Takotsubo cardiomyopathy: a novel beta-adrenergic blocker withdrawal syndrome

The authors describe two cases of takotsubo cardiomyopathy developing after an abrupt withdrawal of carvedilol and bisoprolol. Takotsubo or stress cardiomyopathy is characterized by acute and reversible cardiac dysfunction without coronary artery disease. It is triggered by acute emotional or physical stress, drugs or drug withdrawal. The immediate discontinuation of the long acting vasodilator beta-blocker, carvedilol has not yet been described to cause takotsubo cardiomyopathy. The authors recommend cautious withdrawal of beta-blockers. Orv. Hetil., 2013, 154, 267–271.

Arrhythmia occurrence with takotsubo cardiomyopathy: a literature review

AIMS

Takotsubo cardiomyopathy (TC) or the apical ballooning syndrome is a reversible cardiomyopathy mimicking acute myocardial infarction (AMI). Although malignant arrhythmia is considered less likely to occur in TC than with AMI, sporadic reports of malignant arrhythmia with TC, however, have been reported. We reviewed the medical literature on TC and arrhythmias and describe in the summary the reported findings and discuss possible specific scenarios where arrhythmia may be more likely in patients with TC.

METHODS AND RESULTS

Articles were identified on PubMed using the MeSH terms 'Takotsubo Cardiomyopathy' or 'Apical Ballooning Syndrome'. Seventy-four unique case series with five or more TC patients were identified, with a cumulative total of 1876 cases. Twelve series (242 cases) were excluded because Mayo criteria were not met. Twenty-five series (816 cases, 43.5%) reported on arrhythmia and were included in the analysis.

CONCLUSION

Areas for further prospective study include the duration and mechanism of residual risk and optimal risk stratification and modification. The current state of evidence would support beta-blockers in the acute setting to control tachyarrhythmia, although there is little evidence to support their use beyond convalescence when used for this indication alone. Those in heart failure and cardiogenic shock should be managed with established evidence-based therapies for these conditions. The use of internal defibrillators in TC requires consideration only on a case-by-case basis.

Takotsubo cardiomyopathy and QT interval prolongation: who are the patients at risk for torsades de pointes?

OBJECTIVES

QT interval prolongation is prevalent among patients with Takotsubo cardiomyopathy (TC), whereas torsades de pointes (TdP) has rarely been reported in these patients. We studied all peer-reviewed reports on TC-associated QT interval prolongation and all peer-reviewed reports on TC-associated TdP to characterize the clinical circumstances leading to TdP in patients with TC.

METHODS

The literature search yielded 14 reports on TC-associated TdP and 26 reports on TC-associated QT interval prolongation. Overall, 15 patients with TC-associated TdP and 86 patients with TC-associated QT interval prolongation were reported. We systematically reviewed each report and recorded the risk factors for TdP as well as the clinical circumstances of TC.

RESULTS

The prevalence of the male sex was higher among patients with TC-associated TdP relative to patients with TC-associated QT interval prolongation (26.7% vs 5.8%; P = .01). There was a trend in the mean maximal corrected QT interval being longer among patients with TC-associated TdP relative to patients with TC-associated QT interval prolongation (679.9 +/- 230.6 vs 555.9 +/- 63.8 milliseconds; P = .06). There were no differences between patients with TC-associated TdP and patients with TC-associated QT interval prolongation in mean age, maximal troponin levels, and lowest ejection fraction. Overall, 12 (80.0%) patients with TC-associated TdP had risk factors for TdP other than the female sex and systolic dysfunction, including suspicion of congenital long QT syndrome, bradycardia, hypokalemia, recent conversion from atrial fibrillation to sinus rhythm, and using QT prolonging agents.

CONCLUSIONS

Men with TC-associated QT interval prolongation are at risk for TdP. Most patients with TC-associated TdP have risk factors for TdP other than the female sex and systolic dysfunction.

Reverse Takotsubo syndrome pattern induced by local anaesthesia

A szerzők a stressz-cardiomyopathiának, vagy más néven Takotsubo-szindrómának egy új megjelenési formáját ismertetik. Míg a klasszikus Takotsubo-szindróma esetén a szívcsúcs dilatációjának reverzíbilis volta figyelhető meg, a reverz Takotsubo-szindróma esetén pont fordítva, a bazális szegmensek reverzíbilis dilatációja és az apex hiperkinetikus mozgása látható. A reverz Takotsubo-jelenséget egy 36 éves nőbetegnél láttuk, akinél fülplasztikai műtét kapcsán tonogen-lidocainos lokális injekció váltotta ki a panaszokat és tüneteket. A tartós mellkasi fájdalom, EKG-eltérés és troponinpozitivitás hátterében coronariabetegség nem volt, az echokardiográfia a bal kamra bazális szegmenseinek akynesisét és az apex hyperkinesisét mutatta. A falmozgászavarok 3 nap alatt megszűntek.