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Kurisu S, Fujiwara H. Takotsubo Syndrome After Alcohol Withdrawal in a Patient With Suspected Alcoholic Cardiomyopathy. Cureus 2024; 16:e57175. [PMID: 38681458 PMCID: PMC11056032 DOI: 10.7759/cureus.57175] [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: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Takotsubo syndrome is a non-ischemic cardiomyopathy characterized by transient left ventricular (LV) apical ballooning, which typically occurs after exposure to emotional or physical stress in elderly women. An 85-year-old woman with hypertension presented with a recent onset of palpitation and exertional dyspnea. The patient had a long-standing history of alcohol consumption, and transthoracic echocardiography revealed diffuse LV hypokinesia including apical area with an ejection fraction of 30%. The patient was suspected of alcoholic cardiomyopathy and was recommended to quit alcohol consumption. Six weeks after the first admission, the patient presented to the emergency department with a three-day history of dyspnea. Based on newly developed negative T-waves and LV apical akinesia in the absence of significant coronary artery disease, the patient was diagnosed with takotsubo syndrome combined with suspected alcoholic cardiomyopathy. Clinicians should be aware that takotsubo syndrome can occur even in the presence of reduced LV ejection fraction, leading to further LV systolic dysfunction.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiology, Hiroshima-Nishi Medical Center, Otake, JPN
| | - Hitoshi Fujiwara
- Department of Cardiology, Hiroshima-Nishi Medical Center, Otake, JPN
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Nandal S, Castles A, Asrar Ul Haq M, van Gaal W. Takotsubo cardiomyopathy triggered by status epilepticus: case report and literature review. BMJ Case Rep 2019; 12:12/1/e225924. [PMID: 30700451 DOI: 10.1136/bcr-2018-225924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Takotsubo cardiomyopathy (TC) is acute stress-induced cardiomyopathy with characteristic transient wall motion abnormalities. TC has a clinical presentation similar to an acute coronary syndrome, including chest pain or dyspnoea, ECG changes and elevated cardiac enzymes. TC often occurs after emotional stress. There are approximately 50 TC cases reported related to seizure activity, and our review revealed 15 articles which were associated with status epilepticus. This condition can be a serious complication of seizures. We report a case of TC after status epilepticus in a patient who had been seizure-free for 20 years.
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Affiliation(s)
- Savvy Nandal
- Department of Cardiology, The Northern Health, Epping, Victoria, Australia
| | - Anastasia Castles
- Department of Cardiology, The Northern Health, Epping, Victoria, Australia
| | | | - William van Gaal
- Department of Cardiology, The Northern Health, Epping, Victoria, Australia
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Stöllberger C, Sauerberg M, Finsterer J. Immediate versus delayed detection of Takotsubo syndrome after epileptic seizures. J Neurol Sci 2018; 397:42-47. [PMID: 30583237 DOI: 10.1016/j.jns.2018.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/03/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
Takotsubo syndrome(TTS) is often preceded by emotional or physical stress. Epileptic seizures are described in >100 cases. It is unknown whether patients with immediate and delayed detection of seizure-induced TTS differ. We screened the literature and compared clinical and electrocardiographic (ECG) findings. In 48 cases with seizure-associated TTS, the time between seizure and TTS-detection was reported. Troponin levels were elevated in 37/40. ECG abnormalities were negative T-waves(40%), ST-elevations(33%) and ventricular fibrillation/flutter(10%). Immediate detection was reported in 23 patients, in the remaining 25 patients, TTS was detected 5-288 h postictally. Patients did not differ in gender, age or symptoms. Negative T-waves were more frequent in patients with delayed detection(64 vs. 13%, p = .0009), whereas ECG-abnormalities suggesting acute myocardial infarction tended to be more prevalent in patients with immediate detection. Due to lack of typical symptoms, seizure-induced TTS can be overlooked. Postictally, an ECG should be recorded and troponin levels measured. New T-wave inversions might indicate seizure-induced TTS.
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Affiliation(s)
| | - Markus Sauerberg
- Wittgenstein Centre, Vienna Institute of Demography, Austrian Academy of Sciences, Welthandelsplatz 2, Level 2, 1020 Vienna, Austria.
| | - Josef Finsterer
- Krankenanstalt Rudolfstiftung Wien, Juchgasse 25, 1030 Vienna, Austria
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Ishida T, Uchida H, Miyazaki K, Yukawa T, Sugiyama K, Hamabe Y, Mimura M, Suzuki T. A Possible Role of Takotsubo Cardiomyopathy in Ventricular Fibrillation During Delirium Tremens: A Case Report and Literature Review. PSYCHOSOMATICS 2017; 59:293-297. [PMID: 29336786 DOI: 10.1016/j.psym.2017.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 11/19/2017] [Accepted: 11/20/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Takuto Ishida
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Miyazaki
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takahiro Yukawa
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yuuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takefumi Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Neuropsychiatry and Clinical Ethics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Seizure Associated Takotsubo Syndrome: A Rare Combination. Case Rep Cardiol 2017; 2017:8458054. [PMID: 28811941 PMCID: PMC5546119 DOI: 10.1155/2017/8458054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/16/2017] [Accepted: 06/20/2017] [Indexed: 01/27/2023] Open
Abstract
Takotsubo cardiomyopathy (TC) is increasingly recognized in neurocritical care population especially in postmenopausal females. We are presenting a 61-year-old African American female with past medical history of epilepsy, bipolar disorder, and hypertension who presented with multiple episodes of seizures due to noncompliance with antiepileptic medications. She was on telemetry which showed ST alarm. Electrocardiogram (ECG) was ordered and showed ST elevation in anterolateral leads and troponins were positive. Subsequently Takotsubo cardiomyopathy was diagnosed by left ventriculography findings and absence of angiographic evidence of obstructive coronary artery disease. Echocardiogram showed apical hypokinesia, ejection fraction of 40%, and systolic anterior motion of mitral valve with hyperdynamic left ventricle, in the absence of intracoronary thrombus formation in the angiogram. Electroencephalography showed evidence of generalized tonic-clonic seizure. She was treated with supportive therapy. This case illustrates importance of ECG in all patients with seizure irrespective of cardiac symptoms as TC could be the cause of Sudden Unexpected Death in Epilepsy (SUDEP) and may be underdiagnosed and so undertreated.
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Adrenergic Inhibition with Dexmedetomidine to Treat Stress Cardiomyopathy during Alcohol Withdrawal: A Case Report and Literature Review. Case Rep Crit Care 2016; 2016:9693653. [PMID: 27006838 PMCID: PMC4783539 DOI: 10.1155/2016/9693653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 01/31/2023] Open
Abstract
Stress (Takotsubo) cardiomyopathy is a form of reversible left ventricular dysfunction with a heightened risk of ventricular arrhythmia thought to be caused by high circulating catecholamines. We report a case of stress cardiomyopathy that developed during severe alcohol withdrawal successfully treated with dexmedetomidine. The case involves a 53-year-old man with a significant history of alcohol abuse who presented to a teaching hospital with new-onset seizures. His symptoms of acute alcohol withdrawal were initially treated with benzodiazepines, but the patient later developed hypotension, and stress cardiomyopathy was suspected based on ECG and echocardiographic findings. Adjunctive treatment with the alpha-2-adrenergic agonist, dexmedetomidine, was initiated to curtail excessive sympathetic outflow of the withdrawal syndrome, thereby targeting the presumed pathophysiology of the cardiomyopathy. Significant clinical improvement was observed within one day of initiation of dexmedetomidine. These findings are consistent with other reports suggesting that sympathetic dysregulation during alcohol withdrawal produces ideal pathobiology for stress cardiomyopathy and leads to ventricular arrhythmogenicity. Stress cardiomyopathy should be recognized as a complication of alcohol withdrawal that significantly increases cardiac-related mortality. By helping to correct autonomic dysregulation of the withdrawal syndrome, dexmedetomidine may be useful in the treatment of stress-induced cardiomyopathy.
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Finsterer J, Bersano A. Seizure-triggered Takotsubo syndrome rarely causes SUDEP. Seizure 2015; 31:84-7. [DOI: 10.1016/j.seizure.2015.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/18/2015] [Accepted: 07/20/2015] [Indexed: 11/15/2022] Open
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Finsterer J, Wahbi K. CNS disease triggering Takotsubo stress cardiomyopathy. Int J Cardiol 2014; 177:322-9. [PMID: 25213573 DOI: 10.1016/j.ijcard.2014.08.101] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/17/2014] [Indexed: 01/23/2023]
Abstract
There are a number of hereditary and non-hereditary central nervous system (CNS) disorders, which directly or indirectly affect the heart (brain-heart disorders). The most well-known of these CNS disorders are epilepsy, stroke, infectious or immunological encephalitis/meningitis, migraine, and traumatic brain injury. In addition, a number of hereditary and non-hereditary neurodegenerative disorders may impair cardiac functions. Affection of the heart may manifest not only as arrhythmias, myocardial infarction, autonomic impairment, systolic dysfunction/heart failure, arterial hypertension, or pulmonary hypertension, but also as stress cardiomyopathy (Takotsubo syndrome, TTS). CNS disease triggering TTS includes subarachnoid bleeding, epilepsy, ischemic stroke, intracerebral bleeding, migraine, encephalitis, traumatic brain injury, PRES syndrome, or ALS. Usually, TTS is acutely precipitated by stress triggered by various different events. TTS is one of the cardiac abnormalities most frequently induced by CNS disorders. Appropriate management of TTS from CNS disorders is essential to improve the outcome of affected patients.
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Affiliation(s)
| | - Karim Wahbi
- Paris-Descartes, Sorbonne Paris Cite University, 75006 Paris, France; AP-HP, Cardiology Department, Cochin Hospital, Paris, France; AP-HP, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
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Finsterer J, Stöllberger C, Avanzini M, Bastovansky A, Keller H. Aborted sudden unexplained death in epilepsy in a neuromuscular disorder leading to Takotsubo syndrome. Int J Cardiol 2013; 168:e145-7. [DOI: 10.1016/j.ijcard.2013.08.072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/19/2013] [Indexed: 01/22/2023]
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Stress cardiomyopathy (tako-tsubo) triggered by nervous system diseases: A systematic review of the reported cases. Int J Cardiol 2013; 167:2441-8. [DOI: 10.1016/j.ijcard.2013.01.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/19/2012] [Accepted: 01/18/2013] [Indexed: 01/09/2023]
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Ratanapo S, Srivali N, Cheungpasitporn W, Bischof EF. Association between takotsubo syndrome and thrombocytopenia. Am J Emerg Med 2013; 31:630. [DOI: 10.1016/j.ajem.2012.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022] Open
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Dupuis M, van Rijckevorsel K, Evrard F, Dubuisson N, Dupuis F, Van Robays P. Takotsubo syndrome (TKS): A possible mechanism of sudden unexplained death in epilepsy (SUDEP). Seizure 2012; 21:51-4. [DOI: 10.1016/j.seizure.2011.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 09/15/2011] [Accepted: 09/16/2011] [Indexed: 10/16/2022] Open
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Stöllberger C, Wegner C, Finsterer J. Seizure-induced Takotsubo syndrome is more frequent than reported. Int J Cardiol 2011; 150:359-60. [DOI: 10.1016/j.ijcard.2011.05.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 05/13/2011] [Indexed: 11/27/2022]
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Abstract
Takotsubo cardiomyopathy is characterized by chest pain, dyspnea, electrocardiographic changes resembling an acute coronary syndrome, and transient wall-motion abnormalities without identifiable coronary culprit lesion explaining the wall-motion abnormality. Takotsubo cardiomyopathy occurs frequently after emotional or physical stress. Seizures have been reported as triggers of takotsubo cardiomyopathy. It is unknown if seizure-associated takotsubo cardiomyopathy differs from takotsubo cardiomyopathy associated with other triggers. Seizure-associated takotsubo cardiomyopathy cases from the literature were compared with takotsubo cardiomyopathy series comprising 30 or more patients. Thirty-six seizure-associated takotsubo cardiomyopathy cases (6 male, mean-age 61.5 years) were found. Seizure-type were tonic-clonic (n = 13), generalized (n = 5), status epilepticus (n = 6), grand mal (n = 2), or not reported (n = 13). Twelve patients had a history of epilepsy, in 15 patients takotsubo cardiomyopathy-associated seizure was the first or the information was not given (n = 9). In 17 patients takotsubo cardiomyopathy occurred immediately after the seizure, in 9 patients 1-72 h postictally, and in 10 patients, the interval was not reported. In 20 patients neurologic disorders were reported and in 14 psychiatric disorders were reported. There were medical comorbidities in 17 patients, arterial hypertension (n = 11), hyponatremia (n = 2), and cancer (n = 2). Compared with 974 patients reported in takotsubo cardiomyopathy -series, patients with seizure-associated takotsubo cardiomyopathy were younger (61.5 vs. 68.5 years, p < 0.0001), more frequently males (17 vs. 9%, p = 0.004), had less frequent chest pain (6 vs.76%, p < 0.005), more frequent cardiogenic shock (25 vs. 8%, p = 0.003), and more frequent recurrency (14 vs. 3%, p = 0.004). Seizure-associated takotsubo cardiomyopathy manifests frequently as sudden hemodynamic deterioration, which could result in death in the absence of adequate help. Probably some cases of sudden unexpected death in epilepsy are attributable to takotsubo cardiomyopathy.
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