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Jaafar N, Sharma R, Sairam J, Duddu A. Volvulus is Stressful: Stress-Induced Cardiomyopathy Secondary to Gastric Volvulus and Paraesophageal Hernia. Cureus 2024; 16:e61031. [PMID: 38915959 PMCID: PMC11194533 DOI: 10.7759/cureus.61031] [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: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Stress-induced cardiomyopathy (SCM) is a cardiac systolic dysfunction caused by various stressful triggers. It is often transient and reversible upon the reversal of the underlying stressor. We present the case of a 70-year-old female with SCM in the setting of gastric volvulus and incarcerated para-esophageal hernia.
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Affiliation(s)
- Nadim Jaafar
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Rahul Sharma
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Jayashrei Sairam
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
| | - Akshay Duddu
- Internal Medicine, Greater Baltimore Medical Center, Towson, USA
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2
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Counseller Q, Aboelkassem Y. Recent technologies in cardiac imaging. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 4:984492. [PMID: 36704232 PMCID: PMC9872125 DOI: 10.3389/fmedt.2022.984492] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
Cardiac imaging allows physicians to view the structure and function of the heart to detect various heart abnormalities, ranging from inefficiencies in contraction, regulation of volumetric input and output of blood, deficits in valve function and structure, accumulation of plaque in arteries, and more. Commonly used cardiovascular imaging techniques include x-ray, computed tomography (CT), magnetic resonance imaging (MRI), echocardiogram, and positron emission tomography (PET)/single-photon emission computed tomography (SPECT). More recently, even more tools are at our disposal for investigating the heart's physiology, performance, structure, and function due to technological advancements. This review study summarizes cardiac imaging techniques with a particular interest in MRI and CT, noting each tool's origin, benefits, downfalls, clinical application, and advancement of cardiac imaging in the near future.
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Affiliation(s)
- Quinn Counseller
- College of Health Sciences, University of Michigan, Flint, MI, United States
| | - Yasser Aboelkassem
- College of Innovation and Technology, University of Michigan, Flint, MI, United States,Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, United States,Correspondence: Yasser Aboelkassem
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3
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Pancholi P, Emami N, Fazzari MJ, Kapoor S. Stress cardiomyopathy in critical care: A case series of 109 patients. World J Crit Care Med 2022; 11:149-159. [PMID: 36331975 PMCID: PMC9136722 DOI: 10.5492/wjccm.v11.i3.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/20/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Critically ill patients are at risk of developing stress cardiomyopathy (SC) but can be under-recognized.
AIM To describe a case series of patients with SC admitted to critical care units.
METHODS We conducted a retrospective observational study at a tertiary care teaching hospital. All adult (≥ 18 years old) patients admitted to the critical care units with stress cardiomyopathy over 5 years were included.
RESULTS Of 24279 admissions to the critical care units [19139 to medical-surgical intensive care units (MSICUs) and 5140 in coronary care units (CCUs)], 109 patients with SC were identified. Sixty (55%) were admitted to the coronary care units (CCUs) and forty-nine (45%) to the medical-surgical units (MSICUs). The overall incidence of SC was 0.44%, incidence in CCU and MSICU was 1.16% and 0.25% respectively. Sixty-two (57%) had confirmed SC and underwent cardiac catheterization whereas 47 (43%) had clinical SC, and did not undergo cardiac catheterization. Forty-three (72%) patients in the CCUs were diagnosed with primary SC, whereas all (100%) patients in MSICUs developed secondary SC. Acute respiratory failure that required invasive mechanical ventilation and shock developed in twenty-nine (59%) MSICU patients. There were no statistically significant differences in intensive care unit (ICU) mortality, in-hospital mortality, use of inotropic or mechanical circulatory support based on type of unit or anatomical variant.
CONCLUSION Stress cardiomyopathy can be under-recognized in the critical care setting. Intensivists should have a high index of suspicion for SC in patients who develop sudden or worsening unexplained hemodynamic instability, arrhythmias or respiratory failure in ICU.
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Affiliation(s)
- Parth Pancholi
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States
| | - Nader Emami
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States
| | - Melissa J Fazzari
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Sumit Kapoor
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States
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Prashanth S, Venkategowda PM. Epidural Steroid Injection—Procedure-related Stress (Takotsubo) Cardiomyopathy: A Rare Case. Indian J Crit Care Med 2022; 26:524-525. [PMID: 35656062 PMCID: PMC9067496 DOI: 10.5005/jp-journals-10071-24179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- S Prashanth
- Department of Critical Care Medicine, Apollo Hospital, Bengaluru, Karnataka, India
| | - Pradeep M Venkategowda
- Department of Critical Care Medicine, Apollo Hospital, Bengaluru, Karnataka, India
- Pradeep M Venkategowda, Department of Critical Care Medicine, Apollo Hospital, Bengaluru, Karnataka, India, Phone: +91 8897575704, e-mail:
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Al-Tkrit A, Mekaiel A, Aneeb M, Alawawdeh F, Mangla A. Left Ventricular Free Wall Rupture in Broken-Heart Syndrome: A Fatal Complication. Cureus 2020; 12:e11316. [PMID: 33282591 PMCID: PMC7714725 DOI: 10.7759/cureus.11316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Takotsubo cardiomyopathy is usually a transient condition and is treated conservatively. It is rarely associated with ventricular free wall rupture, a fatal complication of the disease described in this report. Cardiothoracic surgery performed emergent ventricular wall repair; however, treatment was unsuccessful, and the patient expired.
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Affiliation(s)
- Amna Al-Tkrit
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Andrew Mekaiel
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Mohammad Aneeb
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Firas Alawawdeh
- Internal Medicine, Jamaica Hospital Medical Center, Queens, USA
| | - Aditya Mangla
- Cardiology, Jamaica Hospital Medical Center, Queens, USA
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6
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Sclerotherapy Induced Takotsubo Syndrome. Case Rep Cardiol 2020; 2020:5626078. [PMID: 32082640 PMCID: PMC6983283 DOI: 10.1155/2020/5626078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/02/2019] [Accepted: 01/04/2020] [Indexed: 11/25/2022] Open
Abstract
A 66-year-old female was brought to the emergency department for acute-onset left-sided chest pain. Prior to arrival, she was at an outpatient appointment with a vascular surgeon for elective sclerotherapy treatment of her lower extremity varicose veins. After receiving an IV injection of polidocanol, she developed severe chest pain with left arm and jaw numbness for the first time in her life. Upon arrival to the ED, the patient reported that her symptoms had resolved. Electrocardiogram (ECG) on presentation was significant for T-wave inversions in leads V1-V3. An initial set of cardiac enzymes showed a troponin I level of 0.62 ng/mL, which subsequently increased to 2.26 ng/mL. Her echocardiogram was significant for mild left ventricular systolic dysfunction with apical hypokinesis (ejection fraction 50%). A repeat ECG showed new T-wave inversions compared to that from the time of admission. The patient eventually agreed to cardiac catheterization, which revealed patent vessels without coronary artery disease, supporting our diagnosis of Takotsubo syndrome and what is the first reported case of likely polidocanol-induced Takotsubo syndrome in the United States.
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7
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Traumatic Takotsubo Cardiomyopathy in a Patient with Extensive Coronary Artery Disease. Case Rep Emerg Med 2019; 2019:7270426. [PMID: 31308982 PMCID: PMC6594314 DOI: 10.1155/2019/7270426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/08/2019] [Accepted: 05/19/2019] [Indexed: 11/18/2022] Open
Abstract
Takotsubo Cardiomyopathy (TCM) should be considered in the differential diagnosis for patients with cardiovascular symptoms not only following emotional trauma but also following motor vehicle accidents. A 45-year-old woman presented with chest pain following a motor vehicle accident. While she had an elevated troponin level and an extensive history of cardiac disease, her electrocardiogram was normal. Echocardiogram, however, demonstrated transiently reduced left ventricular systolic function with mid to apical hypokinesis consistent with TCM. We emphasize the use of a diagnostic score and point of care focused cardiac ultrasound (FOCUS) to expedite the recognition, evaluation, and treatment of suspected TCM in an Emergency Department setting.
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8
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Kim DH, Lee SH, Kim SC, Kim T, Kang C, Jeong JH, Park YJ, Lim D, Lee SB. The ratio of N-terminal pro-B-type natriuretic peptide to troponin I for differentiating acute coronary syndrome. Am J Emerg Med 2019; 37:1013-1019. [DOI: 10.1016/j.ajem.2018.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/03/2018] [Accepted: 08/11/2018] [Indexed: 10/28/2022] Open
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9
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Nonaka D, Takase H, Machii M, Ohno K. Intraventricular thrombus and severe mitral regurgitation in the acute phase of takotsubo cardiomyopathy: two case reports. J Med Case Rep 2019; 13:152. [PMID: 31103033 PMCID: PMC6525980 DOI: 10.1186/s13256-019-2081-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/11/2019] [Indexed: 01/23/2023] Open
Abstract
Background Takotsubo cardiomyopathy is characterized by chest symptoms, electrocardiographic changes, and new regional wall motion abnormality in the apical segment of the left ventricle in the absence of obstructive coronary artery disease. Particularly, apical ballooning is broadly recognized as the classic form of takotsubo cardiomyopathy. Although the prognosis of most patients with takotsubo cardiomyopathy is generally favorable, complications associated with the morphological features of transient apical ballooning are not uncommon. Case presentation We describe two cases of transient complications in postmenopausal patients with takotsubo cardiomyopathy. Intraventricular thrombus was observed in Asian patient 1, and severe mitral regurgitation was observed in Asian patient 2. These complications were confirmed by transthoracic echocardiography immediately after typical takotsubo cardiomyopathy with apical ballooning was diagnosed. Anticoagulant therapy with heparin and warfarin was continued for 1 week in patient 1. After the therapy, complete resolution of the apical thrombus and recovery of systolic function of the left ventricle was observed by follow-up transthoracic echocardiography. In patient 2, transthoracic echocardiography indicated significant mitral regurgitation, which was caused by left ventricular tethering of the anterior mitral leaflet rather than left ventricular outflow tract obstruction or systolic anterior motion. Because the hemodynamic stability in patient 2 had been preserved, she was managed with conservative treatment. After approximately 1 month, follow-up transthoracic echocardiography revealed that mitral regurgitation had almost disappeared with complete resolution of left ventricular wall motion abnormalities. Conclusions The presented cases indicated that important complications, such as intraventricular thrombus and severe mitral regurgitation, are associated with takotsubo cardiomyopathy in the acute phase. Because these complications are risk factors for developing a thromboembolic event or heart failure and/or pulmonary edema, timely and accurate identification of these complications is critical to achieving optimal clinical outcomes in patients with takotsubo cardiomyopathy.
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Affiliation(s)
- Daishi Nonaka
- Department of Internal Medicine, Enshu Hospital, JA Shizuoka Kohseiren, 1-1-1 Chuo, Naka-ku, Hamamatsu, Shizuoka, 430-0929, Japan.
| | - Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital, JA Shizuoka Kohseiren, 1-1-1 Chuo, Naka-ku, Hamamatsu, Shizuoka, 430-0929, Japan
| | - Masashi Machii
- Department of Internal Medicine, Enshu Hospital, JA Shizuoka Kohseiren, 1-1-1 Chuo, Naka-ku, Hamamatsu, Shizuoka, 430-0929, Japan
| | - Kazuto Ohno
- Department of Internal Medicine, Enshu Hospital, JA Shizuoka Kohseiren, 1-1-1 Chuo, Naka-ku, Hamamatsu, Shizuoka, 430-0929, Japan
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10
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Kalra DK, Lichtenstein SJ, Bai C, Parekh K, Sanghani R, Tracy M, Feinstein S. Takotsubo cardiomyopathy in a man with no trigger and multiple cardioembolic complications-A rare constellation. Echocardiography 2019; 36:975-979. [PMID: 30957272 DOI: 10.1111/echo.14333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/07/2019] [Indexed: 12/14/2022] Open
Abstract
Takotsubo Cardiomyopathy (TC) is an uncommon, transient, reversible cardiomyopathy, with a classic pattern of wall-motion abnormalities, usually seen in women after an emotional stressor. Despite its increased recognition, there remain gaps in the exact mechanisms, predisposing factors, and predictors of recovery; this is particularly true for males where the condition occurs far less frequently than in females. TC typically resolves within weeks, and the prognosis is favorable compared to acute coronary syndromes. Nonetheless, about 1% of cases may be complicated by left ventricular (LV) thrombus and embolism. Herein we describe an atypical case of a man with no obvious trigger, who developed TC with left ventricular thrombus and multiple embolic complications, but subsequently showed complete and full resolution. Multimodality imaging including echocardiography, cardiac CT and cardiac MRI was instrumental in this diagnostic dilemma, as well as useful in guiding treatment options and informing prognosis.
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Affiliation(s)
- Dinesh K Kalra
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | | | - Charlotte Bai
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Keyur Parekh
- Department of Radiology, Rush University Medical Center, Chicago, Illinois
| | - Rupa Sanghani
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Melissa Tracy
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Steven Feinstein
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
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11
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Cusmà-Piccione M, Longobardo L, Oteri A, Manganaro R, Di Bella G, Carerj S, Khandheria BK, Zito C. Takotsubo cardiomyopathy: queries of the current era. J Cardiovasc Med (Hagerstown) 2019; 19:624-632. [PMID: 30234685 DOI: 10.2459/jcm.0000000000000707] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
: Takotsubo cardiomyopathy (TTS), also known as left ventricular apical ballooning syndrome, is an acute, usually reversible heart failure syndrome that most often affects postmenopausal women experiencing an emotionally stressful event. It is characterized by sudden left ventricular dysfunction and wall motion abnormalities involving the apical and mid segments. TTS has been increasingly recognized in recent years, and more and more information about the pathophysiology, diagnosis, and treatment of these patients has been reported. However, much is still unknown. TTS has a wide variety of clinical subtypes and has been described in several clinical contexts. Moreover, TTS simulates ST-segment elevation myocardial infarction and acute myocarditis, and it can be difficult to obtain a certain diagnosis. As a result, clinical decisions are challenging, and many patients currently receive an inappropriate management strategy. The aim of this review is to critically analyze the evidence about this disease reported in the literature, with particular focus on the pathophysiological processes, the diagnostic elements that can help the clinician differentiate it from other diseases, and the best management of these patients.
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Affiliation(s)
- Maurizio Cusmà-Piccione
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Luca Longobardo
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Alessandra Oteri
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Roberta Manganaro
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Gianluca Di Bella
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Scipione Carerj
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health.,Marcus Family Fund for Echocardiography (ECHO) Research and Education, Milwaukee, Wisconsin, USA
| | - Concetta Zito
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino' and Universita' degli Studi di Messina, Messina, Italy
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12
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Katsi V, Georgiopoulos G, Laina A, Koutli E, Parissis J, Tsioufis C, Nihoyannopoulos P, Tousoulis D. Left ventricular ejection fraction as therapeutic target: is it the ideal marker? Heart Fail Rev 2018; 22:641-655. [PMID: 28601914 DOI: 10.1007/s10741-017-9624-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) consists the fastest growing clinical cardiac disease. HF patients are categorized on the basis of underlying left ventricular ejection fraction (LVEF) into HF with preserved EF (HFpEF), reduced LVEF (HFrEF), and mid-range LVEF (HFmrEF). While LVEF is the most commonly used surrogate marker of left ventricular (LV) systolic function, the implementation of two-dimensional echocardiography in estimating this parameter imposes certain caveats on current HF classification. Most importantly, LVEF could fluctuate in repeated measurements or even recover after treatment, thus blunting the borders between proposed categories of HF and enabling upward classification of patients. Under this prism, we sought to summarize possible procedures to improve systolic function in patients with HFrEF either naturally or by the means of pharmacologic and non-pharmacologic treatment and devices. Therefore, we reviewed established pharmacotherapy, including beta-blockers, inhibitors of renin-angiotensin-aldosterone axis, statins, and digoxin as well as novel treatments like sacubitril-valsartan, ranolazine, and ivabradine. In addition, we assessed evidence in favor of cardiac resynchronization therapy and exercise training programs. Finally, innovative therapeutic strategies, including stem cells, xanthine oxidase inhibitors, antibiotic regimens, and omega-3 polyunsaturated fatty acids, were also taken into consideration. We concluded that LVEF is subject to changes in HF after intervention and besides the aforementioned HFrEF, HFpEF, and HFmrEF categories, a new entity of HF patients with recovered LVEF should be acknowledged. An improved global and refined LV function assessment by sophisticated imaging modalities and circulating biomarkers is expected to render HF classification more accurate and indicate patients with viable-yet dysfunctional-myocardium and favorable characteristics as the ideal candidates for LVEF recovery by individualized HF therapy.
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Affiliation(s)
- V Katsi
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - G Georgiopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece.
| | - A Laina
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - E Koutli
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - J Parissis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - C Tsioufis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - P Nihoyannopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - D Tousoulis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
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Abuarqoub A, Garis R, Shaaban H, Khaddash I, Shamoon F. Takotsubo cardiomyopathy with Basal Hypertrophy and outflow obstruction in a patient with bowel ischemia. Int J Crit Illn Inj Sci 2018; 8:44-47. [PMID: 29619340 PMCID: PMC5869801 DOI: 10.4103/ijciis.ijciis_47_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Basal septal hypertrophy is a rare and unique anatomical finding associated with hypertrophic cardiomyopathy (HCM). It is also described as a sigmoid hypertrophy and is linked with aging and chronic hypertension. Takotsubo cardiomyopathy is a transient cardiomyopathy that occurs during periods of high physical or emotional stress. Its occurrence with HCM is relatively common; however, this presentation occurs more often with the classic asymmetrical septal hypertrophy or the apical variant. This case demonstrates its coexistence with isolated sigmoid hypertrophy in an elderly, hypertensive female with severe ischemic bowel disease.
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Affiliation(s)
- Ahmad Abuarqoub
- Department of Cardiology, Saint Joseph's Regional Medical Center, Paterson, NJ, USA
| | - Rana Garis
- Department of Cardiology, Saint Joseph's Regional Medical Center, Paterson, NJ, USA
| | - Hamid Shaaban
- Department of Medicine, Saint Michael's Medical Center, Newark, NJ, USA
| | - Ibrahim Khaddash
- Department of Cardiology, Saint Joseph's Regional Medical Center, Paterson, NJ, USA
| | - Fayez Shamoon
- Department of Cardiology, Saint Joseph's Regional Medical Center, Paterson, NJ, USA
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14
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Takotsubo Cardiomyopathy Triggered by Venous Air Embolism During Craniotomy in the Sitting Position. World Neurosurg 2017; 107:1045.e1-1045.e4. [DOI: 10.1016/j.wneu.2017.07.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022]
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15
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Gupta S, Gupta MM. Takotsubo syndrome. Indian Heart J 2017; 70:165-174. [PMID: 29455773 PMCID: PMC5902911 DOI: 10.1016/j.ihj.2017.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 01/01/2023] Open
Abstract
Takotsubo syndrome is a reversible acute heart failure frequently precipitated by an emotional or physical stress. The clinical presentation resembles acute coronary syndrome. Pathogenesis is complex and may involve brain-heart axis and neuro-hormonal stunning of the myocardium. Coronary angiography reveals normal epicardial arteries with no obstruction or spasm. NT-ProBNP maybe remarkably elevated. Regional wall motion akinesia (RWMA) of left ventricle extends beyond the territory of one coronary artery. Reduced left ventricle ejection fraction (LVEF) and RWMA recover in 6-12 weeks. Prognosis is generally good. Recent meta-analysis shows in-hospital mortality of 1-4.5% and recurrence rate of 5-10% during five year follow-up.
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Affiliation(s)
- Sanjiv Gupta
- NH Narayana Multispeciality Hospital, Jaipur, India.
| | - Madan Mohan Gupta
- Heart and Diabetic Clinic, B-19, Rajender Marg, Bapu Nagar, Jaipur, India
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16
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Kim SA, Jo SH, Park KH, Kim HS, Han SJ, Park WJ. Functional recovery of regional myocardial deformation in patients with takotsubo cardiomyopathy. J Cardiol 2016; 70:68-73. [PMID: 27889396 DOI: 10.1016/j.jjcc.2016.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC) is acute, but completely reversible in the absence of significant coronary artery disease. This study aims to assess the functional recovery of regional myocardial deformation in patients with TC using 2-dimensional (2D) speckle tracking echocardiography. METHODS Thirty-three patients diagnosed with TC (mean age 63 years, 26 female) prospectively underwent serial 2D echocardiography on day 1 (initial presentation), day 4 [the middle, interquartile range (IQR), 2-5 days], and day 21 (recovery, IQR 13-32 days). Twenty-one (64%) patients showed classical type of TC with akinesis of mid-left ventricular (LV) and apical segments and 12 (36%) of patients presented with mid-LV variant with apical sparing. Myocardial deformations were serially assessed using 2D strain analysis. All echocardiographic values on day 21 were compared with the corresponding values from 30 controls of similar age and gender. RESULTS LV ejection fraction (EF) gradually improved at follow-up (32±8% on day 1 vs. 62±4% on day 21, p<0.001). Despite no difference in LVEF between the patients with complete recovery (LVEF >60% on day 21) and controls, the patients showed significantly lower global longitudinal strain than controls. On regional analysis of the mid-LV segments, both longitudinal and circumferential strains of patients with TC were similarly diminished on day 1. During recovery, longitudinal strain showed more delayed recovery than circumferential strain compared to the values of controls. In LV apex of controls, circumferential strain normally presented higher value than longitudinal strain. In LV apex of patients with classical TC, the reduced circumferential strain on day 1 rapidly increased with a wide variation to maintain augmented circumferential shortening. CONCLUSIONS Quantifying LV myocardial deformation in patients with TC is informative in the detection of persistent subtle LV dysfunction and improves our understanding of regional myocardial mechanics during recovery.
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Affiliation(s)
- Sung-Ai Kim
- Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
| | - Sang-Ho Jo
- Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Kyoung-Ha Park
- Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Hyun-Sook Kim
- Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Sang-Jin Han
- Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Woo-Jung Park
- Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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17
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Chung-esaki HM, Nikravan S. A 50-Year-Old Woman With a History of Hypertension and Tobacco Use Presenting With Hypoxia. Chest 2016; 150:e73-6. [DOI: 10.1016/j.chest.2015.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/03/2015] [Indexed: 10/21/2022] Open
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18
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Nam SW, Lee JW, Sim JH, Pack HS, Im C, Lim JS, Ahn SG. A patient with stress induced cardiomyopathy that occurred after cessation of hormone replacement therapy for panhypopituitarism. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Seoung Wan Nam
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jun-Won Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jeong Han Sim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Sung Pack
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Changjo Im
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Gyun Ahn
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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19
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Lee SR, Yoon YE. Diagnosis and Management of Stress-induced Cardiomyopathy in Neurological Intensive Care Units. JOURNAL OF NEUROCRITICAL CARE 2015. [DOI: 10.18700/jnc.2015.8.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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20
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Yoshinaga K, Tomiyama Y, Sakakibara M, Takeuchi K, Tamaki N. Relatively High Prevalence of Takotsubo Cardiomyopathy (Stress-Induced Cardiomyopathy) in the Japanese Population—Contribution of Cardiac Imaging in the Identification of Takotsubo Cardiomyopathy and its Differentiation from Acute Coronary Syndrome. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9328-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Jiang W, Samad Z, Boyle S, Becker RC, Williams R, Kuhn C, Ortel TL, Rogers J, Kuchibhatla M, O'Connor C, Velazquez EJ. Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease. J Am Coll Cardiol 2013; 61:714-22. [PMID: 23410543 DOI: 10.1016/j.jacc.2012.11.037] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 11/26/2012] [Accepted: 11/27/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the prevalence and clinical characteristics of mental stress-induced myocardial ischemia. BACKGROUND Mental stress-induced myocardial ischemia is prevalent and a risk factor for poor prognosis in patients with coronary heart disease, but past studies mainly studied patients with exercise-induced myocardial ischemia. METHODS Eligible patients with clinically stable coronary heart disease, regardless of exercise stress testing status, underwent a battery of 3 mental stress tests followed by a treadmill test. Stress-induced ischemia, assessed by echocardiography and electrocardiography, was defined as: 1) development or worsening of regional wall motion abnormality; 2) left ventricular ejection fraction reduction ≥ 8%; and/or 3) horizontal or downsloping ST-segment depression ≥ 1 mm in 2 or more leads lasting for ≥ 3 consecutive beats during at least 1 mental test or during the exercise test. RESULTS Mental stress-induced ischemia occurred in 43.45%, whereas exercise-induced ischemia occurred in 33.79% (p = 0.002) of the study population (N = 310). Women (odds ratio [OR]: 1.88), patients who were not married (OR: 1.99), and patients who lived alone (OR: 2.24) were more likely to have mental stress-induced ischemia (all p < 0.05). Multivariate analysis showed that compared with married men or men living with someone, unmarried men (OR: 2.57) and married women (OR: 3.18), or living alone (male OR: 2.25 and female OR: 2.72, respectively) had higher risk for mental stress-induced ischemia (all p < 0.05). CONCLUSIONS Mental stress-induced ischemia is more common than exercise-induced ischemia in patients with clinically stable coronary heart disease. Women, unmarried men, and individuals living alone are at higher risk for mental stress-induced ischemia. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847).
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Affiliation(s)
- Wei Jiang
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
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22
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Hernández-Caballero C, Martín-Bermúdez R, Revuelto-Rey J, Aguilar-Cabello M, Villar-Gallardo J. Neurogenic Stunned Myocardium and Cardiac Transplantation: A Case Report. Transplant Proc 2012; 44:2106-10. [DOI: 10.1016/j.transproceed.2012.07.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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23
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Shin SN, Yun KH, Ko JS, Rhee SJ, Yoo NJ, Kim NH, Oh SK, Jeong JW. Left ventricular thrombus associated with takotsubo cardiomyopathy: a cardioembolic cause of cerebral infarction. J Cardiovasc Ultrasound 2011; 19:152-5. [PMID: 22073327 PMCID: PMC3209596 DOI: 10.4250/jcu.2011.19.3.152] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 05/24/2011] [Accepted: 08/17/2011] [Indexed: 11/22/2022] Open
Abstract
Takotsubo cardiomyopathy, also called stress-induced cardiomyopathy, usually occurs in patients with severe emotional or physiologic stress. The prognosis is favorable, and the wall motion abnormlities normalize within weeks. However, stress-induced cardiomyopathy is rarely assosicated with left ventricular thrombus and thromboembolic complications. Here, we report a case of stress-induced cardiomyopathy with left ventricular thrombus that embolized to cause cerebral infarction.
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Affiliation(s)
- Seoung-Nam Shin
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
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