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Al‐sadi A, Al‐Qahtani A, Al‐Khalaila O, Jawarneh I, Karim SA. An ophthalmologist with myocardial bridging developed takotsubo cardiomyopathy while operating; A case report and literature review. Clin Case Rep 2023; 11:e7353. [PMID: 38028065 PMCID: PMC10665582 DOI: 10.1002/ccr3.7353] [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: 01/30/2023] [Revised: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message Healthcare workers are prone to very high level of physical as well as emotional stress that lead to devastating health-related consequences which include but not limited to cardiovascular events that may lead to death. Recognizing the risk of Takotsubo Cardiomyopathy among healthcare worker is the main aim of this report. Abstract Takotsubo Cardiomyopathy (TC) is a reversible left ventricular wall motion abnormality that could not be explained by coronary artery disease and is typically precipitated by either emotional or physical stress. There is no sufficient data regarding the incidence of TC among healthcare workers and people with myocardial bridging. Here we are describing a case of an ophthalmologist with myocardial bridging who developed TC while in the operation theater.
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Affiliation(s)
- Anas Al‐sadi
- Department of Internal MedicineHamad medical corporationDohaQatar
| | - Awad Al‐Qahtani
- Department of Cardiology, Heart HospitalHamad Medical CorporationDohaQatar
| | - Osama Al‐Khalaila
- Department of Cardiology, Heart HospitalHamad Medical CorporationDohaQatar
| | - Israa Jawarneh
- Department of Internal MedicineKing Abdullah University HospitalAr RamthaJordan
| | - Sabir Abdul Karim
- Department of Cardiology, Heart HospitalHamad Medical CorporationDohaQatar
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Couch LS, Channon K, Thum T. Molecular Mechanisms of Takotsubo Syndrome. Int J Mol Sci 2022; 23:12262. [PMID: 36293121 PMCID: PMC9603071 DOI: 10.3390/ijms232012262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
Takotsubo syndrome (TTS) is a severe but reversible acute heart failure syndrome that occurs following high catecholaminergic stress. TTS patients are similar to those with acute coronary syndrome, with chest pain, dyspnoea and ST segment changes on electrocardiogram, but are characterised by apical akinesia of the left ventricle, with basal hyperkinesia in the absence of culprit coronary artery stenosis. The pathophysiology of TTS is not completely understood and there is a paucity of evidence to guide treatment. The mechanisms of TTS are thought to involve catecholaminergic myocardial stunning, microvascular dysfunction, increased inflammation and changes in cardiomyocyte metabolism. Here, we summarise the available literature to focus on the molecular basis for the pathophysiology of TTS to advance the understanding of the condition.
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Affiliation(s)
- Liam S. Couch
- Department of Cardiovascular Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Keith Channon
- Department of Cardiovascular Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, 30625 Hannover, Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine, 30625 Hannover, Germany
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Karnati S, Guntas G, Rajendran R, Shityakov S, Höring M, Liebisch G, Kosanovic D, Ergün S, Nagai M, Förster CY. Quantitative Lipidomic Analysis of Takotsubo Syndrome Patients' Serum. Front Cardiovasc Med 2022; 9:797154. [PMID: 35514439 PMCID: PMC9062978 DOI: 10.3389/fcvm.2022.797154] [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] [Received: 10/18/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Takotsubo syndrome (TTS), also known as the transient left ventricular apical ballooning syndrome, is in contemporary times known as novel acute cardiac syndrome. It is characterized by transient left ventricular apical akinesis and hyperkinesis of the basal left ventricular portions. Although the precise etiology of TTS is unknown, events like the sudden release of stress hormones, such as the catecholamines and the increased inflammatory status might be plausible causes leading to the cardiovascular pathologies. Recent studies have highlighted that an imbalance in lipid accumulation might promote a deviant immune response as observed in TTS. However, there is no information on comprehensive profiling of serum lipids of TTS patients. Therefore, we investigated a detailed quantitative lipid analysis of TTS patients using ES-MSI. Our results showed significant differences in the majority of lipid species composition in the TTS patients compared to the control group. Furthermore, the computational analyses presented was able to link the altered lipids to the pro-inflammatory cytokines and disseminate possible mechanistic pathways involving TNFα and IL-6. Taken together, our study provides an extensive quantitative lipidome of TTS patients, which may provide a valuable Pre-diagnostic tool. This would facilitate the elucidation of the underlying mechanisms of the disease and to prevent the development of TTS in the future.
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Affiliation(s)
- Srikanth Karnati
- University of Würzburg, Institute of Anatomy and Cell Biology, Würzburg, Germany
- *Correspondence: Srikanth Karnati
| | - Gulcan Guntas
- Department of Biochemistry, Medical Faculty, Atilim University, Ankara, Turkey
| | - Ranjithkumar Rajendran
- Experimental Neurology, Department of Neurology, Justus Liebig University, Giessen, Germany
| | - Sergey Shityakov
- Infochemistry Scientific Center, Laboratory of Chemoinformatics, ITMO University, Saint-Petersburg, Russia
| | - Marcus Höring
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Gerhard Liebisch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Djuro Kosanovic
- Department of Pulmonology, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Süleyman Ergün
- University of Würzburg, Institute of Anatomy and Cell Biology, Würzburg, Germany
| | - Michiaki Nagai
- Hiroshima City Asa Hospital, Department of Cardiology, Hiroshima, Japan
| | - Carola Y. Förster
- University of Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
- Carola Y. Förster
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Kim JH, Jeong YJ, Park J, Lee PH, Jang JY, Lee S, Kim DH, Song JM, Kang DH, Song JK. Different Clinical Features between Definite and Possible Takotsubo Syndrome in a Tertiary Referral Hospital. Cardiology 2021; 147:154-164. [PMID: 34763341 DOI: 10.1159/000520472] [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: 04/23/2021] [Accepted: 10/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although imaging examination to exclude coronary artery disease (CAD) is an indispensable step for a definite diagnosis of Takotsubo syndrome (TTS), this step may be overlooked in a substantial proportion of patients with secondary TTS admitted to a tertiary hospital. However, the clinical profiles and outcomes of these patients with "possible TTS" have rarely been investigated. METHODS Among 420 consecutive TTS patients with characteristic transient ventricular ballooning on repeated echocardiography, 244 patients (58.1%) who underwent an imaging study for CAD were diagnosed with "definite TTS", whereas the remaining 176 were designated with "possible TTS". RESULTS Overall, hypoxia (67.6%) and dyspnea (55.5%) were predominant presentations. The possible group was characterized by higher prevalence of male gender (46.6% vs. 35.2%, p = 0.019), secondary TTS (97.2% vs. 86.5%, p <0.001), cancer (43.2% vs. 29.1%, p = 0.003), sepsis (46.0% vs. 32.0%, p = 0.003), and non-apical ballooning pattern (30.7% vs. 21.3%, p = 0.001) with less common ST-segment elevation on electrocardiogram (18.8% vs. 34.0%, p = 0.001). The possible group showed higher frequency of mechanical ventilation (56.2% vs. 40.2%, p = 0.001), pulmonary edema (72.2% vs. 61.5%, p = 0.023) and shock management (70.5% vs. 54.1%, p = 0.001) with similar in-hospital mortality (17.2% vs. 17.0%, p = 0.964). CONCLUSIONS In real-world clinical practice, coronary evaluation for strict diagnosis of TTS is not frequently feasible. Addition of the possible group without coronary evaluation to the clinical spectrum of TTS would be helpful for fair estimation of clinical implication of TTS.
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Affiliation(s)
- Ju Hyeon Kim
- Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeong Jin Jeong
- Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jino Park
- Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil Hyung Lee
- Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Yoon Jang
- Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sahmin Lee
- Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Song
- Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Hyun Kang
- Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Kwan Song
- Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Madias JE. Takotsubo Cardiomyopathy: Current Treatment. J Clin Med 2021; 10:3440. [PMID: 34362223 PMCID: PMC8347171 DOI: 10.3390/jcm10153440] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Management of takotsubo syndrome (TTS) is currently empirical and supportive, via extrapolation of therapeutic principles worked out for other cardiovascular pathologies. Although it has been emphasized that such non-specific therapies for TTS are consequent to its still elusive pathophysiology, one wonders whether it does not necessarily follow that the absence of knowledge of TTS' pathophysiological underpinnings should prevent us for searching, designing, or even finding, therapies efficacious for its management. Additionally, it is conceivable that therapy for TTS may be in response to pathophysiological/pathoanatomic/pathohistological consequences (e.g., "myocardial stunning/reperfusion injury"), common to both TTS and coronary artery disease, or other cardiovascular disorders). The present review outlines the whole range of management principles of TTS during its acute phase and at follow-up, including considerations pertaining to the recurrence of TTS, and commences with the idea that occasionally management of TTS should consist of mere observation along the "first do no harm" principle, while self-healing is under way. Finally, some new therapeutic hypotheses (i.e., large doses of insulin infusions in association with the employment of intravenous short- and ultrashort-acting β-blockers) are being entertained, based on previous extensive animal work and limited application in patients with neurogenic cardiomyopathy and TTS.
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Affiliation(s)
- John E. Madias
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; ; Tel.: +1-(718)-334-5005; Fax: +1-(718)-334-5990
- Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY 11373, USA
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Fan S, Gao L, Bell AC, Azure JA, Wang Y. Spontaneous myogenic fasciculation associated with the lengthening of cardiac muscle in response to static preloading. Sci Rep 2021; 11:14794. [PMID: 34285326 PMCID: PMC8292328 DOI: 10.1038/s41598-021-94335-w] [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] [Received: 02/19/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
Force enhancement is one kind of myogenic spontaneous fasciculation in lengthening preload striated muscles. In cardiac muscle, the role of this biomechanical event is not well established. The physiological passive property is an essential part for maintaining normal diastole in the heart. In excessive preload heart, force enhancement relative erratic passive properties may cause muscle decompensating, implicate in the development of diastolic dysfunction. In this study, the force enhancement occurrence in mouse cardiac papillary muscle was evaluated by a microstepping stretch method. The intracellular Ca2+ redistribution during occurrence of force enhancement was monitored in real-time by a Flou-3 (2 mM) indicator. The force enhancement amplitude, the enhancement of the prolongation time, and the tension-time integral were analyzed by myography. The results indicated that the force enhancement occurred immediately after active stretching and was rapidly enhanced during sustained static stretch. The presence of the force and the increase in the amplitude synchronized with the acquisition and immediate transfer of Ca2+ to adjacent fibres. In highly preloaded fibres, the enhancement exceeded the maximum passive tension (from 4.49 ± 0.43 N/mm2 to 6.20 ± 0.51 N/mm2). The occurrence of force enhancement were unstable in each static stretch. The increased enhancement amplitude combined with the reduced prolongation time to induce a reduction in the tension-time integral. We concluded that intracellular Ca2+-synchronized force enhancement is one kind of interruption event in excessive preload cardiac muscle. During the cardiac muscle in its passive relaxation period, the occurrence of this interruption affected the rhythmic stability of the cardiac relaxation cycle.
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Affiliation(s)
- Shouyan Fan
- grid.443397.e0000 0004 0368 7493Laboratory of Extreme Environment Sports Medicine, Hainan Medical University, No. 3 Chengxi Xueyuan Road, Haikou, Hainan PFTZ 571199 China
| | - Lingfeng Gao
- grid.443397.e0000 0004 0368 7493Laboratory of Extreme Environment Sports Medicine, Hainan Medical University, No. 3 Chengxi Xueyuan Road, Haikou, Hainan PFTZ 571199 China
| | - Annie Christel Bell
- grid.443397.e0000 0004 0368 7493Laboratory of Extreme Environment Sports Medicine, Hainan Medical University, No. 3 Chengxi Xueyuan Road, Haikou, Hainan PFTZ 571199 China ,grid.443397.e0000 0004 0368 7493School of Emergency Trauma, Hainan Medical University, Haikou, Hainan PFTZ 571199 China
| | - Joseph Akparibila Azure
- grid.443397.e0000 0004 0368 7493Laboratory of Extreme Environment Sports Medicine, Hainan Medical University, No. 3 Chengxi Xueyuan Road, Haikou, Hainan PFTZ 571199 China ,grid.443397.e0000 0004 0368 7493School of Emergency Trauma, Hainan Medical University, Haikou, Hainan PFTZ 571199 China
| | - Yang Wang
- grid.443397.e0000 0004 0368 7493Laboratory of Extreme Environment Sports Medicine, Hainan Medical University, No. 3 Chengxi Xueyuan Road, Haikou, Hainan PFTZ 571199 China
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Agarwal S, Sanghvi C, Odo N, Castresana MR. Perioperative takotsubo cardiomyopathy: Implications for anesthesiologist. Ann Card Anaesth 2020; 22:309-315. [PMID: 31274495 PMCID: PMC6639891 DOI: 10.4103/aca.aca_71_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by transient ventricular dysfunction in the absence of obstructive coronary artery disease that may be triggered by an acute medical illness or intense physical or emotional stress. TCM is often confused with acute myocardial infarction given the similar electrocardiographic changes, cardiac enzymes, hemodynamic perturbations, and myocardial wall motion abnormalities. In the perioperative setting, the clinical picture may be more confusing because of the effect of anesthesia as well as hemodynamic changes related to the surgery itself. However, awareness of various other diagnostic modalities may enable clinicians to distinguish between the two, more systematically and with greater certainty. Despite the large body of literature, there still seems to be an overall paucity in our understanding of the etiopathogenesis, clinical characteristics, natural history, and management of this syndrome, especially in the perioperative setting. This narrative review seeks to present and synthesize the most recent literature on TCM and to identify gaps in current knowledge which can become the basis for future research.
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Affiliation(s)
- Shvetank Agarwal
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Chinar Sanghvi
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nadine Odo
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Manuel R Castresana
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Vijiiac A, Ploscaru V, Vatasescu RG. The Great Myocardial Mimic - Takotsubo Syndrome. MAEDICA 2020; 15:111-121. [PMID: 32419871 PMCID: PMC7221266 DOI: 10.26574/maedica.2020.15.1.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Takotsubo syndrome has been traditionally considered a reversible form of acute heart failure triggered by an emotional or physical stressor, mainly occurring in women of post-menopausal age and often mimicking an acute coronary syndrome. While its pathophysiology is still incompletely understood, sympathetic overstimulation is known to play a central role in the disease. The classical hallmark of the condition was the presence of wall motion abnormalities limited to the apical segments of the ventricle, leading to the so-called apical ballooning, but different patterns of wall motion abnormalities are nowadays recognised. Different definitions and diagnostic criteria for takotsubo syndrome were proposed during the last decades, reflecting the heterogeneity of the condition and the gaps in the thorough understanding of the disease. While initially it was believed to be a benign entity, takotsubo syndrome has in fact similar morbidity and mortality with acute coronary syndromes, both on short- and long-term, highlighting the importance of proper risk stratification. Many questions still remain unanswered concerning the pathophysiology of the syndrome and the optimal therapeutic strategy for these patients.
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Affiliation(s)
- Aura Vijiiac
- Cardiology Department, Emergency Clinical Hospital Bucharest, Romania
| | - Vlad Ploscaru
- Cardiology Department, Emergency Clinical Hospital Bucharest, Romania
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Power HS. Under-diagnosis of Takotsubo Cardiomyopathy Increases Risk of Adverse Events: A Case Study. Cureus 2019; 11:e5749. [PMID: 31723510 PMCID: PMC6825445 DOI: 10.7759/cureus.5749] [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: 11/22/2022] Open
Abstract
Takotsubo cardiomyopathy (TC), or broken-heart syndrome, is characterized by high levels of adrenaline and noradrenaline leading to coronary artery vasospasm. Often presenting similarly to myocardial infarction (MI), Takotsubo is under-diagnosed in the population, typically leading to management under MI guidelines. An 80-year-old woman presented with chest pain and electrocardiogram (EKG or ECG) changes but on further investigations, it emerged that the underlying pathology was not consistent with MI. Here, we highlight the importance of considering alternative diagnoses even with an initially seemingly clear-cut picture of MI. Due to the nature of the pathology, management of Takotsubo under MI protocols can lead to worsened outcomes. It is therefore of importance to increasingly consider TC as a diagnosis in cases of unclear MI.
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Buchmann SJ, Lehmann D, Stevens CE. Takotsubo Cardiomyopathy-Acute Cardiac Dysfunction Associated With Neurological and Psychiatric Disorders. Front Neurol 2019; 10:917. [PMID: 31507520 PMCID: PMC6714036 DOI: 10.3389/fneur.2019.00917] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 08/07/2019] [Indexed: 12/12/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC) is an acute and reversible cardiac wall motion abnormality of the left myocardium. Although many studies focused on etiology, diagnostic and treatment of TTC, precise clinical guidelines on TTC are not available. Research revealed emotional and physical triggering factors of TTC and emphasized the association of TTC with psychiatric and particularly acute neurological disorders. Similar clinical presentation of acute coronary syndrome (ACS) and TTC patients, makes an anamnestic screening for TTC risk factors necessary. In psychiatric anamnesis affective disorders and chronic anxiety disorders are presumably for TTC. Subarachnoid hemorrhages and status epilepticus are typical acute neurological associated with a higher risk for TTC. Moreover, magnetic resonance imaging (MRI) studies reveled brain alterations of the limbic system and reduced connectivity of central autonomic nervous system structures. Diagnosis of TTC is made by elevation of cardiac enzymes, electrocardiogram (ECG) and visualization of myocardial wall motion. Major differential diagnoses like acute coronary syndrome and myocarditis are hereby in synopsis with anamnesis with respect of possible emotional and physical triggering factors of TTC ruled out. In most cases the TTC typical wall motion abnormalities resolve in weeks and therapy is only necessary in hemodynamic instable patients and if rare complications, like cardiac wall ruptures occur. Recently, the two-parted International expert consensus document on Takotsubo syndrome was published, providing a detailed characterization of TTC and allows clinicians to understand this cardiac dysfunction with a multidisciplinary view.
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Affiliation(s)
- Sylvia J Buchmann
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dana Lehmann
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christin E Stevens
- Department of Neurology, Augustahospital Anholt, Isselburg-Anholt, Germany
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Gupta S, Goyal P, Idrees S, Aggarwal S, Bajaj D, Mattana J. Association of Endocrine Conditions With Takotsubo Cardiomyopathy: A Comprehensive Review. J Am Heart Assoc 2018; 7:e009003. [PMID: 30371307 PMCID: PMC6404898 DOI: 10.1161/jaha.118.009003] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sonali Gupta
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Pradeep Goyal
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
- Department of RadiologySt. Vincent's Medical CenterBridgeportCT
| | - Sana Idrees
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Sourabh Aggarwal
- Cardiology DivisionDepartment of MedicineUniversity of Nebraska Medical CenterOmahaNE
| | - Divyansh Bajaj
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
| | - Joseph Mattana
- Department of MedicineSt. Vincent's Medical CenterBridgeportCT
- The Frank H. Netter MD School of Medicine at Quinnipiac UniversityNorth HavenCT
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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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13
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Stress cardiomyopathy of the critically ill: Spectrum of secondary, global, probable and subclinical forms. Indian Heart J 2017; 70:177-184. [PMID: 29455775 PMCID: PMC5903071 DOI: 10.1016/j.ihj.2017.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/05/2017] [Indexed: 02/06/2023] Open
Abstract
Stress cardiomyopathy (SC) typically presents as potential acute coronary syndrome (ACS) in previously healthy people. While there may be physical or mental stressors, the initial symptom is usually chest pain. This form conforms to the published Mayo diagnostic criteria, is well reported and as the presentation is initially cardiac, is considered primary SC. Increasingly we see SC develop several days into the hospitalization secondary to medical or surgical critical illness. This condition is more complex, presents atypically, is not easy to recognize and carries a much worse prognosis. Label of Secondary SC is appropriate as it manifests in sicker hospitalized patients with numerous comorbidities. We review the limited but provocative literature pertinent to SC in the critically ill and describe important clues to identify global, subclinical and probable forms of SC. We illustrate the several unique clinical features, demographic differences and propose a diagnostic algorithm to optimize cardiac care in the critically ill.
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Sestini S, Pestelli F, Leoncini M, Bellandi F, Mazzeo C, Mansi L, Carrio I, Castagnoli A. The natural history of takotsubo syndrome: a two-year follow-up study with myocardial sympathetic and perfusion G-SPECT imaging. Eur J Nucl Med Mol Imaging 2016; 44:267-283. [PMID: 27909770 DOI: 10.1007/s00259-016-3575-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/18/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate changes in sympathetic activity, perfusion, and left ventricular (LV) functionality in takotsubo cardiomyopathy (TTC) patients from onset (T0) to post-onset conditions at 1 month (T1), 1-2 years (T2, T3). METHODS Twenty-two patients (70 ± 11 years) underwent serial gated single photon emission tomography (G-SPECT) studies with 123I-mIBG and 99mTc-Sestamibi. Statistics were performed using ANOVA/Sheffé post-hoc, correlation test, and receiver operating characteristic (ROC) curve analysis (p < 0.05). RESULTS Patients presented at T0 with LV ballooning and reduced early-late mIBG uptake (95%, 100%), left ventricular ejection fraction (LVEF)G-SPECT (86%) and perfusion (77 %). Adrenergic dysfunction was greater in apex, it overlaps with contractile impairment, and both were more severe than perfusion defect. During follow-up, LVEFG-SPECT, contractility, and perfusion were normal, while 82% and 90% of patients at T1 and 50% at T2 and T3 continued to show a reduced apical early-late mIBG distribution. These patients presented at T0-T1 with greater impairment of adrenergic function, contractility, and perfusion. A relationship was present within innervation and both perfusion and contractile parameters at T0 and T1, and between the extent of adrenergic defect at T3 and both the defect extent and age at T0 (cut-off point 42.5%, 72 years). CONCLUSION Outcome for TTC is not limited to a reversible contractile and perfusion abnormalities, but it includes residual adrenergic dysfunction, depending on the level of adrenergic impairment and age of patients at onset. The number of patients, as well as degree of perfusion abnormalities were found to be higher than those previously reported possibly depending on the time-interval between hospital admission and perfusion scan.
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Affiliation(s)
- Stelvio Sestini
- Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy.
| | - Francesco Pestelli
- Deptartment of Internal Medicine, Cardiovascular Unit, N.O.P. - S. Stefano, U.S.L, Toscana Centro, Prato, Italy
| | - Mario Leoncini
- Deptartment of Internal Medicine, Cardiovascular Unit, N.O.P. - S. Stefano, U.S.L, Toscana Centro, Prato, Italy
| | - Francesco Bellandi
- Deptartment of Internal Medicine, Cardiovascular Unit, N.O.P. - S. Stefano, U.S.L, Toscana Centro, Prato, Italy
| | - Christian Mazzeo
- Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy
| | - Luigi Mansi
- Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, University II Naples, Naples, Italy
| | - Ignasi Carrio
- Nuclear Medicine, Hospital Sant Pau, Barcelona, Spain
| | - Antonio Castagnoli
- Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy
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Jung YS, Lee JS, Min YG, Park JS, Jeon WC, Park EJ, Shin JH, Oh S, Choi SC. Carbon monoxide-induced cardiomyopathy. Circ J 2014; 78:1437-44. [PMID: 24705389 DOI: 10.1253/circj.cj-13-1282] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous reports demonstrated mechanisms of cardiac toxicity in acute carbon monoxide (CO) poisoning. Still, none established CO-induced cardiomyopathy (CMP) as a clinical entity. The aim of this study is to investigate CO-induced CMP in patients with acute CO poisoning in terms of its epidemiology, clinical characteristics, and prognosis. METHODS AND RESULTS A retrospective study was conducted on consecutive patients who were diagnosed with acute CO poisoning at the emergency department of Ajou University Hospital during the period of 62 month. Six hundred and twenty-six patients were diagnosed with acute CO poisoning. During the initial echocardiography, 19 patients were abnormal: (1) global hypokinesia/akinesia (n=7), (2) regional wall hypokinesia/akinesia [n=12; takotsubo type (n=6), reverse takotsubo type (n=2), non-specific type (n=4)]. The ejection fraction (EF) was 36.3±13.5% (from 15% to 55%) and less than 45% for 14 patients. In the follow-up echocardiography performed within 12 days after the initial performance, most patients were found to have cardiac wall motion abnormalities, and their EF had returned to normal (ie, EF ≥50%). CONCLUSIONS CO-induced CMP was identified in 3.04% (n=19) of all patients (n=626). It might not be too critical in acute clinical courses of acute CO poisoning because the prognosis seems favorable. Considering the common factors between CO-induced CMP and takotsubo CMP, myocardial stunning subject to a catecholamine surge most likely plays a central role in the development of CO-induced CMP.
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Affiliation(s)
- Yoon-Seok Jung
- Department of Emergency Medicine, Ajou University School of Medicine
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