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Xenogiannis I, Nikolakopoulos I, Vemmou E, Brilakis ES, Herman R, Sharkey SW. Protean Electrocardiographic Patterns of ST-Segment Elevation in Patients With Takotsubo Syndrome. Am J Cardiol 2023; 206:292-294. [PMID: 37722226 DOI: 10.1016/j.amjcard.2023.08.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Iosif Xenogiannis
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Evangelia Vemmou
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota; Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Robert Herman
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Cardiovascular Center Aalst, Aalst, Belgium; Powerful Medical, Bratislava, Slovakia
| | - Scott W Sharkey
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
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Sonaglioni A, Lombardo M, Grasso E, Nicolosi GL, Foti N, Lonati C, Harari S. Presumed Takotsubo syndrome is associated with high in-hospital mortality in very elderly frail females: a case series. Aging Clin Exp Res 2023; 35:2851-2856. [PMID: 37581859 DOI: 10.1007/s40520-023-02517-5] [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: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/16/2023]
Abstract
Given the aging of general population, very elderly females with Takotsubo syndrome (TTS) are not rarely encountered in clinical practice. Although coronary angiography with left ventriculography is the gold standard diagnostic tool to exclude or confirm TTS, currently, this invasive procedure is less frequently performed in older patients with several comorbidities, such as renal failure, anemia, infections, neurological disorders, malignancy, and severe frailty. In these patients, a "presumed" TTS is diagnosed on the basis of clinical presentation, electrocardiogram, cardiac biomarkers, and echocardiographic findings without coronary angiography. While, in younger patients, TTS is generally a benign condition, in very elderly females, it is associated with higher in-hospital mortality and poor prognosis. Herein, we present four cases of ultra-octogenarian females diagnosed with "presumed TTS", who did not undergo coronary angiography due to severe frailty and multiple comorbidities and who exhibited poor outcome. This could arise the question if an early more aggressive approach could have changed final results. Probably, the solution could only be a personalized decision deriving from a profound and detailed discussion of each case through a multidisciplinary team approach.
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Affiliation(s)
| | | | - Enzo Grasso
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | | | - Nicolò Foti
- Division of Internal Medicine, MultiMedica IRCCS, Milan, Italy
| | - Chiara Lonati
- Division of Internal Medicine, MultiMedica IRCCS, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy.
| | - Sergio Harari
- Division of Internal Medicine, MultiMedica IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy
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3
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Alhuarrat MAD, Barzallo D, Seo J, Naser A, Alhuarrat MR, Minuti A, Kokkinidis DG, Schizas D. Meta-Analysis and Clinical Features of Perioperative Takotsubo Cardiomyopathy in Noncardiac Surgery. Am J Cardiol 2023; 201:78-85. [PMID: 37352669 DOI: 10.1016/j.amjcard.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/25/2023]
Abstract
Perioperative takotsubo cardiomyopathy (pTCM) is an increasing condition defined as cardiomyopathy in the setting of emotional and physiologic stressors imposed by surgery. We aimed to classify and understand the presentation, management, and prognosis of noncardiac surgery pTCM in published cases. As such, a review of previous studies using the PubMed, Embase, Cochrane, and Web of Science databases was conducted to obtain case reports and series reporting noncardiac pTCM from inception to September 2022, and a crude analysis was conducted to classify the clinical features. Of the 1,002 studies, 96 met our inclusion criteria, of which 101 cases were extracted and included in the final systematic review. A total of 29.7% of cases occurred during general surgery and 20.8% during transplant procedures. The median age at presentation was 55 years, with a 42 to 65 interquartile range. The prevalence of hypertension and mood disorders were 22.8% and 9.9%, respectively. Before the procedures, physiologic stressors occurred more commonly than emotional stressors (20.8% and 11%, respectively). Objective findings, including ST-T-wave changes, new arrhythmias, and hypotension, were the most common initial presenting symptoms. Most cases occurred during emergence from surgery or on the first postoperative day. Mechanical circulatory support was required in 15.8% of the cases, and the all-cause in-hospital mortality was 6.9%. The ejection fraction and symptoms improved within a median of 2 weeks after diagnosis (interquartile range 1 to 6). In conclusion, the risk factors, triggers, and outcomes of pTCM appear to differ from those of classic nonperioperative TCM presentations. Future studies will help shed light on this more frequently diagnosed condition complicating some noncardiac surgical cases.
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Affiliation(s)
| | - Diego Barzallo
- Division of Internal Medicine, NYC Health + Hospitals/Jacobi Medical Center and
| | - Jiyoung Seo
- Division of Internal Medicine, NYC Health + Hospitals/Jacobi Medical Center and
| | - Ahmad Naser
- Division of Internal Medicine, NYC Health + Hospitals/Jacobi Medical Center and
| | | | - Aurelia Minuti
- Head, Research & Education, D. Samuel Gottesman Library, Albert Einstein College of Medicine, Bronx, New York
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Chhabra L. ST-elevation in Takotsubo cardiomyopathy. J Electrocardiol 2023; 77:78-79. [PMID: 36737393 DOI: 10.1016/j.jelectrocard.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Lovely Chhabra
- Director of Invasive Cardiology, MHRH, Westchester Medical Center Network Advanced Physician Services, Valhalla, NY, United States of America.
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Chyu KY, Shah PK. Electrocardiograms in Critical Care Cardiology: Is it Acute Coronary Syndrome? JACC Case Rep 2022; 4:1394-1398. [PMID: 36388710 PMCID: PMC9663980 DOI: 10.1016/j.jaccas.2022.06.028] [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: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 06/16/2023]
Abstract
Patients with critical illness may present with electrocardiogram (ECG) findings difficult for physicians to distinguish them from acute coronary syndrome. This article provides three cases of such clinical scenarios. Examples of ECGs and their clinical characteristics and significance are discussed. (Level of Difficulty: Beginner.).
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Affiliation(s)
| | - Prediman K. Shah
- Address for correspondence: Dr. Prediman K. Shah, Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, 127 South San Vicente Boulevard, Suite A-3307, Los Angeles, California 90048, USA.
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Imburgio S, Johal A, Udongwo N, Eltawansy S, Upadhyaya V, Raza M. An Unusual Etiology: Subarachnoid Hemorrhage Resulting in Transient Apical Ballooning Syndrome. J Med Cases 2022; 13:541-544. [PMID: 36506760 PMCID: PMC9728150 DOI: 10.14740/jmc4018] [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: 10/04/2022] [Accepted: 11/02/2022] [Indexed: 11/28/2022] Open
Abstract
Intracranial bleeds, such as subarachnoid hemorrhage, carry high morbidity and mortality rates. Often intracranial hemorrhages result in debilitating residual neurological symptoms but can be so extensive that cardiac complications can also be seen. We present a rare case of a patient who was found to have a subarachnoid hemorrhage that incited the development of Takotsubo cardiomyopathy, which subsequently progressed to an acute myocardial infarction. The aim of this case report is to explore the underlying pathophysiology of how cerebral hemorrhage can result in apical ballooning of the left ventricle through various mechanisms including sympathetic-induced surge in catecholamines and neurogenic damage to the myocardium. We also intend to highlight the importance for clinicians to consider brain bleeds in the differential diagnosis when a patient presents with an acute myocardial infarction as treatment with heparin is generally contraindicated.
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Affiliation(s)
- Steven Imburgio
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA,Corresponding Author: Steven Imburgio, Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA.
| | - Anmol Johal
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Ndausung Udongwo
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Sherif Eltawansy
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Vandan Upadhyaya
- Division of Cardiology, Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Mohammad Raza
- Division of Cardiology, Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
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Moady G, Atar S. Stress-Induced Cardiomyopathy—Considerations for Diagnosis and Management during the COVID-19 Pandemic. Medicina (B Aires) 2022; 58:medicina58020192. [PMID: 35208516 PMCID: PMC8875249 DOI: 10.3390/medicina58020192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is associated with several cardiovascular manifestations including myocardial injury, myocarditis, arrhythmia, and pulmonary embolism. Rare cases of stress-induced cardiomyopathy, or takotsubo syndrome have also been reported during the acute infection, and secondary to stress following lockdown and self-isolation. Diagnosis in the setting of the acute infection is challenging since conventional imaging modalities such as transthoracic echocardiography and coronary angiography should be restricted to minimize physician-patient contact until the patients is tested negative for COVID-19. The use of point of care hand-held ultrasound is appropriate for this purpose. The overall course of the disease seems to be similar to takotsubo in the general population. Physicians should be familiar with the clinical presentation, possible complications, and management of takotsubo during COVID-19 outbreak. Here, we review the special considerations in the diagnosis and management of takotsubo syndrome during the current pandemic.
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Affiliation(s)
- Gassan Moady
- Department of Cardiology, Galilee Medical Center, Nahariya 2221006, Israel;
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
- Correspondence: ; Tel.: +972-4-9107273
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya 2221006, Israel;
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
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