Case Of Stress-induced Cardiomyopathy Research Articles

A Case of Stress-Induced Cardiomyopathy After Ketamine Infusion

A Case of Stress-Induced Cardiomyopathy After Ketamine Infusion

Image-guided Thermal Ablation as a Promising Approach to Both Nontoxic and Toxic Autonomously Functioning Thyroid Nodules

Although thermal ablation has been recommended as an alternative therapy option for autonomously functioning thyroid nodules (AFTN), current clinical evidence mainly focuses on toxic AFTN. This study aims to evaluate and compare the efficacy and safety of thermal ablation (percutaneous radiofrequency ablation or microwave ablation) in treating nontoxic and toxic AFTN. AFTN patients who received a single session of thermal ablation with a follow-up period ≥12 months were recruited. Changes in nodule volume and thyroid function, and complications were evaluated. Technical efficacy was defined as the maintenance or restoration of euthyroidism with a volume reduction rate (VRR) ≥80% at the last follow-up. In total, 51 AFTN patients (age: 43.8±13.9 years, female: 88.2%) with a median follow-up period of 18.0 (12.0-24.0) months were included, where 31 were nontoxic (nontoxic group), and 20 were toxic (toxic group) before ablation. The median VRR was 96.3% (80.1%-98.5%) and 88.3% (78.3%-96.2%) in the nontoxic and toxic groups, respectively, and the respective euthyroidism rates were 93.5% (29/31, 2 evolved to toxic) and 75.0% (15/20, 5 remained toxic). The corresponding technical efficacy was 77.4% (24/31) and 55.0% (11/20, p=0.126). Except for one case of stress-induced cardiomyopathy in the toxic group, no permanent hypothyroidism or other major complications occurred in both groups. Image-guided thermal ablation is efficacious and safe in treating AFTN, both nontoxic and toxic. Recognition of nontoxic AFTN would be helpful for treatment, efficacy evaluation, and follow-up.

A Rare Case of Stress-Induced Cardiomyopathy due to Intracranial Aneurysm

Stress-induced cardiomyopathy (SICM) is characterized by transient systolic dysfunction of the apical and mid segments of the left ventricle without obstructive coronary artery disease. The precipitate causes are reported either an emotional or physically stressful event, which induces hyper-catecholamine secretion. It is extremely rare that SICM was induced by internal carotid artery (ICA) aneurysmal dilation. In this case report, we present an 86-year-old female patient with SICM induced by ICA aneurysm with panhypopituitarism, who on hormone replacement therapy had normalized asynergy.

A Case of Stress-Induced Cardiomyopathy after Propofol Anesthesia

Propofol is an intravenous hypnotic agent that is generally used for sedation in the intensive care unit and for induction of anesthesia during minimally invasive surgery, endoscopy, and plastic surgery in local clinics. Low blood pressure and transient apnea might occur under propofol sedation, whereas stress-induced cardiomyopathy is a very rare complication. We herein describe a case involving a 25-year-old woman without cardiovascular risk factors who developed stress-induced cardiomyopathy after propofol injection for anesthesia and was treated with conservative treatment. This case reminds us that clinicians should consider the possible occurrence of stress-induced cardiomyopathy after anesthesia using propofol, even in patients without cardiovascular risk factors. (Korean J Med 2015,89:206-209)

Two Case of Stress Induced Cardiomyopathy after Injection of Epinephrine during Middle Ear Surgery

현재 이과학 영역의 수술에서 출혈을 줄이기 위해 혈관 수 축작용이 있는 epinephrine을 수술부위에 국소주사 또는 점 막 도포의 형태로 널리 이용하고 있다. 허용 범위 용량 내의 epinephrine 사용은 그 자체가 심혈관계에 영향을 미쳐 심계항 진, 빈맥, 부정맥과 같은 부작용을 일으킬 수 있고, 과량 사용되거 나 혈관에 직접 주입될 경우 전신 흡수에 의한 심독성이 발 현되어 심근증, 폐부종, 심정지 등의 심각한 합병증이 일어날 수 있다. Epinephrine과 같은 catecholamine의 증가에 의한 심근 증은 1969년 지주막하출혈 환자에게서 처음 보고되었고, 크롬친화세포종 환자의 내인성 catecholamine 증가에 의한 심근증과 epinephrine을 국소주사한 후 발생한 심근증에 대 해 다수의 증례를 찾아볼 수 있으나, 이과학 영역의 수술에서 허용범위 용량 내의 epinephrine 국소주사 후 발생한 심근증 은 극히 드물다. 심근증 중 하나인 스트레스 유발성 심근증(stress induced cardiomyopathy, SCI)은 개별적인 관상동맥의 혈액 공급부위 와는 무관하게 수축기에 심기저부의 심근운동만 살아있고 심 첨부가 풍선처럼 부풀어 오르는 양상(apical ballooning)을 보 이는 심장질환으로, 갑작스런 감정적인 스트레스, 물리적 활동 의 증가, catecholamine의 갑작스런 증가 등이 원인으로 추정되 고 있으며, 급성 심근경색증의 진단기준에 부합하나, 관상 동 맥 조영술상 의미 있는 협착이나 폐쇄소견은 보이지 않는 질환 을 지칭한다. 이에 저자들은 수술 전 시행한 심전도 및 혈액검사에서 특이 소견을 보이지 않았던 환자에서 중이 수술 중 허용범위 내 용 량의 epinephrine을 피하주사 후 발생한 심근증 2예를 경험 하였기에 문헌고찰과 함께 보고하는 바이다. Two Case of Stress Induced Cardiomyopathy after Injection of Epinephrine during Middle Ear Surgery Hyung Gyun Na, Si-Youn Song, Yong-Dae Kim, and Chang Hoon Bae Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu; and Center for Respiratory Disease, Yeungnam University Medical Center, Daegu, Korea

Stress-induced Cardiomyopathy Precipitated by Triathlon Competition: A Case Report

Stress-induced cardiomyopathy in post-menopausal women is transient and typically precipitated by severe emotional or physical stress. We report a rare case of stressinduced cardiomyopathy mimicking acute coronary syndrome in a middle-aged female triathlete. The initial presentation included chest tightness and dyspnea; however, acute pulmonary edema and cardiogenic shock developed shortly after admission. Electrocardiography showed non-specific ST-T changes and echocardiography revealed severe left ventricular dysfunction with regional wall motion abnormalities. Coronary angiography did not reveal significant coronary artery obstruction. The patient was placed on ventilatory support and administered diuretics and an angiotensin-converting enzyme inhibitor. Follow-up echocardiography on day 3 showed nearly normal left ventricular wall motion with a 54% ejection fraction, and follow-up radiography of the chest revealed no evidence of pulmonary edema. The endotracheal tube was removed on the third day of hospitalization and the patient was discharged two days later without complications.

A Case of Stress-Induced Cardiomyopathy in Sheehan's Syndrome

Cardiogenic shock after stress-induced cardiomyopathy is very rare and serious, and a reversible, clinical consequence of untreated adrenal insufficiency that is attributable to Sheehan’s syndrome. A 53-year-old female presented with confusion, congestive heart failure, and hypotension. Endocrine testing, prior medical history, and brain MRI confirmed the presence of hypopituitarism and secondary adrenal insufficiency owing to undiagnosed Sheehan’s syndrome. After glucocorticoid replacement therapy, her cardiac function recovered completely. Stress-induced cardiomyopathy should be considered as a possible cause of unexplained heart failure in patients with Sheehan’s syndrome and adrenal insufficiency. (Korean J Med 2014;87:347-351)