Transient left ventricular dysfunction consistent with Takotsubo syndrome — A case series

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Midventricular variant of transient apical ballooning: a likely demonstration of its pathophysiologic mechanism.

Case presentation: A 60-year-old woman presented to the emergency department 2 hours after the onset of severe retrosternal chest pain that started soon after she was told that her son had died in a car accident. A 12-lead ECG demonstrated ST-elevation in the precordial leads (Figure 1), and the plasma troponin T level was elevated at 0.07 ng/mL. A diagnosis of acute ST-elevation myocardial infarction was made, and the patient was admitted for emergency coronary angiography, which revealed normal coronary arteries. The left ventriculogram showed severe systolic dysfunction involving the mid and apical segments (Data Supplement Movie I). Figure 1. Twelve-lead ECG demonstrating ST-segment elevation in precordial leads. Physicians have long been aware of the possible association between stress and cardiovascular events. Awareness has increased of a distinct cardiac syndrome that was originally described in the Japanese population and was called Takotsubo cardiomyopathy, named after the octopus-trapping pot with a round bottom and narrow neck that resembles the left ventriculogram during systole in these patients.1,2 Other names used to describe the condition include apical ballooning syndrome (ABS), broken heart syndrome, and stress or ampulla cardiomyopathy. The precise incidence of ABS is unknown, but it may account for 1% to 2% of patients who present with an acute myocardial infarction.3 The majority of patients have a clinical presentation that is indistinguishable from an acute coronary syndrome. Most present with chest pain at rest, although some patients have dyspnea alone as their initial presenting symptom. Rarely, patients present with syncope or an out-of-hospital cardiac arrest.4 ABS appears to occur almost exclusively in postmenopausal women; however, a few cases have been reported in younger women and males.4 The patients are usually hemodynamically stable, but clinical findings of mild-to-moderate congestive heart failure …

Stress Cardiomyopathy: The Midventricular Variant

Use of Cardiac Magnetic Resonance Imaging to Distinguish Between Acute Myocarditis and Takotsubo Cardiomyopathy

TAKOTSUBO CARDIOMYOPATHY SECONDARY TO ACUTE BACTERIAL MENINGITIS

ThyroidVol. 17, No. 2 Images in ThyroidologyLeft Ventricular Apical Ballooning (Takotsubo Cardiomyopathy) in ThyrotoxicosisAlexander M. Rossor, Simon H.S. Pearce, and Philip C. AdamsAlexander M. RossorSearch for more papers by this author, Simon H.S. PearceSearch for more papers by this author, and Philip C. AdamsSearch for more papers by this authorPublished Online:14 Mar 2007https://doi.org/10.1089/thy.2006.0102AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Left Ventricular Apical Ballooning (Takotsubo Cardiomyopathy) in Thyrotoxicosis." , 17(2), pp. 181–182FiguresReferencesRelatedDetailsCited byThe association between Takotsubo cardiomyopathy and thyrotoxicosis: A systematic review26 August 2022 | Endocrine, Vol. 78, No. 3Association of Endocrine Conditions With Takotsubo Cardiomyopathy: A Comprehensive ReviewJournal of the American Heart Association, Vol. 7, No. 19Congestive Heart Failure Secondary to a TSH-Secreting Pituitary Adenoma Aggravated by Takotsubo Cardiomyopathy in an Elderly PatientAACE Clinical Case Reports, Vol. 4, No. 2Comorbidities Frequency in Takotsubo Syndrome: An International Collaborative Systematic Review Including 1109 PatientsThe American Journal of Medicine, Vol. 128, No. 6Takotsubo cardiomyopathy and endocrine disorders: a mini-review of case reportsThe American Journal of Emergency Medicine, Vol. 32, No. 11Takotsubo Cardiomyopathy Associated with Thyrotoxicosis: A Case Report and Review of the Literature Myrto Eliades, Diala El-Maouche, Chitra Choudhary, Bruce Zinsmeister, and Kenneth D. Burman11 February 2014 | Thyroid, Vol. 24, No. 2Broken heart syndrome triggered by an obstructive goiter not associated with thyrotoxicosis11 July 2013 | Canadian Journal of Anesthesia/Journal canadien d'anesthésie, Vol. 60, No. 8A case of asymptomatic patient with hyperthyroidism documented the onset of Takotsubo cardiomyopathy by holter monitoringInternational Journal of Cardiology, Vol. 151, No. 3Stress CardiomyopathyCritical Pathways in Cardiology: A Journal of Evidence-Based Medicine, Vol. 10, No. 3Transient Left Ventricular Systolic Dysfunction with Thrombus and Subsequent Cardioembolic Stroke in Short-Term Overt HypothyroidismCardiology, Vol. 119, No. 1Takotsubo cardiomyopathy in thyrotoxicosisInternational Journal of Cardiology, Vol. 145, No. 3Takotsubo Cardiomyopathy: A Unique Cardiomyopathy With Variable Ventricular MorphologyJACC: Cardiovascular Imaging, Vol. 3, No. 6An Association Between Takotsubo Cardiomyopathy and Thyroid Storm13 March 2015 | Postgraduate Medicine, Vol. 121, No. 3Takotsubo cardiomyopathy associated with autoimmune polyendocrine syndrome IIJournal of Cardiology, Vol. 53, No. 2Takotsubo cardiomyopathy: State-of-the-art review20 January 2009 | Journal of Nuclear Cardiology, Vol. 16, No. 1Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarctionAmerican Heart Journal, Vol. 155, No. 3 Volume 17Issue 2Feb 2007 InformationCopyright 2007, Mary Ann Liebert, Inc.To cite this article:Alexander M. Rossor, Simon H.S. Pearce, and Philip C. Adams.Left Ventricular Apical Ballooning (Takotsubo Cardiomyopathy) in Thyrotoxicosis.Thyroid.Feb 2007.181-182.http://doi.org/10.1089/thy.2006.0102Published in Volume: 17 Issue 2: March 14, 2007PDF download

Reduced estrogen in menopause may predispose women to takotsubo cardiomyopathy.

Takotsubo cardiomyopathy (TC) is a significant cause of acute heart failure in adults. However, triggering factors, ECG and echocardiographic findings, and prognosis of TC have not been well studied in children. Therefore, this study aimed to evaluate the demographic characteristics, signs and symptoms, laboratory findings, and prognosis of children with TC. We analyzed demographic characteristics of childhood TC cases (aged < 18 years) treated at our university hospital from 2014 to 2019. The triggering factors of TC; outcomes of the disease; and laboratory, ECG, and echocardiographic findings at presentation were also examined. A total of 17 patients (mean age 9.71 ± 5.03 years, 52.9% female) were included in the study. Chest pain, palpitation, and dyspnea were the most common presenting symptoms. The most common triggering factor was emotional stress (47%) in our study population. Ten patients (58.8%) had a classical form of TC, with apical left ventricular wall motion abnormalities. None of the patients died, and 15 (88.2%) had complete recovery of left ventricular systolic function. Only two patients (11.8%) had a left ventricular ejection fraction < 50% at the end of follow-up.Conclusion: This is the first retrospective data on childhood TC. The majority of patients with TC experienced an emotional stress as a trigger of the disease, and nearly 90% of the patients completely recovered.What is Known? • The occurrence of acute heart failure following an emotional or physical stress is called Takotsubo cardiomyopathy (TC). • Takotsubo cardiomyopathy is rarely reported in childrenWhat is New? • The present study is the first case series of children with TC. • In contrast to the female predominance in adult population, TC was almost equally distributed between boys and girls in the pediatric age group.

Takotsubo Cardiomyopathy: A Nurse’s Guide

Background: Abrupt conditional changes can interfere with the harmony between the brain and the heart, thereby following impaired cardiovascular function. Stress cardiomyopathy (SC) is a typical sample. SC is a disorder associated with transient left ventricular apical ballooning that is induced by stress. The precise molecular mechanisms of SC remain unclear. Methods and results: (1) By analyzing a new animal model of SC in rodents inducing by epilepsy, we demonstrated hypothalamic activation due to Ccl2 causes LV dysfunction like SC. (2) Upstream sympathetic activation induces strong upregulation of neuropeptide Y (NPY) expression in the left stellate ganglion (LSG) and LV sympathetic nerves. (3) NPY reduced the frequency of Ca2+ sparks when co-injected with noradrenaline in the ventricular myocytes of adult rat. (4) We demonstreted that NPY reduced the contraction of ventricular myocytes of neonatal rat when co-incuvated with noradrenaline by using phase-contrast microscopy. (5) NPY injection into the LSG induces SC-like LV wall motion. (6) The incidence of SC was less frequent in NPY-/- mice than in NPY+/+ mice. Conclusions: Our results demonstrate how brain activation translates into molecular signals in the cardiac nervous system and leads to LV apical ballooning.

Cardiac Thrombi in Stress (Tako-Tsubo) Cardiomyopathy: More Than an Apical Issue?

Aims and Objectives: Takotsubo cardiomyopathy (TCMP) is an acquired cardiomyopathy associated with physical, emotional, and surgical stress. Current literature on TCMP in liver transplant recipients (LTRs) is limited to case reports and case series. Methods: The Nationwide Readmission Database was utilized to identify all adults with an index admission for LT between 2010 and 2014 who developed TCMP. The prevalence of TCMP at the LT admission or readmission within the calendar year was examined. Predictors of development and health-care utilization of patients with and without TCMP in LTR were compared. Multivariable regression analysis was performed. Results: The prevalence of TCMP in LTRs was found to be 0.5% (141/28,067). Most of these patients developed early TCMP on the index admission for LT (n = 115; 82%). Older (57.5 ± 1.3 vs. 55.1 ± 0.3 years, P &lt; 0.001) females (adjusted odds ratio [aOR]: 2.27; confidence interval [CI]: 1.20–4.27; P = 0.01) with ≥4 Elixhauser comorbidity (aOR: 2.36; CI: 1.15–4.83; P = 0.02) were predisposed to develop TCMP in LTRs. LT at a medium-sized center (aOR: 0.17; CI: 0.03–0.88) has a protective effect on the development of TCMP. Increased health-care utilization in the form of mechanical ventilation, hemodialysis, vasopressors, and intra-aortic balloon pumps is observed in patients with TCMP. This resulted in increased length of stay and cost in patients with TCMP. Moreover, increased mortality was seen in patients who developed TCMP within the same calendar year. Conclusion: This is the first report showing the prevalence of TCMP in LTRs to be 0.5%. Older females with increased comorbidity are predisposed to TCMP. Patients who developed TCMP necessitate a higher acuity of medical care and cause an increased health-care burden and ultimately experience an increase in mortality.

CIGARETTES THAT BROKE HER HEART: COPD-INDUCED TAKOTSUBU CARDIOMYOPATHY

While coronavirus disease 2019 (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has often been perceived as a predominantly respiratory condition, it is characterized by complications in multiple organ systems. Especially the involvement of the cardiovascular system, along with the possibly severe pulmonary injury, is crucial for prognosis. We identified three COVID-19 patients with takotsubo (TT) cardiomyopathy at our infectious diseases treatment center and present their clinical, laboratory, echocardiographic, electrocardiographic, and angiographic features. All patients were female (median age, 67 years); disease severity regarding COVID-19 ranged from asymptomatic to ARDS (adult respiratory syndrome) necessitating mechanical ventilation for 22 days. Angiography revealed normal coronary arteries in patient 1, severe three-vessel coronary artery disease (CAD) in patient 2, and insignificant bystander CAD in patient 3. All patients showed classic apical hypokinesia with basal hyperkinesia. In patient 3, TT cardiomyopathy resulted in transient cardiogenic shock. Twenty-eight-day mortality was 0% in this case series. In conclusion, takotsubo cardiomyopathy may be yet another clinical entity associated with SARS-CoV-2 infection.