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Farjoud Kouhanjani M, Hosseini SA, Mousavi SM, Noroozi Z, Sadeghi P, Jokar-Derisi A, Jamshidi Mouselou MS, Ahmadi M, Attar A. Takotsubo Cardiomyopathy and Autoimmune Disorders: A Systematic Scoping Review of Published Cases. Int J Clin Pract 2024; 2024:7259200. [PMID: 38414580 PMCID: PMC10898954 DOI: 10.1155/2024/7259200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Takotsubo cardiomyopathy (TCM) features transient left ventricular apical dysfunction or ballooning. The underlying mechanism remains elusive; however, evidence suggests the role of different physical and psychological stressors. We systematically reviewed patients presenting with TCM and autoimmunity to explore the link between the two conditions. Methods We applied the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) to report this review. Using keywords related to autoimmune/immune-mediated diseases and TCM, we searched PubMed, Scopus, and WOS in March 2022. The final results were added to a data extraction sheet. Data were analyzed by SPSS version 26.0. Results Our search yielded 121 studies, including 155 patients. Females were considerably predominant. Most patients had a history of autoimmune disease, and almost a third had a history of cardiovascular disease. Dyspnea and chest pain were the most common chief complaints. More than 70% of patients had experienced physical stress. Myasthenia gravis, systemic lupus erythematosus, and multiple sclerosis were the most frequently reported autoimmune diseases. Conclusion There were similarities in age and sex compared to classic TCM. TCM should be considered as a differential diagnosis for ACS, especially in patients with a positive background of autoimmunity. A precise reporting system is required for further studies.
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Affiliation(s)
- Mohsen Farjoud Kouhanjani
- Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Zahra Noroozi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Paniz Sadeghi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armita Jokar-Derisi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Meysam Ahmadi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Attar
- Department of Cardiology, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Mohamed KH, Oshikoya AF, Kumar K, Anigbo CL, Sri Satya Sai Prashanth P, Mohamed AS, Haseeb M, Nasir H. Takotsubo Cardiomyopathy: A Possible Rare Complication of Guillain-Barré Syndrome. Cureus 2023; 15:e40083. [PMID: 37425556 PMCID: PMC10327529 DOI: 10.7759/cureus.40083] [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: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Dysautonomia is a common and severe complication of Guillain-Barré syndrome (GBS), which may manifest as cardiac arrhythmias, labile blood pressure, diaphoresis, and changes in gastrointestinal motility. Takotsubo cardiomyopathy (TCM) is a life-threatening manifestation of dysautonomia in patients with GBS, which is not widely underlined in the literature. The association between GBS and TCM has been well-documented in previous studies; however, there are few reported cases with GBS who developed TCM following their diagnosis with GBS. In this case report, we will discuss our experience treating a 59-year-old female patient who became hemodynamically unstable while recovering from an acute GBS infection. She was diagnosed with TCM after undergoing an echocardiogram and coronary angiogram ruling out thrombotic or obstructive coronary disease and myocarditis.
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Affiliation(s)
- Khalid H Mohamed
- Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
| | - Adetola F Oshikoya
- Internal Medicine, Near East University, Nicosia, CYP
- Internal Medicine, General Hospital Odan Lagos, Lagos, NGA
| | - Kapil Kumar
- Medicine and Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | | | | | - Muhammad Haseeb
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
- Internal Medicine, Mount Sinai Hospital, Brooklyn, USA
| | - Hira Nasir
- Internal Medicine, Mayo Hospital, Lahore, PAK
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Song X, Chi C, Song J, Zhu J. Isolated right ventricular Takotsubo cardiomyopathy in Guillain-Barré syndrome. BMC Cardiovasc Disord 2022; 22:531. [PMID: 36476210 PMCID: PMC9727852 DOI: 10.1186/s12872-022-02983-1] [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] [Received: 05/18/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy can present itself in the most varied clinical forms, with extremely variable electrocardiogram anomalies and presence of comorbidities with a significant systemic commitment. Guillain-Barré Syndrome concomitant with isolated right ventricular Takotsubo cardiomyopathy is a rare entity. Here we present a patient with Guillain-Barré syndrome who had electrocardiogram abnormalities consistent with isolated right ventricular Takotsubo cardiomyopathy which have not been described in literature. This case report may prompt early identification of right ventricular involvement in neurological comorbidities, especially if the electrocardiogram is not frankly suggestive of an acute ischemic condition linked to coronary artery disease. CASE PRESENTATION A 37-year-old woman was misdiagnosed as acute coronary syndrome because of abnormally elevated troponin T level and electrocardiogram findings in the Emergency Department. Due to absence of any significant stenosis in the main coronary artery, the primary diagnosis was ruled out. Based on reanalysis of the ECG abnormalities, the patient was diagnosed as a case of isolated right ventricular Takotsubo cardiomyopathy in Guillain-Barré Syndrome. This case demonstrates the importance of electrocardiogram as a critical tool to identify isolated right ventricular Takotsubo cardiomyopathy in Guillain-Barré Syndrome. Indeed, in this case, the electrocardiogram abnormalities were distributed beyond the territory of a single coronary artery distribution. CONCLUSIONS The described electrocardiogram findings of isolated right ventricular Takotsubo cardiomyopathy in Guillain-Barré Syndrome may facilitate identification of right ventricular involvement in neurological diseases.
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Affiliation(s)
- Xiaojing Song
- grid.411634.50000 0004 0632 4559Department of Emergency, Peking University People’s Hospital, Beijing, 100044 China
| | - Cheng Chi
- grid.411634.50000 0004 0632 4559Department of Emergency, Peking University People’s Hospital, Beijing, 100044 China
| | - Junxian Song
- grid.411634.50000 0004 0632 4559Department of Cardiology, Peking University People’s Hospital, Beijing, 100044 China
| | - Jihong Zhu
- grid.411634.50000 0004 0632 4559Department of Emergency, Peking University People’s Hospital, Beijing, 100044 China
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Lee KP, Abdul Halim S, Sapiai NA. A Severe Pharyngeal-Sensory-Ataxic Variant of Guillain-Barré Syndrome With Transient Cardiac Dysfunction and a Positive Anti-sulfatide IgM. Cureus 2022; 14:e29261. [PMID: 36277590 PMCID: PMC9578660 DOI: 10.7759/cureus.29261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/18/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is a heterogeneous group of acute immune-mediated polyradiculoneuropathy that typically presents with classic axonal or demyelinating sensory-motor type. However, there are variants of GBS with atypical presentation. We report a rare case of severe pharyngeal-sensory-ataxic variant of GBS associated with poor cardiac systolic function, elevated troponin, and positive anti-sulfatide IgM. The sensory symptom atypically started in the hands in an ascending pattern, which progressed to involve the trunk and face and, later, all limbs. It was associated with severe dysphagia, ataxia, and generalized areflexia but with preserved muscle strength in all extremities. Recognizing the atypical pattern of presentation and the ability to perform an accurate clinical localization are the utmost important initial steps in making the diagnosis. The patient showed complete recovery after immunoglobulin therapy.
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Fu Z, Huang H, Yu Q, Song Y, Gan X, Li Z, Wu F. Fu's subcutaneous needling for orthostatic hypotension due to Guillain-Barre syndrome: A case report. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2022. [DOI: 10.1016/j.jtcms.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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AbdelMassih AF, Mohammed O, Shoukry KES, Saleem EE, Hawout A, AbdelHameed MA, Girgis M. Neurocardiac injury associated with the severity of motor involvement in pediatric patients with Guillain Barre Syndrome. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2021.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Puentes D, Teijelo D, Stiep TS, Mannava S, Margolesky J. Takotsubo Cardiomyopathy as a Manifestation of Dysautonomia in Guillain-Barré Syndrome: A Case Series and Review of the Literature. Cureus 2021; 13:e16069. [PMID: 34345553 PMCID: PMC8324066 DOI: 10.7759/cureus.16069] [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] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an inflammatory polyneuropathy that classically presents with low back pain, sensory paresthesias, and rapidly progressive weakness. Patients with GBS can develop dysautonomia, and Takotsubo cardiomyopathy (TCM) is a rare potential manifestation of this dysautonomia. This association has been reported only 12 times in the literature so far, which we review here. We present two cases of GBS associated with TCM, to increase awareness with regard to this comorbid relationship, which would encourage prompt initiation of proper supportive care to avoid morbidity and mortality. We report the case of two patients - a 58-year-old man and a 79-year-old woman - who developed TCM in the setting of axonal variants of GBS. Electrodiagnostic results, cerebrospinal fluid profiles, and echocardiogram findings were consistent with these diagnoses. Both patients were treated with intravenous immunoglobulin (IVIG) in an intensive care unit (ICU) setting. Echocardiogram findings were reversible. TCM should be recognized as a potential complication of GBS in patients with dysautonomia. This case series adds to the sparse body of literature describing the association between these two conditions. It is not clear if patients with axonal variants of GBS are more predisposed to developing TCM; further, larger case series in the future may help identify the risk factors associated with it. We hope to shed more light on this possible association to expedite the diagnosis and management of this condition.
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Jones T, Umaskanth N, De Boisanger J, Penn H. Guillain-Barré syndrome complicated by takotsubo cardiomyopathy: an under-recognised association. BMJ Case Rep 2020; 13:13/2/e233591. [PMID: 32060115 DOI: 10.1136/bcr-2019-233591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A 41-year-old woman was admitted with progressive paraesthesia and weakness and was diagnosed with Guillain-Barré syndrome. Following an initial period of recovery with intravenous immunoglobulin treatment, she developed acute chest pain associated with electrocardiographic changes. Investigations excluded acute coronary syndrome and instead confirmed a diagnosis of takotsubo cardiomyopathy, which was treated medically. The patient made an excellent neurological and cardiac recovery. Here we discuss the rarely described association between these two conditions and suggest that patients admitted with Guillain-Barré syndrome may benefit from routine screening with echocardiography.
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Affiliation(s)
- Timothy Jones
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, London, UK
| | - Neelan Umaskanth
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, London, UK
| | - James De Boisanger
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, London, UK
| | - Henry Penn
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, London, UK
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