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Laurence G, Vasiliu A, Blommaert D, Fabien D, Benoit B, Claude H, Antoine G. Typical dynamic electrocardiographic changes in Takotsubo syndrome. Acta Cardiol 2022; 77:146-152. [PMID: 34027823 DOI: 10.1080/00015385.2021.1890924] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS Negative T waves and QTc prolongation often occur in patients with Takotsubo syndrome. Description of typical electrocardiographic changes could be a diagnosis element of this syndrome. This study aimed to clarify on the one hand the more preciously possible the typical electrocardiographic changes, and on the other hand, the timing of occurrence of these abnormalities compared to the trigger occurrence, the symptoms onset and the hospital admission. METHODS AND RESULTS We studied ECGs at admission of 59 patients with Takotsubo syndrome, a 'reference' ECG and each one available during the first five days after admission.We observed significant changes on the pathological ECG compared to reference ECG: the mean number of leads with negative T waves (7.4 ± 1.9 mm vs 2.1 ± 1.4 mm, p < 0.0001), the highest value of negative T wave deflection among all the leads (-6.2 ± 4mm vs -1.4 ± 0.9 mm, p < 0.0001), the sum of all negative T waves (-27 ± 1.7 mm vs -2.8 ± 3.6 mm, p < 0.0001 and a QTc max and QTc mean prolongation (539 ± 63ms vs 457 ± 42ms, p < 0.0001 and 491 ± 52ms vs 421 ± 33ms, p < 0.0001 respectively). We also demonstrated that T waves were significantly more positive in pathological ECG in aVR and V1 compared to the reference one (mean value of T waves respectively of 1.8 ± 1.8 vs -1 ± 1.3, p < 0.0001 and 0.7 ± 1.6 vs 0.004 ± 1.2, p = 0.008). CONCLUSION The QTc prolongation, the profound negative T waves except in aVR and V1 occurring the first two days after admission are electrocardiographic changes typically of Takotsubo syndrome.
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Affiliation(s)
- Gabriel Laurence
- CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - Andrea Vasiliu
- Department of Cardiology, Clinique St. Josef, St Vith, Belgium
| | - Dominique Blommaert
- CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - Dormal Fabien
- CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - Bihin Benoit
- CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - Hanet Claude
- CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | - Guédès Antoine
- CHU UCL Namur site Godinne, Université Catholique de Louvain, Yvoir, Belgium
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Möller C, Eitel C, Thiele H, Eitel I, Stiermaier T. Ventricular arrhythmias in patients with Takotsubo syndrome. J Arrhythm 2018; 34:369-375. [PMID: 30167007 PMCID: PMC6111471 DOI: 10.1002/joa3.12029] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/23/2017] [Indexed: 01/15/2023] Open
Abstract
Takotsubo syndrome (TTS) is a unique nonischemic cardiac disease characterized by acute myocardial dysfunction of the left and/or right ventricle. Patients are predominantly postmenopausal women and usually present with symptoms indistinguishable from acute coronary syndrome. Although the exact pathomechanisms of TTS remain elusive, increasing evidence suggests that sympathetic overdrive and catecholamine excess might play a central role. Despite the complete recovery of ventricular dysfunction within several days to weeks, patients with TTS exhibit considerable short- and long-term mortality rates and ventricular arrhythmias have been identified as key contributor to morbidity and mortality. This article summarizes the prevalence, underlying mechanisms, therapeutic strategies, and prognostic implications of ventricular arrhythmias in TTS. Furthermore, the need for implantable cardioverter-defibrillators is discussed in view of the transient character of the disease.
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Affiliation(s)
- Christian Möller
- Department of Cardiology, Angiology and Intensive Care MedicineMedical Clinic IIUniversity Heart Center LübeckLübeckGermany
- German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LübeckLübeckGermany
| | - Charlotte Eitel
- Department of Cardiology, Angiology and Intensive Care MedicineMedical Clinic IIUniversity Heart Center LübeckLübeckGermany
- German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LübeckLübeckGermany
| | - Holger Thiele
- Department of Cardiology, Angiology and Intensive Care MedicineMedical Clinic IIUniversity Heart Center LübeckLübeckGermany
- German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LübeckLübeckGermany
| | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care MedicineMedical Clinic IIUniversity Heart Center LübeckLübeckGermany
- German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LübeckLübeckGermany
| | - Thomas Stiermaier
- Department of Cardiology, Angiology and Intensive Care MedicineMedical Clinic IIUniversity Heart Center LübeckLübeckGermany
- German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LübeckLübeckGermany
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Stiermaier T, Rommel KP, Eitel C, Möller C, Graf T, Desch S, Thiele H, Eitel I. Management of arrhythmias in patients with Takotsubo cardiomyopathy: Is the implantation of permanent devices necessary? Heart Rhythm 2016; 13:1979-86. [PMID: 27298201 DOI: 10.1016/j.hrthm.2016.06.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Arrhythmias are frequent in Takotsubo cardiomyopathy (TTC) and a major determinant of outcome. OBJECTIVE The purpose of this study was to provide a rationale for management strategies, particularly for permanent device implantation given the reversible nature of TTC. METHODS Treatment strategies of arrhythmias including ventricular fibrillation (VF), ventricular tachycardia (VT), asystole, pulseless electrical activity, and complete atrioventricular (AV) or sinoatrial block were assessed in a bicentric cohort of consecutive patients with TTC (n = 286) with a mean follow-up period of 3.3 ± 2.4 years. RESULTS The prevalence of arrhythmias during the acute phase of TTC was 12.2% (n = 35), consisting predominantly of VT (n = 16 [5.6%]), VF (n = 7 [2.4%]), and complete AV block (n = 8 [2.8%]). Seven patients received a permanent pacemaker because of complete AV (n = 6) or sinoatrial (n = 1) block. Regular device checkups were available in 2 patients and demonstrated ongoing high-degree AV block despite recovery of left ventricular function. Three patients with transient bradyarrhythmias who did not receive devices died shortly after hospital discharge from unknown causes. One patient received an implantable cardioverter-defibrillator after resuscitation for VF and did not require device interventions during 2-year follow-up. Patients with polymorphic VT (n = 7), monomorphic VT (n = 6), or VF (n = 2) who were discharged from hospital survived or died of noncardiac reasons, with the cause of death remaining unclear in 1 patient with monomorphic sustained VT. CONCLUSION Our data suggest that bradyarrhythmias in the acute setting of TTC may require permanent pacemaker implantation. In contrast, polymorphic ventricular arrhythmias might be managed with a temporary approach (eg, wearable cardioverter-defibrillators) until recovery of repolarization time and left ventricular function.
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Affiliation(s)
- Thomas Stiermaier
- Department of Cardiology, Angiology, Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine - Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
| | - Charlotte Eitel
- Department of Cardiology, Angiology, Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian Möller
- Department of Cardiology, Angiology, Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Tobias Graf
- Department of Cardiology, Angiology, Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Steffen Desch
- Department of Cardiology, Angiology, Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Holger Thiele
- Department of Cardiology, Angiology, Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Department of Cardiology, Angiology, Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany,.
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Zorzi A, Baritussio A, ElMaghawry M, Siciliano M, Migliore F, Perazzolo Marra M, Iliceto S, Corrado D. Differential diagnosis at admission between Takotsubo cardiomyopathy and acute apical-anterior myocardial infarction in postmenopausal women. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:298-307. [DOI: 10.1177/2048872615585515] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/06/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Anna Baritussio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Mohamed ElMaghawry
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
- Department of Cardiology, Aswan Heart Center, Egypt
| | | | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | | | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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Rojas-Marte G, John J, Sadiq A, Moskovits N, Saunders P, Shani J. Medication-induced Takotsubo Cardiomyopathy presenting with cardiogenic shock—utility of extracorporeal membrane oxygenation (ECMO): case report and review of the literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:47-51. [DOI: 10.1016/j.carrev.2014.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/09/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
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Zhong-Qun Z, Bo Y, Nikus KC, Pérez-Riera AR, Chong-Quan W, Xian-Ming W. Correlation between ST-segment elevation and negative T waves in the precordial leads in acute pulmonary embolism: insights into serial electrocardiogram changes. Ann Noninvasive Electrocardiol 2013; 19:398-405. [PMID: 24206526 DOI: 10.1111/anec.12115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute pulmonary embolism (APE) is often misdiagnosed as acute coronary syndrome because of the similarity of the presenting symptoms and of the electrocardiogram (ECG) manifestations. In APE, ST-segment elevation (STE) in leads V1 to V3 /V4 , mimicking anteroseptal myocardial infarction, is not a rare phenomenon. Negative T waves (NTW) in the precordial leads mimicking the "Wellens' syndrome" is an important ECG manifestation of APE. The evolution of these ECG changes-STE and NTW-in APE has not been thoroughly studied. METHODS We present two patient cases with APE and their evolving serial ECGs to analyze the correlation between STE and NTW. RESULTS NTW developed later than STE in these two patient cases. CONCLUSIONS NTW might represent a "postischemic" ECG pattern indicating a previous stage with transmural myocardial ischemia.
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Affiliation(s)
- Zhan Zhong-Qun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan City, Hubei Province, China
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