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Ang SP, Chia JE, Krittanawong C, Vummadi T, Deshmukh A, Usman MH, Lavie CJ, Mukherjee D. Racial disparities in trend, clinical characteristics and outcomes in Takotsubo syndrome. Curr Probl Cardiol 2024; 49:102826. [PMID: 39197600 DOI: 10.1016/j.cpcardiol.2024.102826] [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: 08/21/2024] [Accepted: 08/24/2024] [Indexed: 09/01/2024]
Abstract
INTRODUCTION Takotsubo syndrome (TTS) is an acute transient nonischemic cardiomyopathy often characterized by its hallmark feature of left ventricular apical ballooning. The correlation between racial backgrounds and the prognosis of individuals with TTS remains poorly defined. Our study aimed to explore the influence of race on the trends, clinical presentations, and outcomes in patients diagnosed with TTS. METHODS We queried the National Inpatient Sample (NIS) database from 2016 to 2020 and identified hospitalizations with TTS. We compared the clinical features and outcomes across three different races - non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic population. The primary outcome was in-hospital mortality. RESULTS 76,505 weighted hospitalizations for TTS were identified, of which 65,495 (85.6%) were non-Hispanic White, 5,830 (7.6%) were non-Hispanic Black, and 5,180 (6.8%) were Hispanics. After propensity-score matching, NHB patients had higher odds of acute kidney injury (OR: 1.49, 95% CI: 1.21-1.84, p < 0.001) and mechanical ventilation (OR: 1.33, 95% CI: 1.04-1.68, p = 0.02). Hispanic patients had a higher incidence of acute kidney injury requiring dialysis when compared to NHW patients (OR: 2.53, 95% CI: 1.11-5.77, p = 0.027). There was no significant difference in terms of in-hospital mortality between NHB and Hispanic patients when compared to NHW patients. Notably, Hispanic populations experienced a higher mortality rate during the COVID-19 period. CONCLUSION Our study suggested significant differences in the outcomes of TTS across different racial groups. Hispanic populations experienced a higher mortality rate with TTS during the COVID-19 era. Further research should emphasize discovering the factors contributing to the observed disparities.
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Affiliation(s)
- Song Peng Ang
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA.
| | - Jia Ee Chia
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | | | - Tharangini Vummadi
- Department of Anesthesiology, University of Central Florida, Ocala, FL, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Muhammed Haris Usman
- Department of Cardiovascular Disease, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, New Orleans, LA, USA.
| | - Debabrata Mukherjee
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, USA; Department of Cardiovascular Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
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Chen O, Mojahedi A. Investigating the effect of cancer medication in the development of Takotsubo cardiomyopathy. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2024; 14:196-207. [PMID: 39309116 PMCID: PMC11410786 DOI: 10.62347/stfl9135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/10/2024] [Indexed: 09/25/2024]
Abstract
Takotsubo cardiomyopathy (TCM) is a cardiac condition that is usually characterized by sudden heart failure (HF) or chest pain that resembles acute coronary syndrome (ACS). It is identified by severe systolic dysfunction of the left ventricle (LV) and can be caused by physical, medical, or emotional stress. The pathophysiological mechanisms leading to TCM have not yet been clearly determined. TCM is a complex condition to diagnose and may go undetected during cancer treatment due to the wide variety of cardiotoxic effects associated with antineoplastic therapies. Consequently, timely identification and effective treatment are critical to enhancing the prognosis. Nevertheless, TCM is a more prevalent condition in oncology than was previously believed; therefore, clinicians who treat cancer patients should consider it in their differential diagnosis. The purpose of this manuscript is to provide physicians with a summary of the available evidence regarding the ramifications of the association between TCM and cancer to aid in improving patient management.
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Affiliation(s)
- On Chen
- Divison of Cardiology, Stony Brook University HospitalStony Brook, New York, The United States
| | - Azad Mojahedi
- Department of Internal Medicine, Stony Brook University HospitalStony Brook, New York, The United States
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Hassanabad AF, Sembo T, Kidd WT, Har B. Takotsubo cardiomyopathy associated with free wall rupture and ventricular septal defect: a case report. Future Cardiol 2024:1-4. [PMID: 39101463 DOI: 10.1080/14796678.2024.2382541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 08/06/2024] Open
Abstract
Takotsubo cardiomyopathy is a rare cardiac presentation. It can be associated with severe complications such as hemodynamically significant ventricular septal defect and cardiac free wall rupture. In cases of mechanical complications, surgical repair is often indicated. Despite best medical and surgical efforts, patients with Takotsubo cardiomyopathy and mechanical complications carry significant mortality risk. Herein, we present an unusual presentation of Takotsubo cardiomyopathy that was associated with a mechanical complication. Although the patient underwent a successful surgical repair, she passed away from multiorgan failure during the postoperative period.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Canada
| | - Toshiro Sembo
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Canada
| | - William T Kidd
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Canada
| | - Bryan Har
- Section of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Canada
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Pillitteri M, Brogi E, Piagnani C, Bozzetti G, Forfori F. Perioperative management of Takotsubo cardiomyopathy: an overview. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:45. [PMID: 39010210 PMCID: PMC11247845 DOI: 10.1186/s44158-024-00178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
Resembling the morphology of Japanese polyp vessels, the classic form of Takotsubo cardiomyopathy is characterized by the presence of systolic dysfunction of the mid-apical portion of the left ventricle associated with basal hyperkinesia. It is believed that this may be due to a higher density of β-adrenergic receptors in the context of the apical myocardium, which could explain the greater sensitivity of the apex to fluctuations in catecholamine levels.The syndrome is precipitated by significant emotional stress or acute severe pathologies, and it is increasingly diagnosed during the perioperative period. Indeed, surgery, induction of general anaesthesia and critical illness represent potential harmful trigger of stress cardiomyopathy. No universally accepted guidelines are currently available, and, generally, the treatment of TTS relies on health care personal experience and/or local practice. In our daily practice, anaesthesiologists can be asked to manage patients with the diagnosis of new-onset Takotsubo before elective surgery or an emergent surgery in a patient with a concomitant stress cardiomyopathy. Even more, stress cardiomyopathy can arise as a complication during the operation.In this paper, we aim to provide an overview of Takotsubo syndrome and to discuss how to manage Takotsubo during surgery and in anaesthesiologic special settings.
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Affiliation(s)
- Marta Pillitteri
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Etrusca Brogi
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Chiara Piagnani
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Giuseppe Bozzetti
- Department of Anaesthesia, Peri Operative Medicine and Critical Care, NHS Golden Jubilee, Glasgow, UK
| | - Francesco Forfori
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
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Tan B, Chen L, Yan S, Pan H, Zhang J, Wei H. Risk of stress cardiomyopathy associated with selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors: a real-world pharmacovigilance analysis. Sci Rep 2024; 14:15167. [PMID: 38956425 PMCID: PMC11220088 DOI: 10.1038/s41598-024-66155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are reported to cause stress cardiomyopathy (SC). This study evaluated the association between SSRI/SNRI use and the occurrence of cardiomyopathy in the publicly available U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. Disproportionate analysis and likelihood ratio tests were used to identify risk associated with SSRIs or SNRIs and the incidence of SC, using data from between from 2012 to 2022 acquired from the FAERS database. The study identified 132 individual case safety reports (ICSRs) of SC associated with SSRIs or SNRIs. Venlafaxine (48%) and fluoxetine (27%) were the most common antidepressants of the ICSRs. Approximately 80% of SC cases were reported in females, with individuals aged 45-65 years identified as a high-risk population. Both venlafaxine (ratio-scale information component [RSIC] 2.54, 95% CI 2.06-3.04) and fluoxetine (RSIC 3.20, 95% CI 2.31-4.47) were associated with SC, with likelihood ratio estimates of 3.55 (p = 0.02) for venlafaxine and 4.82 (p = 0.008) for fluoxetine. The median time to cardiomyopathy onset was 20 days, with hospitalization reported in 48.33% of patients. Venlafaxine and fluoxetine were associated with SC risk, particularly in middle-aged women. Caution should be exercised when using SSRIs or SNRIs combined with other serotonergic medications.
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Affiliation(s)
- Boyu Tan
- Department of Pharmacy, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Department of Pharmacy, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People's Republic of China
| | - Li Chen
- Department of Pharmacy, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People's Republic of China
| | - Sulan Yan
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People's Republic of China
| | - Huijie Pan
- Department of Pharmacy, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Jingxian Zhang
- Department of Pharmacy, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Hongyan Wei
- Department of Pharmacy, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.
- Institute of I Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People's Republic of China.
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Escaño L, Desai P, Chaudhry S. From Hyperglycemia to Broken Heart Syndrome: A Case of Diabetic Ketoacidosis-Induced Takotsubo Cardiomyopathy. Cureus 2024; 16:e64907. [PMID: 39156256 PMCID: PMC11330627 DOI: 10.7759/cureus.64907] [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] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
Diabetic ketoacidosis (DKA) is one of the hyperglycemic emergencies seen in patients with poorly controlled diabetes mellitus. One of the potential cardiovascular complications of this hyperglycemic crisis, not that well documented in the literature, is takotsubo cardiomyopathy (TCM) also known as stress-induced cardiomyopathy or "broken heart syndrome". It is a reversible condition where the heart muscle becomes suddenly weakened and stunned, which is mostly known to develop in patients who have suffered a stressful life event or are undergoing an acute illness. We present an interesting case of a 45-year-old female with a history of poorly controlled diabetes mellitus who presented with significant hyperglycemia and laboratory results concerning DKA. The patient was also complaining of new-onset chest pain on arrival. Further workup revealed elevated troponin, severely reduced ejection fraction, and echocardiographic findings concerning TCM. The coexistence of DKA and TCM is rare but clinically significant. This case emphasizes the value of clinical vigilance in patients with this hyperglycemic crisis and encourages us to always consider stress-induced cardiomyopathy as a potential complication. Further research is needed to better elucidate the exact mechanisms linking DKA and stress-induced cardiomyopathy. This will help improve outcomes and prevent recurrence in this vulnerable patient population.
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Sanchez Morey D, Kholoki S. Takotsubo Cardiomyopathy Mimicking Multivessel Coronary Artery Disease Following Spinal Surgery. Cureus 2024; 16:e61795. [PMID: 38846549 PMCID: PMC11155228 DOI: 10.7759/cureus.61795] [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] [Accepted: 06/06/2024] [Indexed: 06/09/2024] Open
Abstract
Takotsubo cardiomyopathy (TC), also known as "broken-heart syndrome," is a reversible form of left ventricular dysfunction predominantly affecting post-menopausal women. This case report describes a 62-year-old female who presented with dyspnea and chest pain six weeks after left transforaminal lumbar decompression and fusion surgery. Despite clinical findings suggestive of multivessel coronary artery disease (MVD), angiography revealed normal coronary arteries, confirming TC and stress-induced myocardial infarction. The patient's clinical course highlights the importance of recognizing TC's diverse clinical presentations, especially following surgical interventions, and underscores the need for individualized diagnostic approaches and treatment strategies. The case emphasizes the role of ongoing monitoring and research to understand TC's pathophysiology and optimize therapeutic management.
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Affiliation(s)
| | - Samer Kholoki
- Internal Medicine, La Grange Memorial Hospital, Chicago, USA
- Internal Medicine, Saint James School of Medicine, Chicago, USA
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8
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Humayra S, Yahya N, Ning CJ, Mir IA, Mohamed AL, Manan HA. Systematic review of cardiovascular magnetic resonance imaging T1 and T2 mapping in patients with Takotsubo syndrome. Heliyon 2024; 10:e29755. [PMID: 38707280 PMCID: PMC11068528 DOI: 10.1016/j.heliyon.2024.e29755] [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: 12/14/2023] [Revised: 03/24/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
Background Current imaging advancements quantify the use of cardiovascular magnetic resonance (CMR) derived T1 and T2 tissue characterization as robust indicators for cardiomyopathies, but limited literature exists on its clinical application in Takotsubo syndrome (TTS). This systematic review evaluated the T1 and T2 parametric mapping to delineate the current diagnostic and prognostic CMR imaging outcomes in TTS. Methods A comprehensive literature search until October 2023 was performed on ScienceDirect, PubMed, Web of Science, and Cochrane Library by two independent reviewers adhering to the PRISMA framework. The Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of studies. Results Out of 198 results, 8 studies were included in this qualitative synthesis, accounting for a total population of 399 subjects (TTS = 201, controls = 175, acute myocarditis = 14, and acute regional myocardial oedema without infarction = 9). Approximately 50.4 % were TTS patients aged between 61 and 73 years, whereof, females (n = 181, 90.0 %) and apical variants (n = 180, 89.6 %) were significantly higher, and emotional stressor (n = 42; 20.9 %) was more prevalent than physical (n = 27; 13.4 %). The NOS identified 62.5 % of studies as moderate and 37.5 % as high quality. Parametric tissue mapping revealed significantly prolonged T1 and T2 relaxation times at 1.5T and 3T respectively in TTS (1053-1164 msec, 1292-1438 msec; and 56-67 msec, 60-90 msec) with higher extracellular volume (ECV) fraction (29-36 %), compared to healthy subjects (944-1211 msec, 1189-1251 msec; and 46-54 msec, 32-68 msec; 23-29 %) and myocarditis (1058 msec, 60 msec). Other significant myocardial abnormalities included increased left ventricular (LV) end-systolic and diastolic volume and reduced global longitudinal strain. Overall, myocardial oedema, altered LV mass and strain, and worse LV systolic function, with higher native T1, T2, and ECV values were consistent. Conclusions Future research with substantially larger clinical trials is vital to explore the CMR imaging findings in diverse TTS patient cohorts and correlate the T1 and T2 mapping outcomes with demographic/clinical covariates. CMR is a valuable imaging tool for TTS diagnosis and prognostication. T1 and T2 parametric mapping facilitates the quantification of oedema, inflammation, and myocardial injury in Takotsubo.
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Affiliation(s)
- Syeda Humayra
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, School of Diagnostic & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Chai Jia Ning
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
- Department of Radiology and Intervention, Hospital Pakar Kanak-Kanak (UKM Specialist Children's Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Imtiyaz Ali Mir
- Department of Physiotherapy, M Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, 43000, Selangor, Malaysia
- Faculty of Health Sciences, Lincoln University College, Petaling Jaya, 47301, Selangor, Malaysia
| | - Abdul Latiff Mohamed
- Faculty of Medicine, University of Cyberjaya, Persiaran Bestari, Cyber 11, 63000, Cyberjaya, Selangor, Malaysia
| | - Hanani Abdul Manan
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
- Department of Radiology and Intervention, Hospital Pakar Kanak-Kanak (UKM Specialist Children's Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
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Marshall ER, Maliel KT, Burtson KM. A Case of Reverse Takotsubo Cardiomyopathy After Administering a Local Anesthetic Containing Epinephrine. Cureus 2024; 16:e57476. [PMID: 38707064 PMCID: PMC11068121 DOI: 10.7759/cureus.57476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/07/2024] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a rare syndrome characterized by acute and transient distinctive wall motion abnormalities accompanied by other defined objective findings. There are many variants of TCM, including the reverse (or basal) subtype. While the pathogenesis is not fully understood, both endogenous and exogenous catecholamines have been implicated. This case report describes a 30-year-old active-duty military female who developed reverse TCM immediately following local anesthetic with epinephrine administration in preparation for an elective septorhinoplasty. She developed electrocardiogram (ECG) changes, temporary hemodynamic instability, and cardiac troponin elevation. Transthoracic echocardiogram (TTE) demonstrated significantly reduced systolic and diastolic function, with akinesis of the basal segments and normal wall motion of the apical segments, consistent with a reverse Takotsubo pattern. Coronary computed tomography (CT) angiography showed normal coronary arteries. Repeat TTE was performed two days after the initial event and showed near-complete resolution of the wall motion abnormalities. Fourteen days later, TTE showed normalization of cardiac function. While there is a favorable prognosis for most patients with this diagnosis, there does remain the potential for significant adverse outcomes, risk of recurrence, and a non-negligible mortality rate. It is widely known that physical and emotional triggers can precipitate TCM through the release of catecholamines. This case, in addition to numerous other case reports, provides further documentation and support that exogenous epinephrine administration is also associated with the development of TCM. Clinicians should consider the diagnosis of Takotsubo cardiomyopathy if hemodynamic or ECG changes arise following epinephrine administration.
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Affiliation(s)
- Emma R Marshall
- Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, USA
- Internal Medicine, Wright Patterson Medical Center, Dayton, USA
| | | | - Kathryn M Burtson
- Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, USA
- Internal Medicine, Wright Patterson Medical Center, Dayton, USA
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Hassanzadeh S, Suleiman A, Correia JJ, Montazerin SM. COVID-19 vaccines-associated Takotsubo cardiomyopathy: A narrative review. LE INFEZIONI IN MEDICINA 2024; 32:1-11. [PMID: 38456019 PMCID: PMC10917559 DOI: 10.53854/liim-3201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024]
Abstract
Takotsubo cardiomyopathy (TTC) is a severe, acute, reversible, and self-limited cardiac dysfunction. It usually affects postmenopausal women and is mostly triggered by physical or emotional stressors. Following the COVID-19 pandemic, millions of doses of different types of COVID-19 vaccines are being administered globally. There have been reports of different cardiac complications after receiving COVID-19 vaccines. To our knowledge, there have been 16 reported cases of COVID-19 vaccination-associated TTC. In this study, we first provide a brief overview of TTC and then an overview of selected reported TTC cases following COVID-19 vaccinations. It is crucial to highlight that the occurrence of TTC after vaccination does not establish a direct cause-and-effect relationship between immunization and TTC. Further investigations are necessary to examine any potential association between COVID-19 vaccines and the incidence of TTC. Additionally, the benefits of receiving COVID-19 vaccines significantly outweigh the potential risks of developing adverse events.
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Affiliation(s)
- Shakiba Hassanzadeh
- Department of Pathology, East Carolina University, Greenville, North Carolina, USA
| | - Addi Suleiman
- Department of Cardiology, Saint Michael’s Medical Center, Newark, New Jersey, USA
| | - Joaquim J. Correia
- Department of Cardiology and Electrophysiology, Saint Michael’s Medical Center, Newark, New Jersey, USA
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Ortega MDC, Bullard JP, Del Mar Unceta M, Sánchez-Pedreño FO, Molero P, de Asúa DR. Takotsubo cardiomyopathy secondary to electroconvulsive therapy in a young adult with Down syndrome regression disorder. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32078. [PMID: 38041246 DOI: 10.1002/ajmg.c.32078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
We report the case of an 18-year-old woman with Down syndrome (DS) who developed Takotsubo cardiomyopathy (TSC) immediately after the administration of electroconvulsive therapy (ECT), a treatment prescribed for Down syndrome regression disorder resistant to oral psychotropic drugs. TSC is a nonischemic cardiomyopathy related to psychological or physical stress, which has been described as a rare complication of ECT (Kinoshita et al., 2023, Journal of Electroconvulsive Therapy, 39, 185-192). The clinical description of the case is accompanied by a discussion of the peculiarities of the autonomic nervous system in DS.
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Affiliation(s)
- María Del Carmen Ortega
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Madrid, Spain
| | - José Pablo Bullard
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - María Del Mar Unceta
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Felipe Ortuño Sánchez-Pedreño
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
- Health Research Institute, Navarra (IdiSNA), Pamplona, Spain
| | - Patricio Molero
- Department of Psychiatry and Clinical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
- Health Research Institute, Navarra (IdiSNA), Pamplona, Spain
| | - Diego Real de Asúa
- Department of Internal Medicine, Adult Down Syndrome Outpatient Clinic, Hospital Universitario de La Princesa, Madrid, Spain
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12
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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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von Mackensen JKR, Shazly AE, Schoenrath F, Kempfert J, Starck CT, Potapov EV, Jacobs S, Falk V, Wert L. Successful treatment of cardiogenic shock due to Takotsubo syndrome with implantation of a temporary microaxial left ventricular assist device in transaxillary approach. J Cardiothorac Surg 2023; 18:343. [PMID: 38012790 PMCID: PMC10683305 DOI: 10.1186/s13019-023-02459-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Cardiogenic shock (CS) can occur in patients with Takotsubo syndrome (TTS). As TTS has received increasing attention and has been more closely researched, several aspects of the pathogenesis have been identified, particularly that an excessive release of catecholamines plays an important role. Nevertheless, evidence on specific therapy concepts is still lacking. As a result, TTS with severe hemodynamic instability and low cardiac output creates unique challenges, and mechanical circulatory support is needed with as few inotropic drugs as possible. METHODS We present a 77-year-old female patient who underwent minimally invasive surgical mitral valve replacement. After an uneventful course, the patient developed acute heart failure eleven days after surgery. Transthoracic echocardiography (TTE) revealed a new onset of TTS. The patient needed left ventricular venting and full haemodynamic flow. We successfully implanted a microaxial left ventricular assist device (Impella 5.5) using the transaxillary approach. The haemodynamic situation stabilised immediately. The patient was weaned and the Impella 5.5 was explanted after five days. CONCLUSION We present the first-in-man implantation of a transaxillary Impella 5.5 in a patient with TTS. The patient benefitted from Impella 5.5 therapy with full haemodynamic support and venting of the left ventricle.
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Affiliation(s)
- Johanna K R von Mackensen
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Ahmed El Shazly
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Center for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Center for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - Christoph T Starck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Center for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Center for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Center for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Center for Cardiovascular Research) partner site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Leonhard Wert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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14
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González-Jasso JG, Montero-Pola YL, Toledo-Salinas O, Schlie-Villa W, Muñóz-López A, García-Hernández E. [Takotsubo cardiomyopathy associated with abnormal birth of the coronary arteries]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:882-887. [PMID: 37995560 PMCID: PMC10727765 DOI: 10.5281/zenodo.10064743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/03/2023] [Indexed: 11/25/2023]
Abstract
Background Takotsubo cardiomyopathy (TM) is a form of non-ischemic cardiomyopathy. It is characterized by transient regional systolic dysfunction of the left ventricle that mimics acute myocardial infarction. The main objective of this article is to report the case of a patient with TM associated with abnormal birth of the left coronary trunk. Clinical case A 76-year-old woman with typical angina at rest, with an electrocardiogram that showed dynamic changes in the T wave and elevation of biomarkers. Coronary angiography showed epicardial coronary arteries without significant lesions and abnormal birth of the left coronary trunk from the proximal segment of the right coronary artery. The patient progressed favorably, and the transthoracic echocardiogram showed no mobility disorders 3 months after the event. Conclusions TM and abnormal birth of the coronary arteries are rare diseases whose simultaneous presentation is extraordinary. The diagnosis of both clinical entities is made by coronary angiography and echocardiogram, and their treatment is similar to that of patients with acute coronary syndrome. Abnormal birth of the left coronary trunk with retroaortic switch reaching the contralateral site has a good clinical prognosis and echocardiographic follow-up should be performed 4 weeks after the onset of the condition.
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Affiliation(s)
- Jesús Guadalupe González-Jasso
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Yuyi Lizeth Montero-Pola
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Coronarios. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Otoniel Toledo-Salinas
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Intensivos. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Werner Schlie-Villa
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Alexander Muñóz-López
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Ernesto García-Hernández
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Coronarios. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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15
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Philippides D, Hong A, Eukovich A, Chaudhry A. A Case of Grave's Thyrotoxicosis-Induced Takotsubo Cardiomyopathy Presenting with Cardiac Arrest After Winning the Lottery. J Community Hosp Intern Med Perspect 2023; 13:97-100. [PMID: 37868663 PMCID: PMC10589048 DOI: 10.55729/2000-9666.1242] [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: 04/09/2023] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 10/24/2023] Open
Abstract
Takotsubo syndrome (TTS) is a nonischemic cardiomyopathy with transient apical ballooning of the left ventricle and reduced ejection fraction that can be caused by severe emotional or physical stress, with diverse clinical presentations. This case describes a patient who went into cardiac arrest at a casino after winning the lottery. She was found to have Takotsubo cardiomyopathy, in the setting of uncontrolled hyperthyroidism. This is a very unique case of TTS presenting with cardiac arrest, and is also an uncommon example of TTS triggered by a positive rather than negative emotional life event.
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Affiliation(s)
- David Philippides
- Department of Internal Medicine, HCA Florida Northwest Hospital,
United States
| | - Angelina Hong
- Department of Internal Medicine, HCA Florida Northwest Hospital,
United States
| | - Amanda Eukovich
- College of Allopathic Medicine, Nova Southeastern University,
United States
| | - Ali Chaudhry
- Department of Critical Care, HCA Florida Northwest Hospital,
United States
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16
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Takuma S, Asaka T, Kitagawa Y, Fujisawa T. Reply to the letter to the editor by Finsterer et al. titled "Before blaming the tooth extraction, consider alternative triggers of Takotsubo". SPECIAL CARE IN DENTISTRY 2023; 43:738-739. [PMID: 36309476 DOI: 10.1111/scd.12796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Shigeru Takuma
- Faculty of Dental Medicine, and Graduate School of Dental Medicine, Department of Dental Anesthesiology, Hokkaido University, Sapporo, Japan
| | - Takuya Asaka
- Faculty of Dental Medicine and Graduate School of Dental Medicine, Department of Oral Diagnosis and Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshimasa Kitagawa
- Faculty of Dental Medicine and Graduate School of Dental Medicine, Department of Oral Diagnosis and Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Faculty of Dental Medicine, and Graduate School of Dental Medicine, Department of Dental Anesthesiology, Hokkaido University, Sapporo, Japan
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17
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Mtour S, Abu-Hilal LH, Barghouthi DI, Njoum Y, Jabbarin F, Adwan B, Abu Asbeh I, Mtour A, Alsallamin I. Takotsubo cardiomyopathy prevalence and associated factors in patients presenting with a clinical picture of acute myocardial infarction in Palestine. Egypt Heart J 2023; 75:71. [PMID: 37578674 PMCID: PMC10425303 DOI: 10.1186/s43044-023-00399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC) is a transient cardiac syndrome that manifests with symptoms resembling acute myocardial infarction (MI). It is characterized by temporary wall-motion abnormalities predominantly affecting the apical and mid-portions of the left ventricle, despite the absence of significant obstructive coronary disease. TC poses diagnostic challenges due to its resemblance to ST-segment elevation myocardial infarction. Our study aimed to determine the prevalence of TC and identify the factors associated with its occurrence in patients presenting with acute MI in Palestine. RESULTS A retrospective analysis was conducted on a cohort of patients diagnosed with TC at Al-Makassed hospital. Women accounted for 90.7% of TC cases (95% CI 88.2-93.2%). The mean age of affected individuals ranged from 62 to 76 years. The most common presenting symptoms were chest pain (83.4%, 95% CI 80.0-86.7%) and dyspnea (20.4%, 95% CI 16.3-24.5%), often following an emotionally or physically stressful event. Electrocardiography (ECG) on admission indicated ST-segment elevations in 71.1% of cases (95% CI 67.2-75.1%), accompanied by mild elevations of Troponins in 85.0% of cases (95% CI 80.8-89.1%). Despite the initial severity, left ventricular ejection fraction (LVEF) improved from 20-49.9 to 59-76% within a mean time of 7-37 days. The in-hospital mortality rate was 1.7% (95% CI 0.5-2.8%), with complete recovery observed in 95.9% of cases (95% CI 93.8-98.1%) and rare recurrence. The underlying etiology is believed to involve exaggerated sympathetic stimulation. CONCLUSIONS TC should be considered as a significant differential diagnosis in acute coronary syndrome (ACS) cases, particularly among postmenopausal women with a preceding stressful event. Our study provides insights into the prevalence and characteristics of TC in the Palestinian population. While stress has been recognized as a potential trigger for TC, further research is needed to explore if there are specific associations between occupation and other unique stressors in the Palestinian context and the prevalence of TC. The study's results can raise awareness among healthcare professionals in Palestine about the prevalence and characteristics of TC in their patient population.
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Affiliation(s)
- Sameer Mtour
- Cardiology Department, Al-Makassed Hospital, Jerusalem, Palestine
| | | | | | - Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Farah Jabbarin
- Cardiology Department, Al-Makassed Hospital, Jerusalem, Palestine
| | - Bilal Adwan
- Cardiology Department, Al-Makassed Hospital, Jerusalem, Palestine
| | | | - Ali Mtour
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Isaac Alsallamin
- Cardiology Department, Al-Makassed Hospital, Jerusalem, Palestine
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18
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Matta AG, Carrié D. Epidemiology, Pathophysiology, Diagnosis, and Principles of Management of Takotsubo Cardiomyopathy: A Review. Med Sci Monit 2023; 29:e939020. [PMID: 36872594 PMCID: PMC9999670 DOI: 10.12659/msm.939020] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is a reversible syndrome commonly found among patients presenting for acute coronary syndromes, especially women. With the COVID-19 pandemic, the incidence of takotsubo cardiomyopathy was dramatically increased. However, this clinical cardiac entity remains underdiagnosed, largely due to the interplay with acute coronary syndrome. The pathophysiology of takotsubo cardiomyopathy is miscellaneous, including coronary vasospasm, microcirculatory dysfunction, catecholamine surge, and sympathetic overdrive. Diagnosing takotsubo cardiomyopathy requires a high index of clinical suspicion and multimodality tests. To date, there are no guidelines for the management of takotsubo cardiomyopathy. Thus, available data are derived from case series, retrospective analyses, and experts' opinions. Heart failure medicines were investigated in takotsubo cardiomyopathy patients. Evidence supports the benefits of angiotensin-converting enzyme inhibitors and angiotensin receptors blockers use on mortality and recurrence rates, while results from use of beta-blockers are controversial. In complicated cases, inotropes are preferred over vasopressors, except in the presence of left ventricular outflow tract obstruction, in which medical therapy is limited to fluids administration and beta-blockers. Use of oral vitamin K antagonist can benefit patients at high thrombo-embolic risk for up to 3 months. Mechanical supports are reserved for refractory hemodynamically unstable cases. This review aims to provide an update on the epidemiology, diagnosis, and outcomes of takotsubo cardiomyopathy, and an extended discussion on the management of complicated and non-complicated cases.
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Affiliation(s)
- Anthony Georges Matta
- Department of Cardiology, Toulouse University Hospital, Toulouse, France.,Department of Cardiology, Hôpitaux Civils de Colmar, Colmar, France
| | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
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19
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Daneshrad JA, Ordovas K, Sierra-Galan LM, Hays AG, Mamas MA, Bucciarelli-Ducci C, Parwani P. Role of Cardiac Magnetic Resonance Imaging in the Evaluation of MINOCA. J Clin Med 2023; 12:jcm12052017. [PMID: 36902806 PMCID: PMC10003970 DOI: 10.3390/jcm12052017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/03/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
Myocardial infarction with Non Obstructive Coronary Arteries (MINOCA) is defined by patients presenting with signs and symptoms similar to acute myocardial infarction, but are found to have non-obstructive coronary arteries angiography. What was once considered a benign phenomenon, MINOCA has been proven to carry with it significant morbidity and worse mortality when compared to the general population. As the awareness for MINOCA has increased, guidelines have focused on this unique situation. Cardiac magnetic resonance (CMR) has proven to be an essential first step in the diagnosis of patients with suspected MINOCA. CMR has also been shown to be crucial when differentiating between MINOCA like presentations such as myocarditis, takotsubo and other forms of cardiomyopathy. The following review focuses on demographics of patients with MINOCA, their unique clinical presentation as well as the role of CMR in the evaluation of MINOCA.
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Affiliation(s)
- Justin A. Daneshrad
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA 92354, USA
| | - Karen Ordovas
- Department of Cardiothoracic Imaging, University of Washington, Seattle, WA 98195, USA
| | | | - Allison G. Hays
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Mamas A. Mamas
- Keele Cardiac Research Group, Institutes of Science and Technology in Medicine and Primary Care, Keele University, Stoke-on-Trent, Staffordshire ST4 2DE, UK
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys’ and St Thomas NHS Foundation Trust, London SE1 7EH, UK
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London WC2R 2LS, UK
| | - Purvi Parwani
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, CA 92354, USA
- Correspondence:
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20
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Takuma S, Asaka T, Kitagawa Y, Fujisawa T. Takotsubo syndrome after a minimally invasive tooth extraction in a patient without dental phobia: A case report. SPECIAL CARE IN DENTISTRY 2023; 43:281-285. [PMID: 35934843 DOI: 10.1111/scd.12766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
Takotsubo syndrome (TTS) is a rare, stress-induced acute cardiac disorder. Its precipitating factors include emotionally or physically stressful events and exogenous and endogenous adrenaline. In this report, we describe a case of atypical TTS in a 73-year-old woman who reported no dental fear and required acute cardiac care in an outpatient setting. She underwent routine extraction of an upper left premolar under local anesthesia. She reported heart palpitations after the injection, and the procedure was completed in 15 min. After presenting symptoms of sweating, pale skin, vomiting, low blood pressure, and ST-segment elevation, cardiologists ordered echocardiography, coronary angiography, and ventriculography. Upon receiving a TTS diagnosis, the patient was hospitalized and administered an intra-aortic balloon pump and beta-blocker. Her symptoms resolved, and she was discharged with no sequelae. We found no precipitating factors in the progression of TTS in this case, which suggests that TTS can develop in the absence of precipitating factors. All general dentists and oral surgeons should recognize the possible risk of TTS, even during minimally invasive dental procedures, such as routine extractions in patients without dental phobia.
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Affiliation(s)
- Shigeru Takuma
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Takuya Asaka
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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21
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Ziaka M, Exadaktylos A. The Heart Is at Risk: Understanding Stroke-Heart-Brain Interactions with Focus on Neurogenic Stress Cardiomyopathy-A Review. J Stroke 2023; 25:39-54. [PMID: 36592971 PMCID: PMC9911836 DOI: 10.5853/jos.2022.02173] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/04/2022] [Accepted: 11/14/2022] [Indexed: 01/04/2023] Open
Abstract
In recent years, it has been convincingly demonstrated that acute brain injury may cause severe cardiac complications-such as neurogenic stress cardiomyopathy (NSC), a specific form of takotsubo cardiomyopathy. The pathophysiology of these brain-heart interactions is complex and involves sympathetic hyperactivity, activation of the hypothalamic-pituitary-adrenal axis, as well as immune and inflammatory pathways. There have been great strides in our understanding of the axis from the brain to the heart in patients with isolated acute brain injury and more specifically in patients with stroke. On the other hand, in patients with NSC, research has mainly focused on hemodynamic dysfunction due to arrhythmias, regional wall motion abnormality, or left ventricular hypokinesia that leads to impaired cerebral perfusion pressure. Comparatively little is known about the underlying secondary and delayed cerebral complications. The aim of the present review is to describe the stroke-heart-brain axis and highlight the main pathophysiological mechanisms leading to secondary and delayed cerebral injury in patients with concurrent hemorrhagic or ischemic stroke and NSC as well as to identify further areas of research that could potentially improve outcomes in this specific patient population.
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Affiliation(s)
- Mairi Ziaka
- Department of Internal Medicine, Thun General Hospital, Thun, Switzerland
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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