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Madias JE. Frequent POCUS and auscultation for an earlier diagnosis of takotsubo syndrome and unraveling of its pathophysiology: The possible crucial role of LVOTO. Curr Probl Cardiol 2024; 49:102482. [PMID: 38401826 DOI: 10.1016/j.cpcardiol.2024.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
There is ample literature associating LVOTO with hypertension, AMI, LV hypertrophy, sigmoid septum, HCM, and TTS, particularly in midde aged/elderly/postmenopausal women, suggestive of a causal role for LVOTO in the pathophysiology of TTS. Although there is significant evidence that TTS is triggered by a sudden autonomic sympathetic nervous system surge and/or elevated blood-ridden catecholamines, the exact pathophysiologic trajectory leading to the clinical expression of the disease is still being debated. This review expounds on the possibility that LVOTO is a causal early component of this trajectory, and proposes that TTS is a malady within the broad spectrum of the myocardial ischemic injury/stunned myocardium states. The postulated underlying mechanism by which LVOTO causes TTS is a sudden abterload rise, with resultant oxygen/energy supply/demand mismatch, leading to a transient myocardial ischemia/injury myocardial stunning state. This needs to be explored painstakingly, and this review includes some suggestions for such undertaking. Ellucidation of the pathophysiology of TTS, and possible proof about a mechanistic role of LVOTO, may ensure that our current pharmacological and device panoply is adequate for the management of TTS.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States.
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2
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Elkattawy O, Sames A, Kunamneni S, Sutariya R, Ismail M, Mohamed O, Lee TJ, Javed J, Elkattawy S, Hossain A, Shamoon F. Pulmonary Embolism in Patients Admitted With Takotsubo Cardiomyopathy: Prevalence and Associated In-Hospital Adverse Events. Cureus 2024; 16:e59268. [PMID: 38813344 PMCID: PMC11135138 DOI: 10.7759/cureus.59268] [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: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Takotsubo cardiomyopathy (TCM) is a poorly understood condition typically characterized by abnormal left ventricular wall motion without causative coronary artery disease and typically presents in post-menopausal women after the experience of a physical or emotional stressor. The pathophysiology of TCM is complex and multifactorial, resulting in complications with varied severity; one of the most concerning complications is thromboembolism, specifically, pulmonary embolism (PE), which is understudied in its relation to TCM. The purpose of this study was to characterize and evaluate the real-world prevalence and outcomes of PE in TCM. Methods Data were derived from the National Inpatient Sample database from January 2016 to December 2019. The primary outcomes assessed were baseline and hospital admission characteristics and comorbidities for patients with TCM with and without PE. Outcomes for TCM patients with PE and predictors of mortality in TCM were also analyzed. Results PE developed in 788 of 40,120 patients with TCM (1.96%). After multivariate adjustment, PE was found to be independently associated with intracardiac thrombus (adjusted odds ratio (aOR) 2.067; 95% confidence interval (CI): 1.198-3.566; p = 0.009) and right heart catheterization (RHC) (aOR: 1.971; 95% CI: 1.160-3.350; p = 0.012). Mortality in patients with TCM was associated with, among other factors, age in years at admission (aOR: 1.104; 95% CI: 1.010-1.017; p = 0.001), African American race (aOR: 1.191; 95% CI: 1.020-1.391; p = 0.027), Asian or Pacific Islander race (aOR: 1.637; 95% CI: 1.283-2.090; p = 0.001), coagulopathy (aOR: 3.393; 95% CI: 2.889-2.986; p = 0.001), liver disease (aOR: 1.446; 95% CI: 1.147-1.824; p = 0.002), atrial fibrillation (aOR: 1.460; 95% CI: 1.320-1.615; p = 0.001), and pulmonary embolism (aOR: 2.217; 95% CI: 1.781-2.760; p = 0.001). Conclusion In a large cohort of patients admitted with TCM, we found the prevalence of PE to be 1.96%. PE, along with comorbidities such as coagulopathy and atrial fibrillation, was found to be a significant predictor of mortality in this patient cohort.
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Affiliation(s)
- Omar Elkattawy
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Antonia Sames
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sruthi Kunamneni
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Riya Sutariya
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Mohamed Ismail
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Omar Mohamed
- Medicine, Saint Barnabas Medical Center, Livingston, USA
| | - Thomas J Lee
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Jahanzeb Javed
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sherif Elkattawy
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Afif Hossain
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Fayez Shamoon
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
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Hassanzadeh S, Suleiman A, Correia JJ, Montazerin SM. COVID-19 vaccines-associated Takotsubo cardiomyopathy: A narrative review. LE INFEZIONI IN MEDICINA 2024; 32:1-11. [PMID: 38456019 PMCID: PMC10917559 DOI: 10.53854/liim-3201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024]
Abstract
Takotsubo cardiomyopathy (TTC) is a severe, acute, reversible, and self-limited cardiac dysfunction. It usually affects postmenopausal women and is mostly triggered by physical or emotional stressors. Following the COVID-19 pandemic, millions of doses of different types of COVID-19 vaccines are being administered globally. There have been reports of different cardiac complications after receiving COVID-19 vaccines. To our knowledge, there have been 16 reported cases of COVID-19 vaccination-associated TTC. In this study, we first provide a brief overview of TTC and then an overview of selected reported TTC cases following COVID-19 vaccinations. It is crucial to highlight that the occurrence of TTC after vaccination does not establish a direct cause-and-effect relationship between immunization and TTC. Further investigations are necessary to examine any potential association between COVID-19 vaccines and the incidence of TTC. Additionally, the benefits of receiving COVID-19 vaccines significantly outweigh the potential risks of developing adverse events.
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Affiliation(s)
- Shakiba Hassanzadeh
- Department of Pathology, East Carolina University, Greenville, North Carolina, USA
| | - Addi Suleiman
- Department of Cardiology, Saint Michael’s Medical Center, Newark, New Jersey, USA
| | - Joaquim J. Correia
- Department of Cardiology and Electrophysiology, Saint Michael’s Medical Center, Newark, New Jersey, USA
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4
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Jabbour JP, Arcari L, Cacciotti L, Magrì D, Recchioni T, Valeri L, Maggio E, Vizza CD, Badagliacca R, Papa S. Long-Term Functional Limitations on Cardiopulmonary Exercise Testing in Emotion-Triggered Takotsubo Syndrome. J Clin Med 2024; 13:1163. [PMID: 38398482 PMCID: PMC10889098 DOI: 10.3390/jcm13041163] [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: 01/25/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Background: In patients with prior Takotsubo syndrome (TTS), long-lasting functional cardiac limitations were described as compared with normal subjects. Emotion-triggered Takotsubo syndrome (E-TTS) has more favorable outcomes than TTS preceded by a physical trigger or by no identifiable factors. The aim of the present study was to assess long-term cardiac functional limitations in a cohort of asymptomatic E-TTS patients. Methods: We enrolled n = 40 asymptomatic patients with a diagnosis of E-TTS. Cardiopulmonary exercise tests (CPET) were performed at 30 (12-40) months median follow-up from the acute event. A cohort of n = 40 individuals matched for age, sex, body mass index and comorbidities served as control. Results: Despite recovery of left ventricular ejection fraction, patients with prior E-TTS had lower peak VO2 and percentage of predicted peak VO2 (17.8 ± 3.6 vs. 22.1 ± 6.5; p < 0.001 and 75.2 ± 14.1% vs. 100.6 ± 17.1%, p < 0.001), VO2 at anaerobic threshold (AT) (11.5 [10.1-12.9] vs. 14.4 [12.5-18.7]; p < 0.001), peak O2 pulse (9.8 ± 2.5 vs. 12.9 ± 3.5; p < 0.001) and higher VE/VCO2 slope (30.5 ± 3.7 vs. 27.3 ± 3.5; p < 0.001) compared with matched controls. We found no statistically significant differences in heart rate reserve (HRR), respiratory equivalent ratio (RER), mean blood pressure and peak PetCO2 between patients and controls. Conclusions: Despite its favorable outcome, patients with E-TTS in our population were found to have subclinical long-term functional cardiac limitations as compared with a control cohort.
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Affiliation(s)
- Jean Pierre Jabbour
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Luca Arcari
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, Italy;
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, Italy;
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Tommaso Recchioni
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Livia Valeri
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Enrico Maggio
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Carmine Dario Vizza
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Roberto Badagliacca
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
| | - Silvia Papa
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (J.P.J.); (L.A.); (T.R.); (L.V.); (E.M.); (C.D.V.); (R.B.)
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Vreeburg YL, Knight DS, Coghlan JG, Ong VH, Denton CP. Recurrent episodes of Takotsubo cardiomyopathy in systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2024; 9:NP7-NP11. [PMID: 38333521 PMCID: PMC10848928 DOI: 10.1177/23971983231188824] [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: 05/30/2023] [Accepted: 07/01/2023] [Indexed: 02/10/2024]
Abstract
Systemic sclerosis is an autoimmune disease characterized by fibrosis and small vessel vasculopathy, which affects various organ systems, such as the heart. Takotsubo cardiomyopathy is a transient cardiomyopathy in reaction to an emotional or physical trigger. There may be clinical and pathogenetic overlap between Takotsubo cardiomyopathy and primary systemic sclerosis heart disease, and some patients with systemic sclerosis have been diagnosed with recurrent Takotsubo cardiomyopathy. Our large systemic sclerosis clinical cohort was reviewed to identify cases diagnosed with Takotsubo cardiomyopathy. The clinical features, laboratory and imaging results were reviewed and evaluated to perform a comparison between cases. We identified five patients with systemic sclerosis, all female (age 68.6 ± 5.7 years), who were diagnosed with Takotsubo cardiomyopathy. Two of these patients had recurrent episodes: one case with a history of multiple episodes and the other with one recurrence. Typical features included repolarization abnormalities on the electrocardiogram and transient left ventricular dysfunction observed using echocardiography or cardiac magnetic resonance imaging. Our findings build upon previous reports and observations that systemic sclerosis may cause Takotsubo cardiomyopathy. To our knowledge, this is the largest case series of Takotsubo syndrome in patients with systemic sclerosis. This association may provide novel insights into the aetiopathogenesis of Takotsubo cardiomyopathy as part of primary systemic sclerosis heart involvement.
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Affiliation(s)
- Yumiko L Vreeburg
- Centre for Rheumatology and Connective Tissue Diseases, University College London Medical School, London, UK
| | | | - John G Coghlan
- Department of Cardiology, Royal Free Hospital, London, UK
| | - Voon H Ong
- Centre for Rheumatology and Connective Tissue Diseases, University College London Medical School, London, UK
- Department of Rheumatology, Royal Free Hospital, London, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, University College London Medical School, London, UK
- Department of Rheumatology, Royal Free Hospital, London, UK
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González-Jasso JG, Montero-Pola YL, Toledo-Salinas O, Schlie-Villa W, Muñóz-López A, García-Hernández E. [Takotsubo cardiomyopathy associated with abnormal birth of the coronary arteries]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:882-887. [PMID: 37995560 PMCID: PMC10727765 DOI: 10.5281/zenodo.10064743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/03/2023] [Indexed: 11/25/2023]
Abstract
Background Takotsubo cardiomyopathy (TM) is a form of non-ischemic cardiomyopathy. It is characterized by transient regional systolic dysfunction of the left ventricle that mimics acute myocardial infarction. The main objective of this article is to report the case of a patient with TM associated with abnormal birth of the left coronary trunk. Clinical case A 76-year-old woman with typical angina at rest, with an electrocardiogram that showed dynamic changes in the T wave and elevation of biomarkers. Coronary angiography showed epicardial coronary arteries without significant lesions and abnormal birth of the left coronary trunk from the proximal segment of the right coronary artery. The patient progressed favorably, and the transthoracic echocardiogram showed no mobility disorders 3 months after the event. Conclusions TM and abnormal birth of the coronary arteries are rare diseases whose simultaneous presentation is extraordinary. The diagnosis of both clinical entities is made by coronary angiography and echocardiogram, and their treatment is similar to that of patients with acute coronary syndrome. Abnormal birth of the left coronary trunk with retroaortic switch reaching the contralateral site has a good clinical prognosis and echocardiographic follow-up should be performed 4 weeks after the onset of the condition.
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Affiliation(s)
- Jesús Guadalupe González-Jasso
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Yuyi Lizeth Montero-Pola
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Coronarios. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Otoniel Toledo-Salinas
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Intensivos. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Werner Schlie-Villa
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Alexander Muñóz-López
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Servicio de Cardiología. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Ernesto García-Hernández
- Instituto Mexicano del Seguro Social, Centro Médico Nacional “La Raza”, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Unidad de Cuidados Coronarios. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
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7
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Madias JE. An Opportune Time to Consider Glucose-Insulin-Potassium Therapy for Takotsubo Syndrome. Am J Cardiovasc Drugs 2023; 23:467-470. [PMID: 37526886 DOI: 10.1007/s40256-023-00597-2] [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] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
This viewpoint takes the position that the management of takotsubo syndrome (TTS) should not wait the elucidation of the pathophysiology of this mysterious malady but should move along the direction currently implemented for acute coronary syndromes (ACS). Accordingly, and since there is a current rekindled interest in the salutary effect of glucose-insulin-potassium (GIK) for the management of acute myocardial infarction, and in general of the broad domain of ACS, it is the opinion of this author that it is an opportune time for the same therapeutic principles, including GIK, applied for the broad domain of suspected ACS (in view of the prospective phase 3 IMMEDIATE-2 trial), to be considered for TTS.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA.
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8
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Szántó D, Luterán P, Gál J, Nagy EV, Fülesdi B, Molnár C. Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review. Rev Cardiovasc Med 2023; 24:177. [PMID: 39077518 PMCID: PMC11264119 DOI: 10.31083/j.rcm2406177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/20/2023] [Accepted: 05/04/2023] [Indexed: 07/31/2024] Open
Abstract
Takotsubo syndrome (TS) is a frequent complication of subarachnoid hemorrhage (SAH), especially in massive SAH with severe neurological damage. The initial presentation of TS is similar to acute coronary syndrome, causing differential diagnostic issues. Unnecessary diagnostic steps and uncertainty in therapy may delay the definitive treatment of the aneurysm, therefore increasing the risk of rebleeding. The purpose of this review is to summarize the latest knowledge on the diagnosis and therapy of TS in SAH and to provide a diagnostic and therapeutic algorithm for the acute phase, promoting the early definitive treatment of the aneurysm. Rapid hemodynamic stabilization and early aneurysm securing are key points in reducing the risk of delayed cerebral ischemia and improving outcomes. In acute SAH noninvasive bedside diagnostic methods are preferred and securing the aneurysm is the priority. The combination of electrocardiography, cardiac biomarkers, and echocardiography is of great importance in differentiating TS from acute myocardial infarction. The risk-benefit ratio of coronary angiography should be carefully and individually considered and its use should be limited to patients with strong evidence of myocardial ischemia, after the successful endovascular treatment of the aneurysm. Invasive hemodynamic monitoring may be beneficial in cases of cardiogenic shock or pulmonary edema. In patients with hemodynamical instability secondary to TS, the use of non-catecholamine inotropes, especially levosimendan is recommended. In refractory hypotension, mechanical support should be considered. The left ventricular function improves within days to months after the acute event, low initial ejection fraction may predispose to delayed recovery.
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Affiliation(s)
- Dorottya Szántó
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- ELKH-DE Cerebrovascular Research Group, 4032 Debrecen, Hungary
| | - Péter Luterán
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Judit Gál
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Endre V. Nagy
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Béla Fülesdi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- ELKH-DE Cerebrovascular Research Group, 4032 Debrecen, Hungary
| | - Csilla Molnár
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
- ELKH-DE Cerebrovascular Research Group, 4032 Debrecen, Hungary
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9
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Madias JE. Some inquiries about the currently launched BROKEN SWEDEHEART therapeutic trial for takotsubo syndrome. Am Heart J 2023; 258:190-191. [PMID: 36925272 DOI: 10.1016/j.ahj.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY.
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10
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Hirono K. Cardiomyopathy: A New Perspective from Diagnostic Strategy. J Clin Med 2023; 12:jcm12062360. [PMID: 36983361 PMCID: PMC10053908 DOI: 10.3390/jcm12062360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Cardiomyopathy entails a broad group of diseases, acquired or genetic, which result in a similar phenotype [...].
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Affiliation(s)
- Keiichi Hirono
- Department of Pediatrics, University of Toyama, Toyama 930-0194, Japan
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11
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Casey B, Chen G, Bahekar A, Patel D, Guddeti R. Biventricular Takotsubo Cardiomyopathy Secondary to COVID-19. Cureus 2023; 15:e36153. [PMID: 37065403 PMCID: PMC10102670 DOI: 10.7759/cureus.36153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a heart failure syndrome characterized by acute and transient dysfunction of the apical segment of the left ventricle. Since the emergence of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the diagnosis of TCM has increased in prevalence. Here we present an intriguing case of a patient who initially presented to the hospital with respiratory failure and received a diagnosis of COVID-19. During the patient's hospital course, he was also diagnosed with biventricular TCM and subsequently experienced complete resolution of TCM before discharge. Providers should be cognizant of the potential cardiovascular complications of COVID-19 and consider those heart failure syndromes, including TCM, could be causing some of the respiratory dysfunction in these patients.
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12
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Shankar A, Devaraj N. Classic Unprovoked Takotsubo Syndrome: A Case Report. Cureus 2023; 15:e36056. [PMID: 37056535 PMCID: PMC10091156 DOI: 10.7759/cureus.36056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/16/2023] Open
Abstract
Although Takotsubo syndrome (TS) has been long recognized, it is now more frequently identified as a cause of stress-induced cardiac injury since its first description in the 1990s. While most cases are transient, many patients can have acute and long-term effects including persistent or worsening heart failure, arrhythmia, cardiac thrombi, outflow tract obstruction, ventricular wall rupture, and cardiogenic shock. Medical optimization is necessary to prevent cardiac remodeling and disease recurrence and manage associated heart failure. The choice of medications may vary from patient to patient based on the inciting factor or the most probable cause. Anticoagulation can be added for a small period of time if there is a concern for thrombus formation from akinesia/dyskinesia. Most patients achieve early recovery and resolution of symptoms and those with persistent manifestations can be managed medically.
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Takotsubo Syndrome: From Bench to Bedside and Bedside to Bench. J Clin Med 2022; 11:jcm11164704. [PMID: 36012945 PMCID: PMC9409923 DOI: 10.3390/jcm11164704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
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Madias JE. Anesthesia/surgery-triggered takotsubo syndrome: A dearth of specific knowledge on its pathophysiology and therapy. J Card Surg 2022; 37:1457. [PMID: 35191087 DOI: 10.1111/jocs.16351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of Cardiology, Elmhurst Hospital Center, Elmhurst, New York, USA
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Topf A, Mirna M, Dienhart C, Jirak P, Bacher N, Boxhammer E, Gharibeh SX, Motloch LJ, Hoppe UC, Lichtenauer M. Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome. Biomedicines 2022; 10:biomedicines10020464. [PMID: 35203673 PMCID: PMC8962389 DOI: 10.3390/biomedicines10020464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Treatment with betablockers is controversial in Takotsubo syndrome (TTS); however, many physicians intuitively initiate or continue betablocker therapy in these patients. The effect of preadmission betablocker use on adverse cardiovascular events has not been studied in the literature. Methods: To investigate this issue, we evaluated clinical complications, defined by the endpoint of occurrence of hemodynamically relevant arrythmia, cardiac decompensation, and all-cause adverse cardiac events, during hospitalization, in 56 patients hospitalized for TTS between April 2017 and July 2021. We compared the risk of adverse cardiovascular events between patients with preadmission betablocker therapy and those without preadmission betablocker therapy. Pretreatment betablocker therapy was defined as daily betablocker intake for more than a week including day of admission. Results: TTS patients taking preadmission betablockers had a significantly increased risk of all-cause complications relative to patients without betablockers in preadmission medication ((52.0% vs. 19.4%, p = 0.010; OR 4.5 (95% Cl 1.38–14.80)). Furthermore, TTS patients already taking betablockers on admission showed a statistically significant increased risk of cardiac decompensation when compared to patients without pretreatment with betablockers (p = 0.013). There were no significant differences in patient characteristics in patients who were taking beta blockers as an adjunct therapy prior to admission for TTS relative to those who were not. There is however an increase in comorbidities, hypertension, and atrial fibrillation, in past medical history in patients taking a preadmission betablocker. The difference is related to therapeutic applications for beta blockers and was not significant based on endpoints of our study. Conclusions: Preadmission betablocker treatment was associated with a 4.5 times higher risk of adverse cardiac events. This increased risk of all-cause complications and of cardiac decompensation within the acute phase of TTS is presumably due to the negative inotropic effects of betablockers and upregulation of β-adrenergic receptors in patients with chronic betablocker therapy.
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Affiliation(s)
- Albert Topf
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
- Correspondence:
| | - Moritz Mirna
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Christiane Dienhart
- Clinic for Internal Medicine I, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria;
| | - Peter Jirak
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Nina Bacher
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Elke Boxhammer
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Sarah X. Gharibeh
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Lukas J. Motloch
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Uta C. Hoppe
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
| | - Michael Lichtenauer
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (P.J.); (N.B.); (E.B.); (S.X.G.); (L.J.M.); (U.C.H.); (M.L.)
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Madias JE. Pathophysiology and therapy of Takotsubo syndrome. Letter regarding the article 'Pathophysiology of Takotsubo syndrome - a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology - Part 1: overview and the central role for catecholamines and sympathetic nervous system'. Eur J Heart Fail 2022; 24:1143. [PMID: 34989094 DOI: 10.1002/ejhf.2413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA
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17
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Madias JE. Pathophysiology of Takotsubo syndrome: still a puzzle. Letter regarding the article 'Pathophysiology of Takotsubo syndrome - a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology - Part 2: vascular pathophysiology, gender and sex hormones, genetics, chronic cardiovascular problems and clinical implications'. Eur J Heart Fail 2021; 24:1323. [PMID: 34816553 DOI: 10.1002/ejhf.2390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/19/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA
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18
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Madias JE. Comment on Paolisso et al. Impact of Admission Hyperglycemia on Heart Failure Events and Mortality in Patients With Takotsubo Syndrome at Long-term Follow-up: Data From HIGH-GLUCOTAKO Investigators. Diabetes Care 2021;44:2158-2161. Diabetes Care 2021; 44:e200. [PMID: 34670793 DOI: 10.2337/dc21-1542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, and Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY
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19
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Madias JE. Fentanyl for the prevention and management of Takotsubo syndrome. Clin Transplant 2021; 35:e14511. [PMID: 34708440 DOI: 10.1111/ctr.14511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of Cardiology, Elmhurst Hospital Center, Elmhurst, New York, USA
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