Broken Heart Syndrome Research Articles

Takotsubo Following Severe Anaphylactic Reaction during Anesthesia Induction

Introduction: Takotsubo cardiomyopathy (apical ballooning or broken heart syndrome) is a reversible left ventricular dysfunction due to apical asynergy that occurs typically after sudden emotional stress in a subject without coronary disease. Anaphylaxis is a severe, life-threatening, generalized hypersensitivity reaction, most often starting with urticaria and/or angioedema, that may involve cardiovascular and respiratory systems. Cardiovascular symptoms, including hypotension, cardiac arrhythmia and chest pain, are presumably linked to cardiac mast cell mediator release. Case Report: We describe the case of a woman who experienced a profound reversible cardiomyopathy with typical features of Takotsubo's syndrome during an anaphylactic reaction. Conclusion: Exposure to catecholamines and beta-receptor agonists used routinely during procedures and diagnostic tests can precipitate all the features of stress cardiomyopathy, including cardiac isoenzyme elevation and rapidly reversible cardiac dysfunction. These observations strongly implicate excessive sympathetic stimulation as central to the pathogenesis of this unique syndrome.

6668 Myxedema Coma and Takotsubo Cardiomyopathy

Abstract Disclosure: A.M. Skariah: None. S. Jain: None. Background: Takotsubo cardiomyopathy (TCM) also know as broken heart syndrome is a transient decrease in systolic cardiac function in the absence of obstructive CAD. TCM is likely related to hyperadrenergic conditions leading to increased cardiac sensitivity to catecholamine surge leading to cardiomyopathy. TCM is more associated with hyperthyroidism. Case presentation: Patient is an 84-year-old female with PMH of celiac disease,hypertension,prediabetes, and atrial fibrillation s/p cardioversion, on amiodarone. She was brought to the ER after having an unwitnessed fall. She was hypotensive 76/56 mm of Hg, hypothermic 35.5 degree C, HR 90 beats/min; labs significant for hyponatremia, macrocytic anemia, TSH 65.47uIU/ml, FT4 <0.4 ng/dl and mild QTC prolongation of 469ms. Family mentioned history of constipation, progressive weakness, poor oral intake, memory problems and cold sensitivity for a couple of months. Started on 1 pressor, 3 units of PRBC and 2 liters of IVF; BP improved; labs and history suggestive of myxedema coma with myxedema coma Popoveniuc score 85 suggestive of high suspicion for myxedema coma.She had TSH 50.39 uIU/ml and FT4 of 0.4 ng/dl for her memory issues workup 2 months prior to presentation but was not started on medication. Upon admission, started stress dose steroids followed by IV levothyroxine 100 mcg. Not started on LT3 given her old age and atrial fibrillation history. Received additional dose of LT4 100 mcg within few hours. TFT improved with TSH 35 uIU/ml and FT4 1 ng/dl after 2 doses. Later same day, shock worsened, and patient was on 3 pressors along with stress dose of steroids. Cardiology was consulted; recommended an Echocardiogram.Echo was done on day 2; EF 55-60 % with severe hypokinesis of apical myocardium consistent with TCM. Normal echocardiogram studies 4 months ago.Started on weight-based regimen of LT4 75 mcg IV on day 3 and switched to 100 mcg oral when patient tolerated pills.Patient was down to 2 pressors on day 3 and gradually off pressors by day 6. Repeat TFT -showed improvement TSH 12 uIU/ml and FT4 0.7 ng/dl—day 5. Eventually her mentation improved and was discharged on oral LT4. Conclusion: TCM is rare complication of treatment of myxedema coma. Our patient developed shock requiring 1 pressor which unexpectedly worsened to 3 pressors requirement after initial LT4 treatment. High doses of LT4 and LT3 which is part of myxedema coma treatment sensitizes myocardial tissue to catecholamines by increasing expression of beta adrenoreceptors in cardiac myocytes with subsequent ionotropic and chronotropic effects. This may contribute to cardiac stunning and TCM. It’s beneficial to evaluate patients with myxedema coma who develop worsening cardiac status after initiation of high dose of thyroid hormone replacement for TCM. Presentation: 6/2/2024

A Narrative Review on Broken Heart Syndrome: A Guide for Clinicians to Understand Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TCM) is a transient and reversible cardiomyopathy which exhibits regional wall motion abnormalities in the absence of obstructive coronary artery disease. While TCM is a rare condition (incidence <1%), its diagnosis has increased since its initial description in 1990. While many cases may follow an acute physical or emotional stressor, pathophysiology is likely multifactorial including factors such as catecholamine surges and microvascular dysfunction. On initial presentation, TCM often mimics acute coronary syndrome but may be differentiated with coronary angiography. Additional laboratory testing and imaging including transthoracic echocardiography may help with diagnosis and identification of complications such as left ventricular (LV) outflow obstruction and LV thrombus. Treatment is supportive, although medications such as angiotensin-converting enzyme inhibitors and beta-blockers have shown some benefit in improving long-term outcomes. Acute complications may include arrhythmia, LV or systemic thrombus, and cardiogenic shock, but most patients do well and experience rapid recovery. TCM continues to be an active area of research as there is still much to be learned regarding its pathogenesis, diagnosis, and treatment. This review analyzes the latest research to provide insight into the presentation, pathophysiology, diagnosis, and management of TCM.

A Case of Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TCM), also called stress cardiomyopathy, broken heart syndrome and apical ballooning syndrome, is a heart problem that occurs after intense stress, sadness or shock. Takotsubo cardiomyopathy usually presents with chest pain and dyspnoea and is similar to the diagnosis of acute coronary syndrome. Echocardiography and coronary angiography have an important role in the diagnosis of Takotsubo cardiomyopathy. In this case report, we wanted to investigate Takotsubo cardiomyopathy in a 59-year-old woman who presented to the emergency department.

Takotsubo Syndrome or Peripartum Cardiomyopathy? Depends on Who You Are Talking to.

Takotsubo syndrome (otherwise known as broken-heart syndrome or left ventricular apical ballooning) is a rare cause of reversible heart failure that predominantly affects postmenopausal women. It was first described by Japanese researchers in the 1990s and has become established as a differential for heart failure following a physically or psychologically stressful event. This was popularised by a spike in cases following natural disasters in Japan. As the recognition of takotsubo syndrome in the differential diagnosis for sudden, onset heart failure in a previously healthy individual has grown, so has the discussion concerning takotsubo in the peripartum period. Peripartum cardiomyopathy is a rare cause of reversible heart failure in the latter weeks of pregnancy and the postpartum period. Morbidity and mortality for both cardiomyopathies can be highly variable, ranging from complete recovery of cardiac function to life threatening arrhythmias and even death. This rapid review highlights the similarities between both cardiomyopathies and challenges the hitherto assumption that both takotsubo and peripartum cardiomyopathies are distinct entities that can easily be distinguished from one another. The implications of this are significant within the context of the behavioural aspects of diagnosis, treatment, and outcome.

Stress Induced Takotsubo Cardiomyopathy Following Blunt Trauma: A Diagnostic Challenge in a Young Female

Takotsubo cardiomyopathy (TC), also known as stress-induced cardiomyopathy or “broken heart syndrome,” is a transient cardiac condition characterised by left ventricular apical ballooning1–3. It clinically mimics acute coronary syndrome (ACS), presenting with similar symptoms and electrocardiographic changes, yet without significant obstructive coronary artery disease on angiography4. While emotional stress is the predominant trigger, physical stressors, including trauma, can also precipitate TC, albeit in a minuscule proportion of cases - approximately 0.001%5. The condition is most frequently observed in elderly females, particularly in the context of emotional or physical stress, though trauma-induced TC in males often presents with more severe manifestations requiring intensive care, including mechanical ventilation5.

MANAGING CARDIOGENIC SHOCK IN TAKO-TSUBO SYNDROME: LEVOSIMENDAN AS A LIFE-SAVING SOLUTION

Tako-Tsubo cardiomyopathy, also known as broken heart syndrome, is an acute cardiac condition often precipitated by intense stress, leading to symptoms that mimic myocardial infarction. The management of cardiogenic shock in this context is challenging, as standard heart failure treatments, such as Dobutamine, may worsen the condition. This case report presents an 82-year-old woman who developed cardiogenic shock due to Tako-Tsubo cardiomyopathy after a prolonged fall. She was successfully treated with Levosimendan, a drug that enhances myocardial contractility and reduces cardiac workload without increasing myocardial oxygen demand. This case underscores the importance of recognizing Tako-Tsubo cardiomyopathy in patients presenting with cardiogenic shock and highlights Levosimendan as a superior treatment option due to its beneficial effects on cardiac function and patient outcomes.

Takotsubo Syndrome and Gender Differences: Exploring Pathophysiological Mechanisms and Clinical Differences for a Personalized Approach in Patient Management.

Takotsubo syndrome (TTS), also known as the broken-heart syndrome, is a reversible condition typically observed in female patients presenting for acute coronary syndromes (ACS). Despite its increasing incidence, TTS often remains undiagnosed due to its overlap with ACS. The pathophysiology of TTS is complex and involves factors such as coronary vasospasm, microcirculatory dysfunction, increased catecholamine levels, and overactivity of the sympathetic nervous system. Diagnosing TTS requires a comprehensive approach, starting with clinical suspicion and progressing to both non-invasive and invasive multimodal tests guided by a specific diagnostic algorithm. Management of TTS should be personalized, considering potential complications, the presence or absence of coronary artery disease (CAD), diagnostic test results, and the patient's clinical course. The current data primarily derive from case series, retrospective analyses, prospective registries, and expert opinions. In recent years, there has been growing recognition of gender differences in the pathophysiology, presentation, and outcomes of TTS. This review provides an updated overview of gender disparities, highlighting the importance of tailored diagnostic and management strategies.

Clinical experience of TAKOTSUBO cardiomyopathy´s case

At a cardiological level there are several similar pathologies, and among them those that have a high percentage of similarity in terms of clinical features are Takotsubo cardiomyopathy and Acute Myocardial Infarction. Presentation with dyspnea, chest pain and a history of a stressful situation, as well as electrocardiographic signs such as ST segment elevation, allow us to suspect both pathologies. Coronary angiography with coronary arteries without obstruction and the echocardiographic image where alterations in the contractility of the left ventricle and the shape of an octopus fishing trap are observed are the main bases for the definitive diagnosis of broken heart syndrome, as in the present case. The clinical part manifests itself as an acute coronary syndrome with ST elevation, but when performing the invasive approach, no occlusion is found in the coronary arteries, which is why it is classified as Takotsubo cardiomyopathy. Regarding treatment, follow-up, continuous monitoring and elimination of the triggering factor are essential to shorten recovery time and reduce the recurrence rate

A Comparative Analysis of Positive and Negative Stimuli for Takotsubo Cardiomyopathy: A Pooled Analysis of Two Studies and a Systematic Review.

Takotsubo cardiomyopathy (TTC) is characterized by transient myocardial dysfunction triggered by both negative and positive emotional experiences, known respectively as broken heart syndrome (BHS) and happy heart syndrome (HHS). Despite the scarcity of comparative analyses between HHS and BHS in the literature, our pooled analysis, incorporating two retrospective registry analyses of 1395 TTC patients (57 HHS and 1338 BHS), reveals that while BHS is more prevalent, both conditions exhibit similar clinical presentations and outcomes. Statistical analyses, utilizing binary random effects models, indicate that diabetes mellitus is less common in HHS patients and serves as a predictor for BHS. Furthermore, there are differences in cardiac imaging between the two groups; individuals with HHS have higher odds of experiencing midventricular ballooning, whereas those with BHS are more likely to have apical ballooning. These findings highlight the similarities in clinical features and outcomes between HHS and BHS, while also illustrating distinct imaging profiles. The study emphasizes the need for future prospective studies to delve deeper into the implications of these TTC subtypes, offering valuable insights into their comparative aspects and underlying mechanisms.

Is Takotsubo syndrome induced by patent ductus arteriosus occlusion?

Takotsubo syndrome (TTS), commonly referred to as "broken heart syndrome," is a distinctive form of acute and reversible heart failure that primarily affects young to middle-aged individuals, particularly women. While emotional or physical stressors often trigger TTS, rare cases have been linked to interventional procedures for congenital heart disease (CHD). Despite its recognition, the exact causes of TTS remain elusive. Research indicates that dysregulation in autonomic nerve function, involving sympathetic and parasympathetic activities, plays a pivotal role. Genetic factors, hormonal influences like estrogen, and inflammatory processes also contribute, unveiling potential gender-specific differences in its occurrence. Understanding these multifaceted aspects of TTS is crucial for refining clinical approaches and therapies. Continued research efforts will not only deepen our understanding of this syndrome but also pave the way for more targeted and effective diagnostic and treatment strategies. In this report, we conduct an in-depth analysis of a case involving a TTS patient, examining the illness progression and treatment procedures. The aim of this analysis is to enhance the understanding of TTS among primary care physicians. By delving into this case, we aspire to prevent misdiagnosis of typical TTS cases that patients may present, thereby ensuring a more accurate diagnosis and appropriate treatment.

Pharmacological Triggers of Takotsubo Cardiomyopathy: An Updated Review of Evidence and Recommendations.

Previous publications in 2011, 2016, and 2022 have presented lists of drugs associated with takotsubo cardiomyopathy (TCM). This review aims to provide updated drug lists that have been reported as potential causes of TCM. Following the same methodology employed in previous reviews, a detailed investigation was carried out in the PubMed/Medline database from June 2022 to July 2023 to identify drug-induced TCM (DITC) case reports. Various search terms related to the drug-induced transient left ventricular ballooning syndrome, ampulla cardiomyopathy, apical ballooning syndrome, drug-induced broken heart syndrome, drug triggered takotsubo cardiomyopathy, takotsubo cardiomyopathy, and iatrogenic takotsubo cardiomyopathy were utilized. Filters for fulltext availability, case reports, human studies, and English language were applied. Articles reporting drugs associated with TCM development were included in the analysis. Foremost 192 case reports were initially identified, with 75 drugs meeting the inclusion criteria after a thorough review. The latest revision identified seven drugs that might lead to TCM, with four drugs (57.14%) already reported in previous reviews and three drugs (42.86%) newly identified. Consequently, the updated drug list potentially triggering TCM in 2023 comprises a sum of 75 drugs. The recent 75 drugs provided additional evidence linking to TCM development. The updated list predominantly includes drugs that induce sympathetic overstimulation, although some drugs on the list have unclear associations with sympathetic nervous system activation.

Exploring the Role of Psychological Stress in Takotsubo Cardiomyopathy a.k.a Broken-Heart Syndrome

This comprehensive review delves into the multifaceted aspects of Takotsubo Cardiomyopathy (TCM), commonly known as Broken Heart Syndrome, exploring its intricate connection with psychological stress. Beginning with an introduction and historical context, the discussion progresses to elucidate the significance of understanding the link between psychological stress and TCM, emphasizing its impact on symptomatology, quality of life, treatment approaches, and psychological well-being. Further, the review unravels the underlying mechanisms and complex pathophysiology of TCM, categorizing its triggers and stressors while exploring the intricate relationship between psychological stress and TCM onset. Additionally, it discusses the implications of war-related stressors on TCM development, underscoring the need for effective stress management strategies tailored to individuals with TCM. Overall, this review offers a comprehensive exploration of TCM, shedding light on its nuanced relationship with psychological stress and advocating for tailored treatment approaches to address the unique needs of affected individuals.

Updates on Prognostication of Takotsubo Cardiomyopathy: A Literature Review

Abstract Takotsubo cardiomyopathy (TTC), commonly known as “broken heart syndrome” or “stress cardiomyopathy,” is characterized by transient left ventricular (LV) systolic dysfunction, usually in the absence of significant obstructive coronary artery stenosis. The pathophysiology of TTC remains elusive; however, the three most common plausible mechanisms include catecholamine surge causing myocardial stunning, multivessel coronary spasm, and microvascular dysfunction. Although initially thought to be a benign, reversible, and transient disorder, newer research data demonstrate that TTC may sometimes have severe short-term complications and some long-term residual effects. Several risk factors have been associated with the outcomes of TTC. In this review, we aim to provide a comprehensive review of the prognostication of TTC in the context of different clinical variables presented in multiple research studies. Various clinical factors, including the types of TTC triggers, the patient’s sex, the presence of cardiogenic shock, atrial arrhythmias, LV tract obstruction, and the presence of certain other clinical comorbidities may significantly impact patient outcomes in TTC patients. A thorough understanding of these factors helps clinicians to better prognosticate the outcome of their patients. Furthermore, early institution of aggressive treatment interventions in the presence of these risk factors may improve the subsequent clinical course.

А rare case of Тakoтsubo cardiomyopathy complicated with high-grade AV block and ventricular tachycardia

Takotsubo cardiomyopathy or broken heart syndrome is a stress-induced cardiomyopathy with clinical, laboratory and ECG resemblance to acute coronary syndrome. Major differences stem from transient segmental wall motion abnormalities beyond the territory of a single coronary artery and the lack of obstructive coronary disease during angiography. Overall the condition is considered as a benign one with a favourable outcome, however there are reports of complicated clinical course by cardiogenic shock, apical thrombus, death and arrhythmias. The latter are reported to occur in 13% of the cases with ventricular arrhythmias (ventricular tachycardia, ventricular fi brillation, torsades de pointes) as a leading fi nding and in minor percentage – high-grade AV block. Despite advances in our knowledge and experience there are still no strict guidelines for the management of conduction disorders. We present the case of a 78-year old lady with an apical variant of Takotsubo, complicated by syncope, complete AV block, new left bundle branch block, paroxysmal atrial fi brillation, ventricular tachycardia and implantation of a permanent pacemaker. During the hospitalization she developed acute cardiac failure with echocardiographic evidence of left ventricular systolic dysfunction and an apical thrombus. The presented case demonstrates the complexity of the condition and the necessity of strict follow-up and timely therapy. 

TAKOTSUBO SYNDROME

Takotsubo syndrome, also known as Takotsubo cardiomyopathy, stress-induced cardiomyopathy, transient apical ballooning and broken heart syndrome, is a disease characterized by transient regional left ventricular systolic dysfunction. It is usually determined by emotional or physical stress. Even though it was thought to be a self-limiting condition, Takotsubo syndrome is now known to be associated with important short and long-term morbidity and mortality. Takotsubo syndrome affects 2-3% of all patients and 5-6% of female patients presenting with acute coronary syndrome (frequently women in the sixth decade). The Takotsubo syndrome cases are mostly preceded by acute emotional or physical triggers such as: family death, financial loss, anxiety, excessive work, domestic abuse, anxiety, fear for medical procedures, severe pain, sepsis, post surgeries, and cancer. Diagnosis of Takotsubo syndrome can sometimes be difficult due to clinical manifestations similar to acute myocardial infarction. Myocardial necrosis biomarkers (Troponin I, Troponin T and Creatinin kinase) are elevated, with values comparable to those in patients with acute myocardial infarction. Transthoracic echocardiography usually shows akinetic or dyskinetic apical and mid-ventricular segments of the left ventricle compared to the hyperkinetic basal segments (“apical ballooning” aspect) and left ventricle systolic dysfunction. The positive diagnosis of Takotsubo syndrome is made on coronary angiography, normal or non-obstructive coronary artery disease

Broken Heart Syndrome: A Rare Case of Recurrent Reverse Takotsubo Cardiomyopathy Associated with Acute Respiratory Failure.

Takotsubo cardiomyopathy accounts for one percent of acute coronary syndrome presentations and has been increasingly recognized [1]. Reverse Takotsubo cardiomyopathy, a variant form of Takotsubo cardiomyopathy presenting with the hyperdynamic function of the apical segments and hypokinesis of the basal or mid-ventricular segments is the rarest type of acute stress cardiomyopathy, with mid-ventricular akinesia and preservation of apical and basal contractility [2]. We report a rare case of an elderly woman admitted to the Intensive Care Unit at Case Western Reserve University Hospital in Cleveland, USA. The patient experienced acute respiratory failure as a result of exacerbated chronic obstructive lung disease and heart failure. Echocardiography revealed reverse Takotsubo cardiomyopathy. Cardiac catheterization showed nonobstructive coronary artery disease. The wall motion abnormalities resolved within two weeks. The case is unique in that she had an identical presentation one year earlier after she had entered the same dusty room! Our case report is unique and describes the rarest form of recurrent reverse Takotsubo cardiomyopathy. Our case demonstrates that reverse Takotsubo cardiomyopathy with identical wall motion abnormalities can recur in a patient upon re-exposure to a similar stressful situation. Early recognition and appropriate treatment can prevent catastrophic outcomes.

Takotsubo syndrome: unravelling the enigma of the broken heart syndrome?-a narrative review.

Takotsubo syndrome (TTS) is a condition characterized by transient ventricular regional wall motion abnormalities, without causative coronary artery disease, typically triggered by emotional or physical stress. TTS is more common in post-menopausal women, closely resembling acute coronary syndrome (ACS) in its clinical presentation, with multiple proposed underlying pathophysiological mechanisms and no evidence-based treatments. This review aims to provide a comprehensive summary of the latest research, encompassing the pathophysiology, diagnostic findings, prognosis, and treatment options for TTS patients. Relevant literature from 1990 to June 2023 on TTS epidemiology, physiopathology, diagnosis, clinical manifestations, treatment, and prognosis was retrieved through PubMed research. Only English publications were included. TTS is an increasingly recognized cardiovascular disorder, a significant release of catecholamines is thought to be a key contributing element, yet its exact mechanism remains unclear. Notably, TTS poses significant short and long-term risks akin to ACS. Initial treatment should focus on ruling out ACS and providing standard care for subsequent left ventricular dysfunction and complications. Research hints at a potential role for Angiotensin-converting enzyme inhibitors and Angiotensin II receptor blockers in improving long-term prognosis in TTS patients. Significant knowledge gaps still exist in our understanding of the pathophysiology, treatment options, and areas for improvement in diagnosing and prognosticating this intriguing condition. Further research is therefore needed.

Takotsubo cardiomyopathy (Broken heart syndrome)

Takotsubo cardiomyopathy or takotsubo syndrome (TTS), also known as stress cardiomyopathy, is a type of non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart. This condition is sometimes called “Broken Heart Syndrome”.it predominantly affects postmenopausal women, often triggered by acute emotional stressors, physical stressors, or a combination of both. The exact pathophysiological mechanisms remain incompletely elucidated. Diagnosis relies on clinical history, physical examination, ECG and cardiomyopathy from acute coronary syndrome is crucial for management.

Abstract 17222: Warriors Takotsubo Syndrome

Background: Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy or "broken heart syndrome," is characterized by transient left ventricular dysfunction, typically triggered by negative emotions or physical stressors. It presents with symptoms similar to acute coronary syndrome, but with no associated coronary artery stenosis. “Happy Takotsubo” syndrome, triggered by intense positive emotions, is an uncommon variant and presents a unique challenge in clinical diagnosis. Case Presentation: An 86-year-old woman who was an avid Golden State Warriors fan developed sudden-onset pressure-like chest pain following intense excitement over the Golden State Warriors winning a critical basketball game. In the emergency department, the patient was found to have a high sensitivity troponin greater than 4,000 and ST elevations in leads V3 to V6, meeting STEMI criteria. Emergent cardiac catheterization revealed no coronary artery stenosis. Echocardiography was significant for apical ballooning of the left ventricle, consistent with TTS (Figure 1). Symptoms resolved following low-dose beta-blocker therapy, and the patient was discharged after 24 hours of observation. Repeat echocardiography eleven days later demonstrated near-resolution of the apical ballooning (Figure 2). Discussion: This case highlights "happy Takotsubo" syndrome as a unique presentation of TTS triggered by intense positive emotions. In this case, the patient developed TTS after experiencing excitement over a Golden State Warriors victory. By sharing this case, we aim to contribute to the existing literature and enhance knowledge about this uncommon presentation.