix Mwembi Oindi
- Department of Obstetrics and Gynecology, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya.
| | - Evan Sequeira
- Department of Obstetrics and Gynecology, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
| | - Herman Ryan Sequeira
- Department of Pulmonary and Critical Care Medicine, Norwalk Hospital/Yale University, Norwalk, CT, USA
| | - Steve Kyende Mutiso
- Department of Obstetrics and Gynecology, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
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Tsigaridas N, Mantzoukis S, Gerasimou M, Bakas K, Andrikos E, Kokkolou E, Tsinta A, Patsouras D. Takotsubo Syndrome during Haemodialysis. Indian J Nephrol 2019; 29:419-423. [PMID: 31798225 PMCID: PMC6883867 DOI: 10.4103/ijn.ijn_267_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Takotsubo syndrome (TS) is typically characterized by transient (reversible) systolic dysfunction of the apical and mid segments of the left ventricle (LV), usually without obstruction of coronary arteries, in postmenopausal women after a stressful event. Usually, patients may experience symptoms such as chest pain, shortness of breath, palpitations, and rarely syncope or cardiogenic shock. There are many theories about pathophysiology of TS. Among these, most acceptable is the catecholamine theory. The prognosis is usually good with recovery of symptoms and imaging findings at most within a few weeks. However, complications may occur. We present the 11th published case of a patient on hemodialysis, who presented with TS and discuss why this situation may occur in patients on hemodialysis. Contrary to our patient, half of previously published cases presented with atypical symptoms. Therefore, it is important to be alert in order to timely diagnose, support the patient, and treat if any complications appear.
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Affiliation(s)
- Nikolaos Tsigaridas
- Department of Nephrology, General Hospital of Ioannina ‘G. Hatzikosta’, Ioannina, Greece
| | - Stavros Mantzoukis
- Department of Nephrology, General Hospital of Ioannina ‘G. Hatzikosta’, Ioannina, Greece,Address for correspondence: Dr. Stavros Mantzoukis, 1 Stratigou Makrigianni Street, Ioannina - 45445; Department of Nephrology, General Hospital of Ioannina “G. Hatzikosta”, Ioannina, Greece. E-mail:
| | - Marina Gerasimou
- Department of Microbiology, General Hospital of Ioannina ‘G. Hatzikosta’, Ioannina, Greece
| | - Konstantinos Bakas
- Department of Cardiology, General Hospital of Ioannina ‘G. Hatzikosta’, Ioannina, Greece
| | - Emilios Andrikos
- Department of Nephrology, General Hospital of Ioannina ‘G. Hatzikosta’, Ioannina, Greece
| | - Elisavet Kokkolou
- Department of Nephrology, General Hospital of Ioannina ‘G. Hatzikosta’, Ioannina, Greece
| | - Aphrodite Tsinta
- Department of Nephrology, General Hospital of Ioannina ‘G. Hatzikosta’, Ioannina, Greece
| | - Dimitrios Patsouras
- Department of Cardiology, General Hospital of Ioannina ‘G. Hatzikosta’, Ioannina, Greece
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Elsayed M, Connemann BJ, Dahme T, Tesfay T, Gahr M. Takotsubo Cardiomyopathy With Inconspicuous Initial Electrocardiogram: A Potentially Serious Cardiac Pathology Related to Emotional Stress. Front Psychiatry 2019; 10:308. [PMID: 31156475 PMCID: PMC6531847 DOI: 10.3389/fpsyt.2019.00308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/18/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction: Takotsubo cardiomyopathy (TCM) is frequently associated with emotional or physical stress. Thus, patients with TCM might present primarily at a psychiatric clinic. Appropriate diagnosis and therapy may thus be delayed. Case report: A 43-year-old female patient presented as an emergency to the psychiatric outpatient clinic after experiencing severe work-related bullying. On admission, she complained of acute left thoracic chest pain as well as depressed mood, low energy, anhedonia, generalized anxiety, and sleep difficulties, present for several weeks. The initial electrocardiogram (ECG) was unremarkable; serum troponin levels, however, were markedly elevated. The patient was transferred to the department of cardiology. Via cardiac catheterization and MRI, an acute coronary syndrome was excluded and apical ballooning and left ventricular dysfunction, compatible with TCM, was found. Conclusion: Patients with acute psychopathology, recent emotional or physical stress, and acute cardiothoracic symptoms should receive immediate cardiological investigations. As the ECG may be normal in patients with TCM, concurrent measurement of the troponin serum level is recommended. Psychiatrists should consider TCM in patients who report recent stressful events accompanied by cardiothoracic symptoms.
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Affiliation(s)
- Mohamed Elsayed
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | | | - Tillman Dahme
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Temsgen Tesfay
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
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Vilela E, Silva M, Guerreiro C, Caeiro D, Fonseca M, Primo J, Braga P, Gama V. Takotsubo syndrome and coronary vasospasm: Two faces of the same coin? Indian Heart J 2018; 70:455-458. [PMID: 29961469 PMCID: PMC6034106 DOI: 10.1016/j.ihj.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 01/25/2023] Open
Affiliation(s)
- Eduardo Vilela
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal.
| | - Marisa Silva
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Cláudio Guerreiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Daniel Caeiro
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Marlene Fonseca
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - João Primo
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Vasco Gama
- Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
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