1
|
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.
Collapse
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
| |
Collapse
|
2
|
Sergi CM. Sudden cardiac death and post-traumatic stress disorder: More research is needed. Contemp Clin Trials Commun 2024; 37:101252. [PMID: 38312475 PMCID: PMC10837689 DOI: 10.1016/j.conctc.2023.101252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/22/2023] [Indexed: 02/06/2024] Open
Abstract
Sudden cardiac death is an event which is traumatic for the individuals, who survive and their relatives. Very few research is concentrated on these survivals and the symptoms arising from post-traumatic stress disorders. In this journal, Birk et al. report on twelve eligible cardiac arrest survivors contacted, of which ten were enrolled. The authors report on heart rate variability biofeedback, which is, according to the authors, a promising non-pharmacologic approach for reducing anxiety. The intervention was comprised of daily sessions of diaphragmatic paced breathing and real-time monitoring of cardiac activity guided by a smartphone app and heart rate monitor. Ninety percent of the patients had good scores for intervention acceptability and feasibility, and 80 % reported good scores for its appropriateness and usability for reducing fear. Trait anxiety decreased significantly pre-to-post intervention. We comment on this finding highlighting other studies targeting sudden cardiac death and supporting that more research with very large randomized clinical trials is needed.
Collapse
Affiliation(s)
- Consolato M Sergi
- Anatomic Pathology Division, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
- Department of Laboratory Medicine and Pathology, Stollery Children's Hospital, Edmonton, AB, Canada
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Thakkar A, Hameed AB, Makshood M, Gudenkauf B, Creanga AA, Malhamé I, Grandi SM, Thorne SA, D'Souza R, Sharma G. Assessment and Prediction of Cardiovascular Contributions to Severe Maternal Morbidity. JACC. ADVANCES 2023; 2:100275. [PMID: 37560021 PMCID: PMC10410605 DOI: 10.1016/j.jacadv.2023.100275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 08/11/2023]
Abstract
Severe maternal morbidity (SMM) refers to any unexpected outcome directly related to pregnancy and childbirth that results in both short-term delivery complications and long-term consequences to a women's health. This affects about 60,000 women annually in the United States. Cardiovascular contributions to SMM including cardiac arrest, arrhythmia, and acute myocardial infarction are on the rise, probably driven by changing demographics of the pregnant population including more women of extreme maternal age and an increased prevalence of cardiometabolic and structural heart disease. The utilization of SMM prediction tools and risk scores specific to cardiovascular disease in pregnancy has helped with risk stratification. Furthermore, health system data monitoring and reporting to identify and assess etiologies of cardiovascular complications has led to improvement in outcomes and greater standardization of care for mothers with cardiovascular disease. Improving cardiovascular disease-related SMM relies on a multipronged approach comprised of patient-level identification of risk factors, individualized review of SMM cases, and validation of risk stratification tools and system-wide improvements in quality of care. In this article, we review the epidemiology and cardiac causes of SMM, we provide a framework of risk prediction clinical tools, and we highlight need for organization of care to improve outcomes.
Collapse
Affiliation(s)
- Aarti Thakkar
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Afshan B. Hameed
- Department of Obstetrics & Gynecology, Department of Medicine, University of California-Irvine, Irvine, California, USA
| | - Minhal Makshood
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brent Gudenkauf
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea A. Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Isabelle Malhamé
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sonia M. Grandi
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara A. Thorne
- Division of Cardiology, Pregnancy & Heart Disease Program, Mount Sinai Hospital & University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Departments of Obstetrics & Gynaecology and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Schmid BC, Yuan R, Watterson L, Yu J, Hacker N. Two case studies of cardiac arrest occurring in medically fit patients undergoing radical hysterectomy for cervical cancer. Gynecol Oncol Rep 2021; 37:100823. [PMID: 34377756 PMCID: PMC8327486 DOI: 10.1016/j.gore.2021.100823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 11/01/2022] Open
Abstract
We report case histories of two young women who had an intraoperative cardiac arrest, potentially caused by preoperative emotional stress, while undergoing open radical hysterectomy for cervical cancer. Neither had any history of heart disease or other comorbidities. Takotsubo cardiomyopathy, a form of stress cardiomyopathy characterized by acute reversible ventricular dysfunction that can occur in the perioperative period, was the cause in one patient. A vasovagal episode during the exploration of the abdomen was the cause in the other. Successful resuscitation and stabilisation of both patients made it possible to continue the surgery and successfully complete both procedures. Takotsubo cardiomyopathy should be considered in any patient showing significant preoperative stress who has a cardiac arrest, even if there is no preoperative morbidity. It is difficult to differentiate from a vasovagal episode intraoperatively. Surgical and anaesthetic teams should be aware of importance of countering severe preoperative stress.
Collapse
Affiliation(s)
- Bernd C Schmid
- Department of Gynaecological Oncology, Royal Hospital for Women, Barker St, Randwick, New South Wales 2031, Australia
| | - Rex Yuan
- Royal Hospital for Women, Department of Anaesthesiology, Barker St, Randwick, NSW 2031, Australia
| | - Leonie Watterson
- Royal Hospital for Women, Department of Anaesthesiology, Barker St, Randwick, NSW 2031, Australia
| | - Jennifer Yu
- Department of Cardiology, Prince of Wales Hospital and the Prince of Wales Clinical School, Barker St, Randwick, NSW 2031, Australia
| | - Neville Hacker
- Royal Hospital for Women and School of Women's and Children's Health, University of New South Wales, Australia
| |
Collapse
|
6
|
Vasquez DN, Basualdo MN, Aphalo VM, Carreras LP, Plotnikow GA, Intile AD, Moreira J. Complications of Congenital Hernia in Pregnancy: A Case Report. A A Pract 2020; 13:102-106. [PMID: 30920425 DOI: 10.1213/xaa.0000000000001004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require prompt repair. A pregnant woman with medical history of repaired congenital hernia was admitted with misdiagnosis of preeclampsia. Physical examination and chest x-ray revealed a Bochdalek hernia. Transitory stabilization prompted surgeons to postpone hernia repair, but an urgent thoracotomy was required to relieve a subsequent bowel obstruction that was complicated by an intrathoracic colonic perforation. Emergent cesarean delivery was required with a good maternal and fetal outcome. A multidisciplinary team was present in the operating room. All monitoring catheters were placed in advance in the intensive care unit. During recovery, the patient experienced ventricular fibrillation, presumed to be a manifestation of takotsubo syndrome, which responded favorably to cardiopulmonary resuscitation.
Collapse
Affiliation(s)
- Daniela N Vasquez
- From the Intensive Care Unit, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | | | - Vanina M Aphalo
- From the Intensive Care Unit, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | - Lucía P Carreras
- From the Intensive Care Unit, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | - Gustavo A Plotnikow
- From the Intensive Care Unit, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | - Alfredo D Intile
- From the Intensive Care Unit, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | - Joaquín Moreira
- Anesthesia, Sanatorio Anchorena, City of Buenos Aires, Argentina
| |
Collapse
|
7
|
Citro R, Bellino M, Minichino F, Di Vece D, Ferraioli D, Petta R. Subsequent Safe Pregnancy with Cesarean Delivery in a Patient with a History of Peripartum Takotsubo Syndrome Complicated by Cardiogenic Shock. J Cardiovasc Echogr 2017; 27:114-117. [PMID: 28758066 PMCID: PMC5516443 DOI: 10.4103/jcecho.jcecho_24_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Takotsubo syndrome (TTS) is an acute and reversible heart failure syndrome, usually occurring in females but rarely in the peripartum period. In women with a history of peripartum TTS, it is unclear how to manage subsequent pregnancies. A 39-year-old female with a history of peripartum TTS complicated by cardiogenic shock became pregnant again. She underwent close cardiological follow-up for monitoring left ventricular systolic function and hemodynamic conditions. Epidural anesthesia was preferred to avoid catecholamine surge during cesarean delivery. After a few days of hospitalization, the patient and the newborn were discharged in good health. In our patient with a history of complicated peripartum TTS, close cardiological follow-up, appropriate management therapy, and anesthesia modality allow us to guide safely a new pregnancy.
Collapse
Affiliation(s)
- Rodolfo Citro
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Michele Bellino
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Flora Minichino
- Division of Anesthesiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Davide Di Vece
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Donatella Ferraioli
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Raffaele Petta
- Division of Obstetrics and Gynecology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| |
Collapse
|