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Kinoshita H, Morita M, Maeda S, Kanegawa M, Sumimoto Y, Masada K, Shimonaga T, Sugino H. A curious Takotsubo cardiomyopathy after COVID-19. IDCases 2024; 36:e01958. [PMID: 38681073 PMCID: PMC11047175 DOI: 10.1016/j.idcr.2024.e01958] [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: 11/05/2023] [Revised: 03/28/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024] Open
Abstract
We present the case of a 66-year-old woman undergoing chronic dialysis who developed pneumonia and enteritis after being infected with COVID-19 and had severe wall motion reduction similar to a left ventricular aneurysm. There was concern that the condition might worsen due to left ventricular wall thinning and curious wall motion abnormalities, but echocardiography one month later showed normalization. After four months, simultaneous binuclear myocardial scintigraphy of thallium and BMIPP showed that the mismatch had disappeared. We considered that there may be other factors specific to COVID-19 infection in addition to the stress associated with infection and reviewed the literature.
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Affiliation(s)
- Haruyuki Kinoshita
- Department of Cardiology National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure 737-0023, Japan
| | - Masashi Morita
- Department of Cardiology National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure 737-0023, Japan
| | - Shiori Maeda
- Department of Cardiology National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure 737-0023, Japan
| | - Munehiro Kanegawa
- Department of Cardiology National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure 737-0023, Japan
| | - Yoji Sumimoto
- Department of Cardiology National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure 737-0023, Japan
| | - Kenji Masada
- Department of Cardiology National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure 737-0023, Japan
| | - Takashi Shimonaga
- Department of Cardiology National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure 737-0023, Japan
| | - Hiroshi Sugino
- Department of Cardiology National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Aoyamacho 3-1, Kure 737-0023, Japan
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Takotsubo cardiomyopathy in a female presenting with status asthmaticus: a case report and review of literature. Egypt Heart J 2022; 74:72. [PMID: 36183036 PMCID: PMC9526768 DOI: 10.1186/s43044-022-00310-9] [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] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
Background Takotsubo cardiomyopathy (TCM) is a non-ischemic syndrome characterized by transient acute left ventricular dysfunction as evident on transthoracic echocardiography. It can often mimic myocardial ischemia and is characterized by the absence of angiographic evidence of obstructive coronary artery disease. Reports of Takotsubo syndrome in elderly with asthma exacerbations have been noted. Case presentation We describe a case of TCM in a 68-year-old female who presented with acute shortness of breath secondary to status asthmaticus. Her electrocardiogram showed ST segment elevations in multiple coronary artery distributions and mildly elevated troponin levels. Coronary angiography showed no significant stenosis of the coronary arteries with left ventriculography that showed systolic apical ballooning with a 10% ejection fraction, consistent with TCM. Conclusions Takotsubo syndrome should be considered in the differential diagnosis of patients presenting with status asthmaticus and elevated troponin levels on admission. Patients should be asked about the use of beta agonist prior to admission. A thorough literature review including a summary of 11 previously published case reports of TCM with acute asthma exacerbations has been presented. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-022-00310-9.
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Badami KG. Transfusion double whammy? Adrenaline-takotsubo-anaphylaxis-Kounis complex post transfusion? Vox Sang 2022; 117:862-865. [PMID: 35191041 DOI: 10.1111/vox.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The adrenaline-takotsubo-anaphylaxis-Kounis, or the ATAK complex, where there are clinical and pathophysiological overlaps between takotsubo and Kounis syndromes, in which histaminergic, adrenergic and other mediators may play roles, was recently described. The objective of this report was to describe three cases where the ATAK complex was suspected to have occurred after transfusion. MATERIALS AND METHODS Three cases were recently reported to the New Zealand Blood Service haemovigilance programme that appeared to have features in common suggestive of the ATAK complex. RESULTS All three patients had had a blood component transfused, an initial severe allergic reaction, treatment with adrenaline or a congener, subsequent acute left ventricular failure or transfusion-associated circulatory overload, and features suggestive of takotsubo cardiomyopathy. CONCLUSIONS Although rarely described, transfusion-associated ATAK complex may be occurring more often than believed. Circumstances during a transfusion may predispose to it. It should be suspected if the sequence of events described above occur. Its characteristics need to be better understood. Risk factors for it may be modifiable.
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Ito M, Fukui K, Miyamoto N, Kato H, Miki K, Shiobara K, Nagai T. Takotsubo cardiomyopathy in a bedridden patient with dementia and communication difficulties due to Alzheimer’s disease. J Rural Med 2022; 17:89-93. [PMID: 35432639 PMCID: PMC8984618 DOI: 10.2185/jrm.2021-055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/18/2021] [Indexed: 11/27/2022] Open
Abstract
Takotsubo cardiomyopathy is a transient wall motion abnormality of the left ventricular
apex, accompanied by emotional or physical stress. Although Takotsubo cardiomyopathy is
generally considered a benign disease, severe clinical complications may occur, and early
detection of the disease is important. In this report, we present the case of an
86-year-old bedridden woman with a history of bronchial asthma who was transferred to our
hospital because of wheezing. She was diagnosed with Alzheimer’s disease and had
communication difficulties. After an asthma attack and improvement, Takotsubo
cardiomyopathy was identified via electrocardiography. She was unable to complain of any
symptoms but showed serial electrocardiographic changes, elevated myocardial markers, and
transient left ventricular apical ballooning. The prevalence of dementia increases
dramatically with age. This case indicates that Takotsubo cardiomyopathy may occur even in
patients with severe dementia, who are bedridden and show communication difficulties in a
clinical setting.
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Affiliation(s)
- Masahiro Ito
- Department of Internal Medicine, Nagaoka-Nishi Hospital, Japan
| | - Kazuhito Fukui
- Department of Internal Medicine, Nagaoka-Nishi Hospital, Japan
| | - Niichi Miyamoto
- Department of Internal Medicine, Nagaoka-Nishi Hospital, Japan
| | - Hiroshi Kato
- Department of Internal Medicine, Nagaoka-Nishi Hospital, Japan
| | - Kenji Miki
- Department of Neurology, Nagaoka-Nishi Hospital, Japan
| | | | - Tsuneo Nagai
- Department of Internal Medicine, Nagaoka-Nishi Hospital, Japan
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Khan MA, Howell A, Pham T, Guzman N. Reverse Takotsubo Cardiomyopathy in the Setting of Acute Asthma Exacerbation. Cureus 2021; 13:e15469. [PMID: 34262807 PMCID: PMC8260191 DOI: 10.7759/cureus.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 11/29/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC) is a reversible form of myocardial injury characterized by transient systolic and diastolic dysfunction secondary to regional left ventricle (LV) wall motion abnormalities. We present a case of a rare variant of TTC, termed reverse TTC (rTTC), involving basal hypokinesis with apical hyperkinesis accounting for less than 5% of identified cases of TTC. Our patient is a 49-year-old Hispanic female who presented for evaluation of dyspnea. She was diagnosed with acute asthma exacerbation. The patient admitted to more frequent use of her albuterol rescue inhaler. Over the course of her hospitalization the patient had elevation of Troponin I and underwent an echocardiogram and coronary angiogram, which revealed the diagnosis of rTTC in the setting of inhaled beta agonist overuse for acute asthma exacerbation. Our case highlights the importance of adequately managing asthma to prevent exacerbation and overuse of inhaled sympathomimetic agents in an effort to decrease the incidence of TTC in the asthmatic population.
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Affiliation(s)
- Muhammad A Khan
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | | | - Thuy Pham
- Cardiology, Orange Park Medical Center, Orange Park, USA
| | - Nilmarie Guzman
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
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Kansara T, Dumancas C, Neri F, Mene-Afejuku TO, Akinlonu A, Mushiyev S, Pekler G, Visco F. Rare Association of Takotsubo Cardiomyopathy with Right Bundle Branch Block in the Dual Setting of Asthma Exacerbation and Psychiatric Illness. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920461. [PMID: 31959739 PMCID: PMC6998788 DOI: 10.12659/ajcr.920461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patient: Male, 58-year-old Final Diagnosis: Takotsubo cardiomyopathy Symptoms: Dyspena Medication:— Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Tikal Kansara
- Department of Internal Medicine, New York Medical College, NYC Health + Hospitals/Metropolitan, New York City, NY, USA
| | - Carissa Dumancas
- Department of Internal Medicine, New York Medical College, NYC Health + Hospitals/Metropolitan, New York City, NY, USA
| | - Feizi Neri
- Department of Internal Medicine, New York Medical College, NYC Health + Hospitals/Metropolitan, New York City, NY, USA
| | - Tuoyo O Mene-Afejuku
- Department of Internal Medicine, New York Medical College, NYC Health + Hospitals/Metropolitan, New York City, NY, USA
| | - Adedoyin Akinlonu
- Department of Internal Medicine, New York Medical College, NYC Health + Hospitals/Metropolitan, New York City, NY, USA
| | - Savi Mushiyev
- Department of Medicine, Division of Cardiology, New York Medical College, NYC Health + Hospitals/Metropolitan, New York City, NY, USA
| | - Gerald Pekler
- Department of Medicine, Division of Cardiology, New York Medical College, NYC Health + Hospitals/Metropolitan, New York City, NY, USA
| | - Ferdinand Visco
- Department of Medicine, Division of Cardiology, New York Medical College, NYC Health + Hospitals/Metropolitan, New York City, NY, USA
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Medina de Chazal H, Del Buono MG, Keyser-Marcus L, Ma L, Moeller FG, Berrocal D, Abbate A. Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review. J Am Coll Cardiol 2018; 72:1955-1971. [PMID: 30309474 PMCID: PMC7058348 DOI: 10.1016/j.jacc.2018.07.072] [Citation(s) in RCA: 316] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Abstract
Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its self-limiting clinical course, but now recognized to be associated with a non-negligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Due to an increased awareness and recognition, the incidence of stress cardiomyopathy has been rising (15-30 cases per 100,000 per year), although the true incidence is unknown as the condition is likely underdiagnosed. Stress cardiomyopathy represents a form of neurocardiogenic myocardial stunning, and while the link between the brain and the heart is established, the exact pathophysiological mechanisms remain unclear. We herein review the proposed risk factors and triggers for the syndrome and discuss a practical approach to diagnosis and treatment of the patients with stress cardiomyopathy, highlighting potential challenges and unresolved questions.
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Affiliation(s)
- Horacio Medina de Chazal
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina
| | - Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Lori Keyser-Marcus
- 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Liangsuo Ma
- Institute of Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
| | - F Gerard Moeller
- 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia; Institute of Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia
| | - Daniel Berrocal
- Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; 'Dianne and C. Kenneth Wright' Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia.
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Kotsiou OS, Douras A, Makris D, Mpaka N, Gourgoulianis KI. Takotsubo cardiomyopathy: A known unknown foe of asthma. J Asthma 2017; 54:880-886. [PMID: 28055270 DOI: 10.1080/02770903.2016.1276586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Patients with uncontrolled asthma are at a greater risk of asthma attacks requiring emergency room visits or hospital admissions. Takotsubo cardiomyopathy is potentially a significant complication in a course of status asthmaticus. CASE STUDY We describe a 43-year-old female patient who presented with status asthmaticus that was further complicated with takotsubo cardiomyopathy. RESULTS Recognizing apical ballooning syndrome is challenging in patients with a history of respiratory disease because the symptoms of the last entity may complicate the diagnostic approach. It is difficult to distinguish clinically apical ballooning syndrome from the acute airway exacerbation itself. Both asthma and takotsubo cardiomyopathy share the same clinical presentation with dyspnea and chest tightness. In our patient, the electrocardiographic abnormalities, the rapidly reversible distinctive characteristics of echocardiography, and the modest elevation of serum cardiac biomarkers levels, in combination with the presence of a stress trigger (severe asthma attack), strongly supported the diagnosis of broken heart syndrome. CONCLUSIONS Clinicians should re-evaluate asthma management and be aware of the complications associated with asthma attacks such as stress-induced cardiomyopathy.
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Affiliation(s)
- Ourania S Kotsiou
- a Department of Respiratory Medicine , Faculty of Medicine, University Hospital of Larissa, University of Thessaly, BIOPOLIS , Larissa , Greece
| | - Alexandros Douras
- b Department of Cardiology , General Hospital of Volos , Magnesia , Greece
| | - Demosthenes Makris
- c Department of Critical Care , University Hospital of Larissa, Faculty of Medicine, University of Thessaly, BIOPOLIS , Larissa , Greece
| | - Nikoleta Mpaka
- b Department of Cardiology , General Hospital of Volos , Magnesia , Greece
| | - Konstantinos I Gourgoulianis
- a Department of Respiratory Medicine , Faculty of Medicine, University Hospital of Larissa, University of Thessaly, BIOPOLIS , Larissa , Greece
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