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Arcari L, Casagrande M, Cacciotti L. Chronic stress and takotsubo syndrome: Constant dropping wears away a stone. Int J Cardiol 2024; 414:132389. [PMID: 39059474 DOI: 10.1016/j.ijcard.2024.132389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 07/21/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Luca Arcari
- Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy; Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy.
| | - Maria Casagrande
- Department of Dynamic and Clinical Psychology, and Health Studies, "Sapienza" University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Luca Cacciotti
- Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
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Frank N, Herrmann MJ, Lauer M, Förster CY. Exploratory Review of the Takotsubo Syndrome and the Possible Role of the Psychosocial Stress Response and Inflammaging. Biomolecules 2024; 14:167. [PMID: 38397404 PMCID: PMC10886847 DOI: 10.3390/biom14020167] [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: 12/12/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Takotsubo syndrome (TTS) is a cardiomyopathy that clinically presents as a transient and reversible left ventricular wall motion abnormality (LVWMA). Recovery can occur spontaneously within hours or weeks. Studies have shown that it mainly affects older people. In particular, there is a higher prevalence in postmenopausal women. Physical and emotional stress factors are widely discussed and generally recognized triggers. In addition, the hypothalamic-pituitary-adrenal (HPA) axis and the associated glucocorticoid-dependent negative feedback play an important role in the resulting immune response. This review aims to highlight the unstudied aspects of the trigger factors of TTS. The focus is on emotional stress/chronic unpredictable mild stress (CUMS), which is influenced by estrogen concentration and noradrenaline, for example, and can lead to changes in the behavioral, hormonal, and autonomic systems. Age- and gender-specific aspects, as well as psychological effects, must also be considered. We hypothesize that this leads to a stronger corticosteroid response and altered feedback of the HPA axis. This may trigger proinflammatory markers and thus immunosuppression, inflammaging, and sympathetic overactivation, which contributes significantly to the development of TTS. The aim is to highlight the importance of CUMS and psychological triggers as risk factors and to make an exploratory proposal based on the new knowledge. Based on the imbalance between the sympathetic and parasympathetic nervous systems, transcutaneous vagus nerve stimulation (tVNS) is presented as a possible new therapeutic approach.
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Affiliation(s)
- Niklas Frank
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg University, 97080 Würzburg, Germany
| | - Martin J. Herrmann
- Center of Mental Health, Department of Psychiatry and Psychotherapy, University Hospital Würzburg, 97080 Würzburg, Germany; (M.J.H.); (M.L.)
| | - Martin Lauer
- Center of Mental Health, Department of Psychiatry and Psychotherapy, University Hospital Würzburg, 97080 Würzburg, Germany; (M.J.H.); (M.L.)
| | - Carola Y. Förster
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg University, 97080 Würzburg, Germany
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3
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Gaddam RR, Amalkar VS, Sali VK, Nakuluri K, Jacobs JS, Kim YR, Li Q, Bahal R, Irani K, Vikram A. Role of miR-204 in segmental cardiac effects of phenylephrine and pressure overload. Biochem Biophys Res Commun 2023; 675:85-91. [PMID: 37454401 DOI: 10.1016/j.bbrc.2023.07.011] [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: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Cardiotoxicity caused by adrenergic receptor agonists overdosing or stress-induced catecholamine release promotes cardiomyopathy, resembling Takotsubo cardiomyopathy (TC). TC is characterized by transient regional systolic dysfunction of the left ventricle. The animal models of TC and modalities for assessing regional wall motion abnormalities in animal models are lacking. We previously reported the protective role of a small noncoding microRNA-204-5p (miR-204) in cardiomyopathies, but its role in TC remains unknown. Here we compared the impact of miR-204 absence on phenylephrine (PE)-induced and transaortic constriction (TAC)-induced changes in cardiac muscle motion in the posterior and anterior apical, mid, and basal segments of the left ventricle using 2-dimensional speckle-tracking echocardiography (2-STE). Wildtype and miR-204-/- mice were subjected to cardiac stress in the form of PE for four weeks or TAC-induced pressure overload for five weeks. PE treatment increased longitudinal and radial motion in the apex of the left ventricle and shortened the peak motion time of all left ventricle segments. The TAC led to decreased longitudinal and radial motion in the left ventricle segments, and there was no difference in the peak motion time. Compared to wildtype mice, PE-induced peak cardiac muscle motion time in the anterior base of the left ventricle was significantly earlier in the miR-204-/- mice. There was no difference in TAC-induced peak cardiac muscle motion time between wildtype and miR-204-/- mice. Our findings demonstrate that PE and TAC induce regional wall motion abnormalities that 2-STE can detect. It also highlights the role of miR-204 in regulating cardiac muscle motion during catecholamine-induced cardiotoxicity.
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Affiliation(s)
- Ravinder Reddy Gaddam
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Veda Sudhir Amalkar
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Veeresh Kumar Sali
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Krishnamurthy Nakuluri
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Julie S Jacobs
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Young-Rae Kim
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Quixia Li
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Raman Bahal
- Department of Pharmaceutical Sciences, University of Connecticut, Storrs, CT-06269, USA
| | - Kaikobad Irani
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA, USA; Veterans Affairs Medical Center, Iowa City, IA, USA, Department of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - Ajit Vikram
- Department of Internal Medicine, Carver College of Medicine University of Iowa, Iowa City, IA, USA; Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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Lezzi P, Lupo R, Cimarelli N, Conte L, De Nunzio G, Botti S, Calcagnile A, Del Coco C, Calabro A, Rubbi I, Carvello M, Vitale E. Clinical Features of Takotsubo Syndrome and Its Differential Diagnostic Criteria in Clinical Nursing Practice: A Review of the Literature. Curr Cardiol Rep 2023; 25:841-850. [PMID: 37466761 PMCID: PMC10403421 DOI: 10.1007/s11886-023-01905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW Takotsubo cardiomyopathy (TCM) is a heart disease that mimics the symptoms of a myocardial infarction (MI). The exact cause of TCM is unknown, but the main theory is that the syndrome is triggered by an excessive release of catecholamines, a consequence of factors related to stress or severe emotional distress. The aim of this review is to summarize the various scientific journal articles on the nursing differential diagnosis of TCM, on the specific nurse training (particularly the role of the Advanced Practice Nurse, APN), and on the nursing educational support for the patient after hospital discharge. RECENT FINDINGS A literature review was conducted on Medline (via PubMed), Web of Science (WoS), Scopus, and Google Scholar databases. Relevant indexed articles that investigated the elements characterizing TCM in nursing differential diagnosis and the role of the APN were identified. RESULTS Sixteen studies were included in the review; they highlighted the role of the nurse in identifying and educating patients with TCM. Nurses must have a thorough understanding of the syndrome, the onset symptoms, the unusual characteristics, and the probable etiology of TCM in order to recognize and promptly treat patients affected by this syndrome and have the opportunity to educate them after hospital discharge to reduce the possibility of recurrence.
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Affiliation(s)
- Pierluigi Lezzi
- 'Veris Delli Ponti' Hospital, ASL (Local Health Authority), Scorrano, Italy
| | - Roberto Lupo
- San Giuseppe da Copertino Hospital', Local Health Authority Lecce, Lecce, Italy
| | | | - Luana Conte
- Laboratory of Biomedical Physics and Environment, Department of Mathematics and Physics "E. De Giorgi", University of Salento, Lecce, Lecce, Italy
- Laboratory of Interdisciplinary Research Applied to Medicine (DReAM), University of Salento and ASL (Local Health Authority) Lecce, Lecce, Italy
| | - Giorgio De Nunzio
- Laboratory of Biomedical Physics and Environment, Department of Mathematics and Physics "E. De Giorgi", University of Salento, Lecce, Lecce, Italy.
- Laboratory of Interdisciplinary Research Applied to Medicine (DReAM), University of Salento and ASL (Local Health Authority) Lecce, Lecce, Italy.
| | - Stefano Botti
- Hematology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | | | - Ciro Del Coco
- San Giuseppe da Copertino Hospital', Local Health Authority Lecce, Lecce, Italy
| | - Antonino Calabro
- Nuovo Ospedale Degli Infermi' Hospital, ASL (Local Health Authority), Biella, Italy
| | - Ivan Rubbi
- School of Nursing, University of Bologna, Bologna, Italy
| | - Maicol Carvello
- Community Hospital', ASL (Local Health Authority) of Romagna, Ravenna, Italy
| | - Elsa Vitale
- Department of Mental Health, ASL (Local Health Authority), Bari, Italy
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Wray J, Layton S, Vaccarella M, Bucciarelli-Ducci C, Biglino G. "Please keep on beating"-Participation in a Creative Workshop Offers Unexpected Benefits to Women With Takotsubo Cardiomyopathy. J Patient Exp 2023; 10:23743735231151765. [PMID: 37441276 PMCID: PMC10334024 DOI: 10.1177/23743735231151765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM) or "broken heart syndrome" is a rare condition that is more common in women than men, particularly those who are postmenopausal. It mimics a myocardial infarction and psychological factors have been implicated in its etiology as well as being consequences of its presentation. As part of a public engagement project we brought together 8 women (of 12 invited) previously diagnosed with TCM to facilitate a discussion, through participation in a creative workshop-based process, about their illness experience, how they made sense of it, and the meaning it had for them in their lives, and to identify areas of unmet need. Through a range of creative activities we identified that participants had high levels of unmet need in terms of information and psychosocial support. All participants enjoyed the creative process and meeting other people with a diagnosis of TCM. The workshop overall was perceived as empowering. Exploring patient narratives during artist-facilitated workshops is one approach for providing the first steps to addressing unmet need, although the importance of ensuring psychological safety cannot be over-stated.
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Affiliation(s)
- Jo Wray
- Centre for Outcomes and Experience Research
in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS
Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical
Research Centre, London, UK
| | | | | | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield
Hospitals, Guys’ and St Thomas’ NHS Trust, London, UK
- School of Biomedical Engineering and Imaging
Sciences, Faculty of Life Sciences and Medicine, King's College University, London, UK
| | - Giovanni Biglino
- Bristol Medical School, University of
Bristol, Bristol, UK
- National Heart and Lung Institute, Imperial
College London, London, UK
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Rondung E, Humphries SM, Olsson EMG, Sundelin R, Norlund F, Held C, Spaak J, Tornvall P, Lyngå P. Reducing stress and anxiety in patients with myocardial infarction with non-obstructive coronary arteries or Takotsubo syndrome: A non-randomized feasibility study. Internet Interv 2022; 29:100562. [PMID: 35910688 PMCID: PMC9334337 DOI: 10.1016/j.invent.2022.100562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND AIM In the aftermath of a myocardial infarction with non-obstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS), patients commonly express high levels of stress and anxiety. Current treatment alternatives rarely address these issues. The planned E-health Treatment of Stress and Anxiety in Stockholm Myocardial Infarction With Non-obstructive Coronaries Study (e-SMINC) aims to evaluate the effects of an internet-based intervention, building on cognitive behavioral therapy (CBT) by comparison with treatment as usual using an RCT approach. This was a small-scale single arm study designed to test the feasibility of the RCT, addressing uncertainties regarding recruitment, data collection, and intervention delivery. METHODS Participant recruitment and screening took place before discharge from the coronary care unit at a large Swedish hospital. Eligible patients were invited to a nine-step psychologist guided, internet-based CBT intervention. The sample size was set in advance to 10 participants completing the intervention. The recruitment and flow of participants were documented and evaluated in relation to seven pre-defined progression criteria. Self-reports of anxiety (HADS-A), stress (PSS-14), cardiac anxiety (CAQ), posttraumatic stress (IES-6) and quality of life (Rand-36), collected at screening, pre-intervention and post-intervention, were analysed descriptively and by effect sizes (Cohen's d). Individual interviews targeting participant experiences were conducted. RESULTS Six out of seven progression criteria yielded no concerns. Out of 49 patients with a working diagnosis of MINOCA or TS, 31 were eligible for screening, 26 consented to participate, and 14 were eligible with regard to symptoms of stress and/or anxiety. Eleven completed the pre-assessment and were given access the intervention, and 9 completed the intervention. Only the number of patients screened prior to eligibility assessment was slightly lower than expected, indicating possible concerns. Self-reports of anxiety, stress, cardiac anxiety, posttraumatic stress, and quality of life all indicated symptom reduction from pre- to post-intervention, generally showing large effect sizes (d = 0.6-2.6). The general consensus among participants was that the programme was helpful and relevant, and that the personal contact with the psychologist was highly valued. Setting aside time to complete assignments was found critical. CONCLUSION Conducting a full scale RCT was found feasible. Inclusion of more study sites and minor amendments to the protocol and intervention were decided to improve feasibility further. TRIAL REGISTRATION Clinicaltrials.govNCT04178434.
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Affiliation(s)
- Elisabet Rondung
- Department of Psychology and Social Work, Mid Sweden University, 831 25 Östersund, Sweden,Corresponding author.
| | | | | | - Runa Sundelin
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Cardiology, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Fredrika Norlund
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, 751 83 Uppsala, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Cardiology, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Cardiology, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden
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Fridlund B, Bruteig E, Dahlviken RM, Fålun N, Norekvål TM. Women's Initial Experiences and up to a Year in Retrospect of Their Life Situation With a Confirmed Takotsubo Syndrome Diagnosis: A Single Case Study Literature Review. J Holist Nurs 2021; 40:146-156. [PMID: 34029129 PMCID: PMC9121527 DOI: 10.1177/08980101211018343] [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] [Indexed: 11/20/2022]
Abstract
Purpose: To describe women's initial experiences and up to a year in
retrospect of their life situation with a confirmed Takotsubo syndrome (TS) diagnosis.
Method: A single case study literature review based on nine articles
published by nurses was analyzed deductively using a nursing life dimension model.
Results: All but one case was conducted on the North American continent and
TS had largely affected women with previous cardiac history and had been triggered by one
or two stressful life events. The biophysical life dimension manifested in distinct and
troublesome inconvenience and in retrospect in fretting and grievous ailments. The
emotional dimension manifested in pronounced ways and attitude-related sensations,
feelings or moods while the intellectual dimension manifested in an unmanageable world of
thought. The spiritual–existential dimension manifested in a life-denying view of life and
the socio-cultural dimension manifested in an asocial life. Conclusions: With
TS best practice in mind and a person-centered care and holistic approach, comprehensive
descriptions are needed of how women identify, interpret, and use knowledge to manage
their life situation. Cardiac nurses need further comprehensive descriptions to implement
actions. Prior to implementation of such programs, this knowledge needs to be disseminated
among cardiac nurses and evaluated in international randomized controlled trials.
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Affiliation(s)
| | | | | | | | - Tone M Norekvål
- 1658University of Bergen.,60498Haukeland University Hospital
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Barranco R, Ventura F. Commentary on "Sudden cardiac death after robbery: Homicide or natural death?". J Forensic Leg Med 2020; 76:102075. [PMID: 33130552 DOI: 10.1016/j.jflm.2020.102075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Rosario Barranco
- Department of Legal and Forensic Medicine, University of Genova, Via De' Toni 12, 16132, Genova, Italy.
| | - Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova, Via De' Toni 12, 16132, Genova, Italy
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Humphries SM, Rondung E, Norlund F, Sundin Ö, Tornvall P, Held C, Spaak J, Lyngå P, Olsson EMG. Designing a Web-Based Psychological Intervention for Patients With Myocardial Infarction With Nonobstructive Coronary Arteries: User-Centered Design Approach. J Med Internet Res 2020; 22:e19066. [PMID: 32940615 PMCID: PMC7530693 DOI: 10.2196/19066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/01/2020] [Accepted: 07/26/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The involvement of patient research partners (PRPs) in research aims to safeguard the needs of patient groups and produce new interventions that are developed based on patient input. Myocardial infarction with nonobstructive coronary arteries (MINOCA), unlike acute myocardial infarction (MI) with obstructive coronary arteries, is presented with no significant obstructive coronary artery disease. Patients with this diagnosis are a subset of those diagnosed with traditional MI and often need more psychological support, something that is presently not established in the current treatment scheme in Swedish health care or elsewhere, to our knowledge. An internet-delivered intervention might offer patients with MINOCA the opportunity to access a psychological treatment that is tailored to their specific needs after MINOCA and could therefore supplement the existing medical care in an easily accessible format. OBJECTIVE This paper aims to describe the development of a therapist-guided, internet-delivered psychological intervention designed specifically for patients with MINOCA. METHODS The study used a participatory design that involved 7 PRPs diagnosed with MINOCA who collaborated with a team consisting of researchers, cardiologists, and psychologists. Intervention content was developed iteratively and presented to the PRPs across several prototypes, each continually adjusted and redesigned according to the feedback received. The intervention and experience of it were discussed by PRPs in a final meeting and then presented to a panel of 2 clinical psychologists and a cardiologist for further input. RESULTS The outcome of the collaboration between PRPs and the research group produced a web-based psychological 9-step program focusing on stress, worry, and valued action. The input from PRPs contributed substantially to the therapy content, homework tasks, interactive activities, multimedia, and design presentation. CONCLUSIONS Working with PRPs to develop an intervention for people with MINOCA produced a web-based intervention that can be further evaluated with the goal of offering a new psychological treatment option to a patient group currently without one. Direct contribution from PRPs enabled us to obtain relevant, insightful, and valuable feedback that was put towards the overall design and content of the intervention.
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Affiliation(s)
| | - Elisabet Rondung
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Fredrika Norlund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Örjan Sundin
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Erik M G Olsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Mäenpää S, Ekstrand E, Petersson C, Nymark C. Patients' experiences when afflicted by takotsubo syndrome - is it time for guidelines? Scand J Caring Sci 2020; 35:824-832. [PMID: 32808352 DOI: 10.1111/scs.12897] [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: 05/03/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Takotsubo syndrome (TTS) is an acute and reversible type of heart failure that shares common features with acute coronary syndrome. It is usually caused by psychological or physical stress, but for a third, triggers cannot be identified. Patients also suffer from residual symptoms and decreased mental health in the recovery phase and may struggle to comprehend and manage everyday living. AIM To describe patients' experiences when afflicted by takotsubo syndrome, after discharge from hospital. METHOD An inductive explorative design using a qualitative approach with semi-structured individual interviews. The text was analysed using qualitative content analysis according to Graneheim and Lundman. RESULT Ten women and one man afflicted by TTS were interviewed two to twelve months after discharge. Six sub-categories were identified, and a main category emerged: The process from symptom onset and understanding to increased awareness and changes in life. The patients suffered from emotional reactions and they sought answers and understanding about the underlying causes. The disease led to changes in patients' daily lives as they were affected physically and psychologically. Spouses and/or bystanders had a positive supporting role, but the patients desired more support from the healthcare professionals such as an earlier appointment for follow-up with a nurse. CONCLUSION Being afflicted by TTS can lead to changes in life conditions but these changes vary among patients. Becoming ill was associated to acute physical stress and prolonged psychological stress and they suffered from emotional reactions. The follow-up care needs to improve as the patients need more guidance from healthcare professionals and earlier appointment for follow-up with a nurse. A structured and multiprofessional treatment with a person-centred approach could support patients in their recovery.
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Affiliation(s)
| | | | - Christina Petersson
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Carolin Nymark
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Cattaneo MM, Pravatà E, Provenzi M, Moccetti M, Kaelin A, Sudano I, Biasucci L, Gallino C, Limoni C, Calanchini C, Gallino A, Crea F, Cattaneo M. Role of the central autonomic nervous system intrinsic functional organisation and psychosocial factors in primary microvascular angina and Takotsubo syndrome. Open Heart 2020; 7:openhrt-2020-001315. [PMID: 32727853 PMCID: PMC7394146 DOI: 10.1136/openhrt-2020-001315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction and objective Dysfunctional central autonomic nervous system network (CAN) at rest may result in aberrant autonomic responses to psychosocial stressors. We hypothesised that patients with primary microvascular angina (MVA) or Takotsubo syndrome (TTS) would exhibit a peculiar functional organisation of the CAN, potentially associated with psychological patterns. Methods Patients underwent a psychosocial evaluation: a clinical diagnostic interview, Millon Clinical Multiaxial Inventory III, State-Trait Anxiety Inventory form Y and Short Form 36 Health Survey (SF-36). The strength of intrinsic functional connectivity (FC) between various nodes of the CAN was investigated using cerebral resting state functional MRI (RS-fMRI). Results We evaluated 50 (46 women) stable patients: 16 patients with MVA, 17 patients with TTS and 17 patients with previous acute myocardial infarction (AMI). Compared with AMI, patients with MVA showed a lower (higher impairment) SF-36 Body-Pain score (p 0.046) and a higher SF-36 Mental-Health score (p 0.039). Patients with TTS showed the strongest FC between two nodes of the CAN (sympathetic midcingulate cortex and parasympathetic primary motor area) (F 6.25, p 0.005) using RS-fMRI. Conclusions The study implements an innovative collaborative research among cardiologists, neuroscientists and psychiatrists (‘Neuro-psycho-heart Team’). MVA showed a discrepancy between the highest level of self-reported body pain and the best mental health score, which might suggest a mechanism of somatisation. TTS exhibited an increased functional integration between two areas of the CAN involved in interoceptive pain awareness and negative emotional status. We implemented an innovative research collaboration among cardiologists, neuroscientists and psychiatrists. These data are hypothesis generating and suggest potential prospective investigations on pathophysiology and implementation of psychotherapy and stress-reducing techniques as therapeutic strategies. Trial registration number NCT02759341.
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Affiliation(s)
- Magdalena Maria Cattaneo
- Cardiovascular Research, Hospital of San Giovanni, Bellinzona, Switzerland .,Internal Medicine, Hospital of San Giovanni, Bellinzona, Switzerland
| | - Emanuele Pravatà
- Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Micol Provenzi
- Psychology, Psycho-Educational Center, Stabio, Switzerland
| | | | - Alain Kaelin
- Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | | | - Luigi Biasucci
- Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Camilla Gallino
- Cardiovascular Research, Hospital of San Giovanni, Bellinzona, Switzerland
| | - Costanzo Limoni
- Biostatistics, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Carlo Calanchini
- Psychiatry, Hospital Malcantonese Castelrotto, Castelrotto, Switzerland
| | - Augusto Gallino
- Cardiovascular Research, Hospital of San Giovanni, Bellinzona, Switzerland.,Cardiology, University of Zurich, Zurich, Switzerland
| | - Filippo Crea
- Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Mattia Cattaneo
- Cardiovascular Research, Hospital of San Giovanni, Bellinzona, Switzerland.,Cardiology, Cardiocentro Ticino, Lugano, Switzerland
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Sundelin R, Bergsten C, Tornvall P, Lyngå P. Self-rated stress and experience in patients with Takotsubo syndrome: a mixed methods study. Eur J Cardiovasc Nurs 2020; 19:740-747. [PMID: 32491953 PMCID: PMC7817986 DOI: 10.1177/1474515120919387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A relation to stress and stressful triggers is often, but not always, described in patients with Takotsubo syndrome. Few studies have focused on patients' self-rated stress in combination with qualitative experiences of stress in Takotsubo syndrome. AIMS The aim of this study was to describe stress before and after the onset of Takotsubo syndrome. METHODS Twenty patients were recruited from five major hospitals in Stockholm, Sweden between December 2014 and November 2018. A mixed methods design was used containing the validated questionnaire, perceived stress scale (PSS-14) filled in at baseline and at a 6 and 12-month follow-up, respectively. Qualitative interviews were made at the 6-month follow-up. RESULTS Self-rated stress, measured by the perceived stress scale, showed stress levels above the cut-off value of 25, at the onset of Takotsubo syndrome (median 30.5). Stress had decreased significantly at the 12-month follow-up (median 20.5, P = 0.039) but remained high in one third of the patients. Qualitative interviews confirmed a high long-term stress and half of the patients had an acute stress trigger before the onset of Takotsubo syndrome. The qualitative interviews showed that the patients had reflected on and tried to find ways to deal with stress, but for many this was not successful. CONCLUSION Patients with Takotsubo syndrome reported long-term stress sometimes with an acute stress trigger before the onset of Takotsubo syndrome. Stress decreased over time but remained high for a considerable number of patients. Despite reflection over stress and attempts to deal with stress many were still affected after 6 months. New treatment options are needed for patients with Takotsubo syndrome.
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Affiliation(s)
- Runa Sundelin
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Chatarina Bergsten
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Per Tornvall
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Patrik Lyngå
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
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13
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Olliges E, Burgdorf C, Ladwig KH, Moeller C, Deftu-Kloes D, Pohl S, Ruettner B, Richardt G, Meissner K, Steger A, Goetzmann L, Ronel J. Psychosocial and physical long-term outcome in patients with a history of takotsubo cardiomyopathy or myocardial infarction - a multi-centered case control study. PSYCHOL HEALTH MED 2020; 25:989-1003. [PMID: 32000523 DOI: 10.1080/13548506.2020.1722315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Physical long-term impacts of Takotsubo Cardiomyopathy (TTC) remain controversial and an underestimation of their severity becomes increasingly evident. Even less is known about mental long-term impacts of TTC. This study aims at a better understanding of the physical and mental long-term effects of TTC in comparison to myocardial infarctions (MI). On average 5 years after disease onset, 68 TTC patients and 68 age- and sex-matched MI patients were assessed for disease-related quality of life, depression, anxiety, chronic stress, social support, resilience, and life events prior to disease onset. Scores of TTC and MI patients were compared to each other and to normative references values. Regression analyses were used to evaluate the predictive value of the number of life events prior to disease onset for physical and mental long-term outcomes. Both groups displayed higher scores in depression and anxiety, higher levels of chronic stress, and lower scores in physical and mental quality of life in comparison to norm samples, while social support did not differ from norms. No differences between the two patient groups were observed. Within both groups, the majority of patients (TTC: 69.1%; MI: 60.3%) reported stressful life events prior to disease onset. In TTCs and MIs, the number of events had a significant impact on long-term mental health and chronic stress. Notably, both patient collectives scored higher in resilience than healthy controls. Results suggest negative long-term impacts of TTC on mental and physical wellbeing, comparable to those of MI. Besides a good somatic-medical care, psychotherapeutic support, including the development of functional coping strategies, might be warranted for TTC patients. The long-term impact of TTC should be taken as serious as that of MI.
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Affiliation(s)
- E Olliges
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich , Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences , Coburg, Germany
| | - C Burgdorf
- Department of Cardiology, Heart and Vascular Centre Bad Bevensen , Bad Bevensen, Germany
| | - K H Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Techni- sche Universitaet Muenchen , Munich, Germany.,Department of Epidemiology II, Helmholtz Zentrum , Munich, Germany
| | - C Moeller
- Medical Clinic II, Luebeck, Universitaetsklinikum Schleswig-Holstein , Germany
| | - D Deftu-Kloes
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken , Bad Seg- eberg, Germany
| | - S Pohl
- Psychiatric Day-care Hospital, Klinikum Frankfurt (Oder) , Frankfurt Oder, Germany
| | - B Ruettner
- Department of Psychology, Medical School Hamburg , Germany
| | - G Richardt
- Department of Cardiology, Segeberger Kliniken , Bad Segeberg, Germany
| | - K Meissner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich , Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences , Coburg, Germany
| | - A Steger
- Klinik und Poliklinik fuer Innere Medizin I, Klinikum rechts der Isar, Technische Universitaet Muenchen , Munich, Germany
| | - L Goetzmann
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken , Bad Seg- eberg, Germany
| | - J Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Techni- sche Universitaet Muenchen , Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinik Barmelweid AG , Barmel- weid, Switzerland
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14
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Abstract
This paper is written from the perspective of patients who have been diagnosed with takotsubo syndrome. It seeks to understand why these patients may feel dissatisfied with the care they receive. We consider four factors: (a) takotsubo syndrome is a relatively new condition and the knowledge base about treatment is limited and not widely disseminated among clinicians; (b) the age and gender profile of the patient group; (c) the implications of the categorisation of takotsubo syndrome as ‘broken heart syndrome’ and the over-emphasis of it as a ‘psychosomatic’ condition; (d) concern that patients with takotsubo syndrome might be labelled as over-emotional, especially if they do not recover quickly. We argue that these factors contribute to patients with takotsubo syndrome feeling poorly served.
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Affiliation(s)
| | - Melanie Rein
- Member of the Guild of Analytical Psychologists, UK and the Independent Group of Analytical Psychologists, UK
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15
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Ma L, Del Buono MG, Moeller FG. Cannabis Use as a Risk Factor for Takotsubo (Stress) Cardiomyopathy: Exploring the Evidence from Brain-Heart Link. Curr Cardiol Rep 2019; 21:121. [DOI: 10.1007/s11886-019-1210-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Clinical Characteristics and Long-Term Mortality Rate in Female Patients with Takotsubo Syndrome Compared with Female Patients with ST-Elevation Acute Myocardial Infarction: A Retrospective Study from a Single Center. Cardiol Res Pract 2019; 2019:9156586. [PMID: 31467703 PMCID: PMC6701322 DOI: 10.1155/2019/9156586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/10/2019] [Accepted: 07/11/2019] [Indexed: 01/22/2023] Open
Abstract
Background Takotsubo syndrome (TTS) is characterized by acute transient, stress-induced, left ventricular systolic dysfunction, generally presenting with apical ballooning. It can mimic an acute coronary syndrome, but with a milder increase in cardiac enzymes and without culprit coronary artery disease on angiography. Data on long-term follow-up and survival in patients with TTS, compared with patients with ST-elevation myocardial infarction (STEMI), are scarce. Purpose To assess all-cause mortality rate and survival in a consecutive series of female patients with TTS compared with age- and sex-matched STEMI patients on long-term follow-up. Methods and Results We collected data of 65 TTS female patients (TTS group) with a mean age of 73.42 ± 11.35 years from 2001 to 2013. Collection of follow-up information was concluded for all patients in 2016. To compare the mortality and survival of TTS patients with those of the STEMI population, we used data from our STEMI Registry, a prospective registry of 7446 STEMI patients admitted from 2001 to 2013 to our cath-lab for primary percutaneous coronary intervention (p-PCI). From the registry, we selected 104 STEMI patients (STEMI group) comparable to our TTS group in terms of age (mean age of 72.33 ± 11.92 years) and sex. On follow-up examination after a median of 1000 days, the TTS group had a lower all-cause mortality rate than the STEMI group (7.69% versus 23.08%). This difference was statistically different between the two groups (log-rank test, p value = 0.03). Conclusions In our study, TTS and STEMI patients displayed a statistically significant difference in long-term survival. Specifically, the TTS group had a lower mortality rate than the STEMI group. This seems to suggest that TTS and STEMI are two different clinical entities with two different clinical outcomes.
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Olliges E, Schneider S, Schmidt G, Sinnecker D, Müller A, Burgdorf C, Braun S, Holdenrieder S, Ebell H, Ladwig KH, Meissner K, Ronel J. Placebo and Nocebo Effects in Patients With Takotsubo Cardiomyopathy and Heart-Healthy Controls. Front Psychiatry 2019; 10:549. [PMID: 31428002 PMCID: PMC6688659 DOI: 10.3389/fpsyt.2019.00549] [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: 12/14/2018] [Accepted: 07/15/2019] [Indexed: 12/03/2022] Open
Abstract
The etiology of takotsubo cardiomyopathy (TTC)-a rare, reversible, and acquired form of cardiac diseases-is not yet fully explained. An exaggerated activation of the sympathetic-nervous-system (SNS) following stressful psychosocial life events is discussed to be of key importance. In this experimental study, we tested whether TTC patients, compared to heart-healthy controls, respond more strongly to supporting placebo interventions and stressful nocebo interventions targeting cardiac function. In a single experimental session, 20 female TTC patients and 20 age matched (mean age 61.5 years, ± 12.89) catheter-confirmed heart-healthy women were examined. Saline solution was administered three times i.v. to all participants, with the verbal suggestion they receive an inert substance with no effects on the heart (neutral condition), a drug that would support cardiac functions (positive condition), and a drug that would burden the heart (negative condition). Systolic and diastolic blood pressure (DBP/SBP), heart rate (HR), endocrine markers cortisol (µg/dl), copeptin (pmol/l), and subjective stress ratings (SUD) were assessed to examine alterations of the SNS and the hypothalamic-pituitary-adrenal axis (HPA). Before and after each intervention SUD was rated. One pre and three post serum cortisol and copeptin samples were assessed, and a long-term electrocardiogram as well as non-invasive, continuous blood pressure was recorded. The study design elucidated a significant increase of SUD levels as a response to the nocebo intervention, while perceived stress remained unaffected during the preceding neutral and positive interventions. Increasing SUD levels were accompanied by higher SBP and an anticipatory increase of HR shortly prior to the nocebo intervention. SBP increased also as a response to positive verbal suggestions (Bonferroni-corrected p-values > .05). Alterations of cortisol and copeptin due to the interventions and significant placebo effects failed to appear. Interestingly no differences between TCC patients and controls could be found.These findings do not support the assumption of an exaggerated activation of the SNS as a discriminatory factor for TTC. Since especially the nocebo intervention revealed negative subjective and objective effects, our results underscore the urgent need to consider carefully the impact of verbal suggestions in the interaction with cardiac patients in daily clinical routine. This study is registered at the Deutsches Register Klinischer Studien (DRKS00009296).
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Affiliation(s)
- Elisabeth Olliges
- Institute of Medical Psychology, Medical Faculty, LMU Munich, Munich, Germany
| | - Simon Schneider
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany
| | - Georg Schmidt
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany
| | - Daniel Sinnecker
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Müller
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany
| | - Christof Burgdorf
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Munich, Technische Universitaet Munich, Munich, Germany.,Department of Cardiology, Heart and Vascular Centre Bad Bevensen, Bad Bevensen, Germany
| | - Siegmund Braun
- Institute of Laboratory Medicine, Deutsches Herzzentrum Munich, Technische Universitaet Munich, Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, Deutsches Herzzentrum Munich, Technische Universitaet Munich, Munich, Germany
| | | | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany.,Department of Epidemiology II, Helmholtz Zentrum, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, Medical Faculty, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universitaet Munich, Munich, Germany.,Department of Psychosomatic Medicine, Klinik Barmelweid AG, Barmelweid, Switzerland
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18
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Rellini G, Piazza R, Loiudice E, Cassin M, Bernardi G, Pavan D, Cervesato E, Nicolosi GL. Heterogeneity of clinical presentation in Tako-Tsubo syndromes: the prevalence of normal segmental wall motion and normal ECG pattern. J Cardiovasc Med (Hagerstown) 2018; 19:717-724. [PMID: 30320724 DOI: 10.2459/jcm.0000000000000729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM The aim of this study is to report the heterogeneity of clinical presentation in Tako-Tsubo syndrome (TTS), including a significant prevalence of normal ECG and echocardiographic patterns in a series of consecutive patients from a single center. METHODS AND RESULTS From our database we selected a total of 168 cases of TTS. A total of 140 of these (Group A); 14 men (10%), mean age 60.3 years, range 39-87; 126 women (90%), mean age 66.1 years, range 43-93; matched the following reported criteria: typical stenocardic pain immediately following an emotional acute stress, or acute medical or surgical event within the preceding 12 h; acute rise and fall of troponin release; absence of significant coronary disease at coronary angiography. ECG findings at presentation ranged from T wave abnormalities (41 cases, 29.3%) to ST elevation (52 cases, 37.1%) and ST depression (11 cases, 7.9%), whereas in 36 cases (25.7%) the ECG was normal. Echocardiography at presentation showed akinesia of the total apical or medium-apical segments in 74 patients (53%), whereas it showed akinesia of left ventricular wall segments in other locations in 30 patients (21%) and even normal regional wall motion and thickening in 36 patients (26%). We described also a series of 13 female patients (mean age 70.2 years; age range 45-85 years) (Group B) who did not complain of chest pain at presentation, but showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography. Finally we selected 15 female patients (mean age 69.3 years; age range 49-89 years) (Group C) who formally did not report acute stress immediately preceding their presentation to the hospital for chest pain. They showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography and only one case of normal ECG pattern at presentation. CONCLUSION In this series of acute TTS, a wide variability of ECG and echocardiographic patterns are observed, ranging from ST elevation with coexisting segmental wall motion abnormalities of the typical TTS to a clinical presentation characterized by normal ECG and normal segmental wall motion pattern.
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Affiliation(s)
| | | | | | | | | | | | | | - Gian L Nicolosi
- Cardiology Department, ARC, Ospedale Civile.,Cardiology Clinic, Policlinico San Giorgio, Pordenone, Italy
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Bergami M, Amaduzzi PL, Bugiardini R. Takotsubo Syndrome: Does the Octopus Trap Hide Dangers? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Manfredini R, Manfredini F, Fabbian F, Salmi R, Gallerani M, Bossone E, Deshmukh AJ. Chronobiology of Takotsubo Syndrome and Myocardial Infarction: Analogies and Differences. Heart Fail Clin 2017; 12:531-42. [PMID: 27638023 DOI: 10.1016/j.hfc.2016.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Several pathophysiologic factors, not harmful if taken alone, are capable of triggering unfavorable events when presenting together within the same temporal window (chronorisk), and the occurrence of many cardiovascular events is not evenly distributed in time. Both acute myocardial infarction and takotsubo syndrome seem to exhibit a temporal preference in their onset, characterized by variations according to time of day, day of the week, and month of the year, although with both analogies and differences.
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Affiliation(s)
- Roberto Manfredini
- Clinica Medica Unit, School of Medicine, University of Ferrara, Via Lodovico Ariosto, 35, Ferrara 44121, Italy.
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, Vascular Diseases Center, School of Medicine, University of Ferrara, Via Lodovico Ariosto, 35, Ferrara 44121, Italy
| | - Fabio Fabbian
- Clinica Medica Unit, School of Medicine, University of Ferrara, Via Lodovico Ariosto, 35, Ferrara 44121, Italy
| | - Raffaella Salmi
- 2nd Internal Unit of Internal Medicine, General Hospital of Ferrara, Via Aldo Moro 8, Ferrara 44020, Italy
| | - Massimo Gallerani
- 1st Internal Unit of Internal Medicine, General Hospital of Ferrara, Via Aldo Moro 8, Ferrara 44020, Italy
| | - Eduardo Bossone
- 'Cava de' Tirreni and Amalfi Coast' Division of Cardiology, Heart Department, University Hospital of Salerno, Via San Leonardo 1, Salerno 84013, Italy
| | - Abhishek J Deshmukh
- Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA
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