1
|
Ong GJ, Nguyen TH, Surikow SY, Horowitz JD. Risk factors for a broken heart: understanding drug-induced causes for Takotsubo syndrome and pharmacological treatment options. Expert Rev Clin Pharmacol 2022; 15:1017-1025. [DOI: 10.1080/17512433.2022.2121701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gao Jing Ong
- Cardiology Unit, Central Adelaide Local Health Network, Adelaide, Australia
- Cardiovascular Pathophysiology and Therapeutics Group, Basil Hetzel Institute, University of Adelaide, Woodville, Australia
| | - Thanh Ha Nguyen
- Cardiovascular Pathophysiology and Therapeutics Group, Basil Hetzel Institute, University of Adelaide, Woodville, Australia
- Northern Adelaide Local Health Network, Elizabeth Vale, Australia
| | - Sven Y Surikow
- Cardiovascular Pathophysiology and Therapeutics Group, Basil Hetzel Institute, University of Adelaide, Woodville, Australia
- Northern Adelaide Local Health Network, Elizabeth Vale, Australia
| | - John D Horowitz
- Cardiovascular Pathophysiology and Therapeutics Group, Basil Hetzel Institute, University of Adelaide, Woodville, Australia
| |
Collapse
|
2
|
Binder AK, Haydek JP, Parihar S, Modlin CE, Tannu M, Aldredge A, Sueblinvong V. Slow on the Uptake, Progression to Heartbreak. J Investig Med High Impact Case Rep 2020; 8:2324709620936832. [PMID: 32583694 PMCID: PMC7318803 DOI: 10.1177/2324709620936832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The prevalence of serotonin syndrome increases over the past several years as more serotonergic medications are being used in clinical practice. It is a potentially lethal condition caused by excessive serotonergic activity. Common causes of serotonin syndrome are the use of prescription medications, illicit drugs, or a combination of substances, leading to an increase in the activity of serotonin in the central and peripheral nervous system. The clinical symptoms range from mild to severe. We report a case of a 25-year-old woman with polysubstance abuse, including cocaine, who presented with confusion, rigidity, high-grade fever, and reduced biventricular function on echocardiogram. Based on the combination of substance used history, clinical presentation, and echocardiogram findings, she was diagnosed with serotonin syndrome complicated by takotsubo cardiomyopathy. She improved after being treated in the intensive care unit and was discharged from the hospital. This patient demonstrates the importance of recognizing and promptly initiating management of serotonin syndrome in order to improve morbidity and mortality.
Collapse
|
3
|
Ong GJ, Nguyen TH, Stansborough J, Surikow S, Mahadavan G, Worthley M, Horowitz J. The N-AcetylCysteine and RAMipril in Takotsubo Syndrome Trial (NACRAM): Rationale and design of a randomised controlled trial of sequential N-Acetylcysteine and ramipril for the management of Takotsubo Syndrome. Contemp Clin Trials 2020; 90:105894. [PMID: 31740426 DOI: 10.1016/j.cct.2019.105894] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Takotsubo Syndrome(TTS), contrary to historical reports, is now increasingly recognised to be associated with substantial mortality and morbidity, both in the short- and long-term. Although TTS is often precipitated by a catecholamine "pulse", in-hospital hypotension is a common occurrence, increasing the risk of mortality. Furthermore, despite the transient catecholamine stimulus, there is increasing evidence that there are significant long term sequelae, including persistently impaired left ventricular(LV) systolic dysfunction, myocardial oedema with fibrosis, as well as persistent impairment of quality of life. A definitive therapeutic option to limit the extent of initial myocardial injury, and to accelerate recovery in TTS is therefore justified. However to date, there has been a lack of prospective studies in this area. DESIGN AND RATIONALE NACRAM is a multi-centre, randomised, placebo-controlled trial, sequentially testing early use of intravenous N-acetylcysteine(NAC), followed by/or oral ramipril for 12 weeks. The rationale for utilising these agents is related to their effects on limiting nitrosative stress and expression of the inflammasome activator thioredoxin interacting protein(TXNIP); both processes fundamental to the pathogenesis of TTS. END POINTS NACRAM is assessing resolution of myocardial oedema on cardiac magnetic resonance imaging(CMR), improvements in LV systolic function as measured by global longitudinal strain(GLS) on echocardiography, quality of life, and inflammatory markers. DISCUSSION To the best of our knowledge, NACRAM will be the first prospective study to help definitively evaluate a therapeutic option in acute attacks of TTS.
Collapse
Affiliation(s)
- Gao Jing Ong
- Cardiology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia; University of Adelaide, Basil Hetzel Institute, Woodville, SA, Australia; Cardiology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Thanh Ha Nguyen
- Cardiology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia; University of Adelaide, Basil Hetzel Institute, Woodville, SA, Australia
| | | | - Sven Surikow
- Cardiology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia; University of Adelaide, Basil Hetzel Institute, Woodville, SA, Australia
| | - Gnanadevan Mahadavan
- Cardiology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia; University of Adelaide, Basil Hetzel Institute, Woodville, SA, Australia; Cardiology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Cardiology Unit, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Matthew Worthley
- Cardiology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia; University of Adelaide, Basil Hetzel Institute, Woodville, SA, Australia; Cardiology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - John Horowitz
- Cardiology Unit, Queen Elizabeth Hospital, Woodville, SA, Australia; University of Adelaide, Basil Hetzel Institute, Woodville, SA, Australia.
| |
Collapse
|