Development Of Takotsubo Cardiomyopathy Research Articles

The Association Between the Location of Subarachnoid Hemorrhage and the Occurrence of Takotsubo Cardiomyopathy: A Systematic Review and Meta-analysis.

Takotsubo cardiomyopathy (TCM) is a syndrome characterized by transient regional cardiac dysfunction of the left ventricle. The goal of this review is to better understand the relationship between the anatomic locations of subarachnoid hemorrhages (SAHs) and the development of TCM as identified through a review of cohort studies. From inception to December 2023, we systematically explored major electronic medical information sources to identify cases of TCM that developed after SAHs. The six selected studies included in the meta-analysis suggest a modest but statistically significant increase in the odds of the events in the posterior circulation group compared to the anterior circulation group, with a combined odds ratio (OR) estimate of around 1.45-1.46. The fixed effect model gives an overall OR of 1.45 with a 95% confidence interval (CI) of 1.01 to 2.10, z = 2.01, p = 0.0442, while the random effects model yields a slightly higher OR of 1.46 with the same 95% CI, z = 2.03, p = 0.0425. There is a tendency for SAH occurrence in the posterior cerebral circulation to cause SAH-related TCM more frequently than in the anterior cerebral circulation.

Development of Takotsubo Cardiomyopathy in 46-Year-Old With Refractory Crohn's Disease

Development of Takotsubo Cardiomyopathy in 46-Year-Old With Refractory Crohn's Disease

Propafenona Bağlı Gelişen Takotsubo Kardiyomiyopatisi: Sadece Bir Tesadüf mü, Yeni Bir Nedensel İlişki mi?

Propafenone is a class 1C antiarrhythmic drug that blocks sodium channels and is used in the treatment of arrhythmia. Because of its rapid effect on terminating paroxysmal episodes of atrial fibrillation, it can be used as a pill-in-the-pocket. In patients with structural heart disease, it is less preferred due to cardiotoxic effects in long-term use. Although propafenone use is known to cause several cardiovascular side effects, the development of Takotsubo cardiomyopathy is unknown. Propafenone toxicity at standard doses is a rare condition. Propafenone plasma concentrations may increase through inhibition of cytochrome P450 2D6 and complete inhibition of 2D6 metabolism can increase propafenone levels by up to 3 to 10 times. In this case report, we aimed to present a 37-year-old female patient who developed Takotsubo cardiomyopathy and cardiogenic shock after the first dose of propafenone use and recovered with medical treatment.

Unveiling the Enigma: Exploring the Intricate Link Between Coronary Microvascular Dysfunction and Takotsubo Cardiomyopathy.

This review article delves into the intricate and evolving relationship between coronary microvascular dysfunction (CMD) and takotsubo cardiomyopathy (TCM), two intriguing cardiovascular conditions increasingly recognised for their potential interplay. We examine their characteristics, shared pathophysiological mechanisms, diagnostic challenges, and management strategies. Emerging evidence suggests a link between microvascular dysfunction and the development of TCM, leading to a deeper exploration of their connection. Accurate diagnosis of both conditions becomes essential, as microvascular dysfunction may modify TCM outcomes. We underscore the significance of understanding this connection for improved patient care, emphasising the need for tailored interventions when CMD and TCM coexist. Collaborative research and heightened clinical awareness are advocated to advance our comprehension of this relationship. Through interdisciplinary efforts, we aim to refine diagnostic precision, develop targeted therapies, and enhance patient outcomes in cardiovascular medicine.

Clinical case of a patient at risk of perioperative recurrence of takotsubo cardiomyopathy

Introduction.Takotsubo syndrome is a new nosological form of acquired cardiomyopathy characterized by transient left ventricular dysfunction in response to physical or psychoemotional stress, clinically and electrocardiographically resembling acute coronary syndrome. Takotsubo cardiomyopathy is a form of stress cardiomyopathy simulating acute myocardial infarction with electrocardiographic and biochemical changes. Despite a large number of publications, there is no definitive understanding of the etiopathogenesis, clinical picture, treatment, as well as measures to prevent the development of takotsubo cardiomyopathy. With the manifestation of takotsubo cardiomyopathy in the perioperative period, the clinical picture may be even less specific, which inevitably leads to diagnostic difficulties. Given that the main trigger of the disease is stress, the development of this disease is an urgent problem of anesthesiology and intensive care. In addition, there is a problem of managing patients with a history of takotsubo cardiopathy, if they need surgical interventions.The aim of the workwas to prove the effectiveness of a number of approaches (premedication with the use of barbiturates and α2-adrenoceptor agonists; monitoring the depth of anesthesia; administration of narcotic analgesics in continuous infusion; use of local anesthetics for skin anesthesia; multimodal anesthesia in the postoperative period) to the perioperative management of patients with a high risk of CT recurrence.Materials and method.We present a clinical case demonstrating the possible tactics of perioperative management of a patient with a history of CT that manifested during anesthesia when a follow-up benefit was needed. The clinical picture is described, the results of instrumental and laboratory investigations indicating a correct CT diagnosis are presented.Results.An individual strategy for perioperative management of the patient was developed and implemented, which made it possible to avoid a CT recurrence. Discussion. The etiopathogenesis of the disease and analysis of the few literature sources on the topic allow us to propose a number of approaches to the perioperative management of patients at risk of recurrence of CT.Conclusions.A number of approaches (premedication with barbiturates and α 2-adrenoceptor agonists; anesthesia depth monitoring; administration of narcotic analgesics in continuous infusion mode; use of local anesthetics for skin anesthesia; multimodal anesthesia in the postoperative period) to perioperative management of patients with high risk of CT recurrence were demonstrated to be successful.

The Connection Between Opioid Withdrawal and Takotsubo Cardiomyopathy: Case Reports of ‘Opioid Octopus Heart’

Introduction Takotsubo Cardiomyopathy (TCM) is an incompletely understood diagnosis. The leading hypothesis of its pathogenesis is that a hyperadrenergic state leads to cardiotoxicity, which is supported by case findings. Withdrawal from opioids is one potential etiology of an excessive adrenergic response and, therefore, may precipitate TCM. Case Presentations Here, we present 2 cases of TCM in patients who chronically used opioids, both at the same institution within 1 month of each other. The first patient is a 68-year-old man who presented with a chronic obstructive pulmonary disease exacerbation and did not disclose his long-standing opioid use disorder. One day after admission, he was found to be in opioid withdrawal and, soon after, developed TCM. He was originally treated for non-ST elevation myocardial infarction and opioid withdrawal but decompensated. He was sent to the intensive care unit (ICU) to receive pressors and fluid resuscitation. He soon recovered and his cardiac function returned to baseline. The second patient is a 33-year-old woman with opioid use disorder taking methadone who presented with lower extremity weakness, edema, and pain. She was diagnosed with infective endocarditis. While awaiting surgery and receiving antibiotics, she developed respiratory failure and was upgraded to the ICU. There was a lapse in her opioid treatment, and she subsequently developed TCM. She was treated with pressors and fluids in the ICU, and eventually recovered with reduced cardiac function at the time of discharge. Conclusions While clinical evidence indicated opioid withdrawal as the likely provoking factor for development of TCM in the first case, the second patient’s symptoms from other clinical complications confounded the cause of her TCM. Twelve similar cases have been reported in the literature, suggesting that opioid withdrawal may be associated with development of TCM. Further quantitative research is required to establish this relationship. Our findings contribute to the theoretical pathophysiology of TCM and offer important considerations for clinical management of opioid withdrawal.

Pathophysiological association of catecholamine stress in a patient with Takotsubo cardiomyopathy and chronic kidney disease

Aim: Takotsubo cardiomyopathy is a transient dysfunction of the heart muscle that occurs in response to a stressful event. A working diagnosis is mostly made for acute ischemic heart disease due to similar clinical presentation and differential diagnostic doubts. Although it is a reversible disorder of cardiac contractility, mortality rate is similar to that of an acute coronary syndrome due to the development of complications. We report the case of a patient with chronic kidney disease and the consequent development of Takotsubo cardiomyopathy, a possible pathophysiological link that has not been reported in the significant number in literature so far. Case report: An 83-year-old patient on a chronic hemodialysis program, due to the development of anginal symptoms specific for the acute coronary syndrome and with a significant increase in cardiospecific enzymes, was transferred to the Coronary care unit for the necessary invasive cardiac treatment. Echocardiographic and coronarographic findings confirmed the diagnosis of Takotsubo cardiomyopathy, which was the first case in a patient on chronic hemodialysis program in our institution. Conslusions: According to available data, about 30 cases of Takotsubo cardiomyopathy have been reported so far, indicating that transient myocardial dysfunction is a rare cardiomyopathy in patients with chronic kidney disease. A small number of literature-recorded cases do not support the similar pathophysiological basis of increased sympathetic activity present in Takotsubo cardiomyopathy and chronic kidney disease.

Miocardiopatia de Takotsubo e suas variáveis: uma revisão integrativa

In post-modern society, changes in people's lifestyle have triggered both professional and personal problems. In this context, encouraging the biopsychosocial look at the patient, there is a concern to research more about Takotsubo Cardiomyopathy. The objective of this research is to identify studies that address the factors that can trigger Takotsubo myocardiopathy. This is an integrative literature review. The evidence found through the retrieved articles indicates the association of CMT with stressors, this being the most likely variable, it is an underdiagnosed pathology because its findings are confused with Acute Coronary Syndrome. The results of the present study demonstrate the association of stressors with the development of Takotsubo Cardiomyopathy, clarifying possible relationships between them.

Predisposing factors and health-care utilization in liver transplant recipients with takotsubo cardiomyopathy: A national analysis

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 < 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.

Pipeline Embolization in Patients with Posterior Circulation Subarachnoid Hemorrhages: Is Takotsubo Cardiomyopathy a Limiting Factor?

Hemorrhagic vascular lesions in the posterior cerebral circulation such as ruptured aneurysms and dissections can be challenging to treat. Flow diversion has become an important off-label option, but few studies have analyzed the safety of these devices in this setting. Using an international, multicenter cohort, we reviewed posterior circulation subarachnoid hemorrhage (SAH) patients treated with the Pipeline Embolization Device (PED) in the acute setting and assessed the incidence of Takotsubo cardiomyopathy (TCM). Eleven neurovascular centers were queried to identify cases of posterior circulation aneurysms or dissections treated with the PED in the acute setting of SAH. Among those, 5 centers had cases that matched the inclusion criteria. The following variables were evaluated: demographics, the location and morphology of the aneurysm, the clinical presentation, the specific form of treatment, complications including the development of TCM, antiplatelet medication regimen, and follow-up time. A total of 23 patients were treated with PED after posterior circulation SAH, and 13% of these developed TCM. The lesions were the result of hemorrhagic intracranial dissection (8 patients), ruptured pseudoaneurysm (3), ruptured saccular aneurysm (7), blister aneurysm (4), and fusiform aneurysm (1). Ninety-one percent of patients had complete or near-complete aneurysm occlusion on follow-up imaging. Five patients died in the perioperative period; 16/18 survivors had a favorable outcome. We describe an unexpectedly high incidence of TCM after the placement of PEDs in patients with posterior circulation SAH in our large case series. Further studies will be needed to elucidate possible causes.

P809Effects of air temperature and pollution on Takotsubo cardiomyopathy

Abstract Background Air temperature and pollution are the main environmental factors influencing cardiovascular mortality and risk of myocardial infarction. Takotsubo cardiomyopathy (TCM) is a transient and reversible myocardial dysfunction whose cause and pathogenesis remain incompletely understood, but which, unlike acute coronary syndrome, does not involve obstructive coronary atherosclerosis or plaque rupture. The potential role of the environment on the risk to develop TCM remains poorly defined. Methods We aimed to study the effects of air temperature, particulate matter (PM) and gaseous pollutants (NO2 and ozone) on hospitalization rate forTCM. All hospitalizations in Belgian Hospitals for TCM (ICD 9:429.83) from 2009 to 2014 were recorded. National air pollution parameters were extracted from the Belgian Environment Agency database. A time-stratified and temperature-matched (except for air temperature effect) case-crossover analysis of the risk of TCM was performed. The main analysis focused on 0-day lag time (lag 0) between exposure and TCM; a lag structure analysis up to lag 4 was also performed. Results 1840 patients were included in the study (88% women). More TCM occurred during the warm compared to the cold period (fig.1; chi2p value <0.05). At lag 0, each decrease of 1°C in ambient air temperature increased the odds ratio (OR) of TCM of 1.020 (IC 95%: 1.003–1.035). This effect was more pronounced during the cold period and at lag 4 (RR 1.060; IC 95%: 1.031–1.091). Conversely, during the warm period and between lag 1 and 4, an increase of 1°C in ambient air temperature increased the RR of TCM (OR 1.053 at lag 3; IC 95%: 1.021–1.086). No significant association was found between TCM and PM10, PM2.5, NO2at any lag. During the warm period, each increase in 10μg/m3 in ozone from lag 1 to 3 increased the risk of TCM (OR 1.089 at lag 3, IC 95%: 1.017–1.168). Conclusions Air temperature strongly influences the onset of TCM. Both cold spells and heat waves seem to be associated with the development of TCM. Ozone exposure also increases the risk of TCM during the warm period, whereas particulate and NO2 pollution do not seem to play a significant role. These patterns seem to differ from those previously reported with STEMI.

P812Takotsubo cardiomyopathy: phenotypic diversity and contemporary management

Abstract Background Takotsubo Cardiomyopathy represents an acute transient decline in left ventricular (LV) function occurring in the absence of obstructive coronary artery disease or acute plaque rupture. Therapeutic strategies vary due to a paucity of evidence-based guidelines. Purpose To evaluate clinical and biochemical characteristics, management approach and outcomes in a contemporary cohort of patients with Takotsubo Cardiomyopathy across two tertiary centres in Victoria, Australia. Neurohormonal associations were explored by characterising the prevalence of pre-existing endocrinopathies and malignancy. Methods We conducted a retrospective study of 240 patients with Takotsubo Cardiomyopathy diagnosed between 2008–2018, utilising data from electronic medical records. Results Patients were predominantly female (91.3%, mean age 66±12 years), smokers (48.3%), and hypertensive (55.0%). A small proportion (16.7%) had pre-existing malignancy (breast 30%, gastrointestinal 23%, genitourinary 19%, lung 9%, other 19%) or endocrine disease (12.5%), largely driven by thyroid disease (94%). Troponin rise was common (94.6%; peak troponin 6.4±13μg/L), though few presented with ST-elevation (21.7%). Psychosocial stress was prevalent (44.6%) compared with physical illness (39.2%) or an unidentified precipitant (16.7%). Management was heterogeneous. Many were discharged on aspirin (37.7%), dual antiplatelet therapy (34%) or statins (35.9%) in the absence of obstructive coronary disease or other clinical indication and were frequently continued beyond 1 year. ACE inhibitors or angiotensin receptor blockers were prescribed in 83.7%, beta blockers in 84.9% or both in 74.9% (continuing beyond 1 year in 60.4%). LV dysfunction occurred in 81.7% at diagnosis (mean LV ejection fraction (LVEF) 45±11%), recovering in 91.3% (mean LVEF 62±8%; 17.2% increase, p<0.001) on repeat echocardiography (mean 107±154 days). Follow up occurred in 81.4%, though most patients with normalised LV function continued heart failure therapy (83.6%). 12-month mortality was rare (7%) as was recurrence (5.1%). Conclusions Management of Takotsubo Cardiomyopathy remains challenging due to phenotypic diversity, variable therapeutic approach and unclear treatment duration. Pre-existing illness, including malignancy and endocrinopathy, may provide a substrate for the development of Takotsubo Cardiomyopathy or amplify cardiac adrenoreceptor sensitivity. Enhanced understanding of possible neurohormonal and cellular mechanisms may facilitate targeted management and preventive strategies. The role of antiplatelets or lipid lowering therapy is not supported in existing literature, however, as this study highlights, they continue to feature heavily in the Takotsubo treatment armamentarium. Further studies are needed to enhance understanding of underlying mechanisms and establish a standardised treatment approach with targeted therapy to promote LV recovery and prevent recurrence. Acknowledgement/Funding None

Takotsubo Cardiomyopathy: Medical and Psychiatric Aspects. Role of Psychotropic Medications in the Treatment of Adults with "Broken Heart" Syndrome.

Takotsubo cardiomyopathy (TTC) is reversible stress-induced cardiomyopathy featuring symptoms of acute myocardial infarction without significant coronary artery abnormalities. TTC is frequently precipitated by stressful emotional events but it also has been reported as a result of substance withdrawal, non-cardiac events, and dangerous drug-to-drug interaction. The plasma levels of both epinephrine and norepinephrine were significantly elevated in TTC patients, suggesting that elevated catecholamine levels might be the main contributing factor. However, the mechanisms underlying susceptibility to development and recurrence are not completely understood.It has been suggested that even a therapeutic dose of antidepressant could be a cause of drug-induced tachycardia and TTC. Moreover, some cases have been reported in which the development of TTC was associated with the serotonin syndrome, neuroleptic malignant syndrome, and similar fatal consequences.The aim of this article is to explore the association between underlying psychiatric disorders and TTC and to determine the role of various psychotropic medications in the progression of stress-induced cardiomyopathy. This article also notes and discusses the current theories underlying the pathophysiology of TTC. This review suggests a serious side effect of antidepressants, and to avoid life-threatening cardiovascular events, such as TTC, for patients with affective and anxiety disorders, prior screening for cardiovascular conditions by ECG with close monitoring might be necessary.

Takotsubo cardiomyopathy in the intensive care unit.

AimsAn angiographic examination is necessary for the diagnosis of takotsubo cardiomyopathy (TTC). However, in the intensive care unit (ICU), intensivists often see patients in whom TTC cannot be diagnosed because they cannot undertake angiography due to the patient's poor general condition. We defined such cases as clinical TTC (cTTC) and investigated the incidence and background of cTTC in the ICU at Kansai Medical University Hospital (Osaka, Japan).MethodsThe study involved 5,084 patients who were admitted to the ICU of Kansai Medical University Hospital between January 2013 and December 2017. We retrospectively investigated the frequency and background of TTC and cTTC.ResultsOf the 5,084 patients, 5 (0.09%) patients admitted to the ICU were diagnosed as having TTC and 19 patients (0.37%) were diagnosed as having cTTC. The most common primary disease among the evaluated patients was sepsis (n = 10) followed by subarachnoid hemorrhage (SAH) (n = 5). Ten of the 335 patients with sepsis (3.0%) were admitted to the ICU with complications due to cTTC. Their blood pressure and heart rate on admission tended to be high, and their Sequential Organ Failure Assessment scores tended to be low. Five of the 172 patients with SAH (2.9%) were admitted to the ICU with complications due to cTTC. These patients were often classified as grade 5 on the Hunt and Hess scale.ConclusionOur study suggests that patients with sepsis or SAH are complicated with cTTC in the ICU. In addition, there might be no correlation between the severity of sepsis and the development of TTC.

Cumulative Impact of Stressful Life Events on the Development of Takotsubo Cardiomyopathy.

The role of stressful life events in the onset of Takotsubo cardiomyopathy (TC) is unclear. This study sought to examine associations between type, timing, and number of stressful life events and onset of TC. A case-control study conducted among consecutive incident female TC cases and myocardial infarction (MI) controls admitted to two emergency departments in New England. Healthy female controls (HC) were recruited from a volunteers' registry. Information about the timing, type, and number of triggers during the 6months preceding hospitalization was systematically collected using the PERI Life Events Scale about 1month post-discharge. Group differences were evaluated using ANOVA, chi-square, and Kruskal-Wallis statistics. Generalized linear models were used to adjust for confounding variables. Between March 2013 and October 2015, 107 women were enrolled (45 TC, 32 MI, and 30 HC). Specific stressful events (death of a relative or close friend (p=0.006); illness or injury to a relative or close friend (p=0.001) were more prevalent in TC cases than MI and HC controls. The onset of TC was associated with exposure to multiple stressful life events during the 6months preceding the index hospitalization (p<0.001) but not with exposure to an acute, recent event (p=0.96). TC onset was associated with specific life events (death or illness to close relative or friend) and with the number of stressful life events occurring in the 6months preceding hospitalization. These findings suggest that grief and cumulative stress could play a major role in the onset of TC.

Drugs as Possible Triggers of Takotsubo Cardiomyopathy: A Comprehensive Literature Search - Update 2015.

In 2011 a list of 20 drugs linked to drug-induced Tako-Tsubo cardiomyopathy (TCM) was published. Thus, the objectives were both to identify cases of drug-induced TCM, and update the 2011 list of drugs as possible triggers of this cardiomyopathy. As the 2011 report of drug-induced TCM, case reports of drug-induced TCM were identified by a comprehensive search in Medline/PubMed database. From December 2010 to March 2015 search terms were Takotsubo cardiomyopathy, Takotsubo cardiomyopathy, stress cardiomyopathy, transient-left-ventricular ballooning syndrome, ampulla cardiomyopathy, apical ballooning syndrome, OR broken heart syndrome; together with "iatrogenic", "drug-induced", OR "induced by". Publications limited to English, Spanish, and French, in humans, and with full texts were retrieved. Articles that recognized any drug as a possible trigger of TCM were selected. Overall, 405 different references were retrieved and 67 were selected (62 case reports and 5 case series) involving 78 patient cases with TCM possibly associated to drugs were reviewed. At total of 44 drugs were recognized as possible drug-induced TCM, mainly with sympathetic effect, and 37 (84.1%) were different to those 20 identified in the 2011 review; therefore, a list of 57 drugs associated to TCM was obtained. There are new case reports that linked drug-use with the development of TCM. The list of 57 drugs obtained is principally integrated by drugs that generate sympathetic overstimulation. Consequently, the recommendation "drug-induced TCM would be considered in patients with TCM, particularly those in which no clear emotional or stress trigger could be identified" is endorsed.

Role of Coronary Microvascular Dysfunction in Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy (TTC) is a relatively frequent acute cardiac condition, but its pathogenesis has not been established as yet. Since the first descriptions of TTC, microvascular dysfunction has been advocated as a possible pathophysiological mechanism underlying the left ventricular wall motion abnormalities that characterize the syndrome. Several noninvasive and invasive methods have confirmed the involvement of coronary microvascular abnormalities in the pathogenesis of TTC, but whether microvascular dysfunction is the primary cause or a secondary phenomenon is still debated. The greater prevalence of TTC among postmenopausal women, along with the relationship identified between physical and emotional triggers and other "neuro-cardiac" mechanisms, suggest that increased microvascular reactivity, possibly sympathetically mediated, may play a pathogenic role in susceptible individuals. This review critically evaluates the possible role of microvascular dysfunction in the development of TTC.

慢性炎症性脱髄性多発神経炎の経過中にたこつぼ型心筋症を発症した一例

慢性炎症性脱髄性多発神経炎（chronic inflammatory demyelinating polyneuropathy, CIDP）の経過中にたこつぼ型心筋症を発症した症例を経験した。56歳，女性。45歳よりCIDPを発症し，以後数回の増悪・寛解を繰り返している。両下肢筋力低下と左顔面神経麻痺をきたし，CIDP急性増悪として入院となった。入院翌日に四肢麻痺，呼吸筋麻痺が出現し，ICUにて人工呼吸管理を行った。同時に免疫グロブリン大量療法を開始した。ICU入室後，循環動態は大きく変動した。ICU入室3日目に，心エコーで壁運動異常を認めた。心基部は正常収縮，心尖部は無収縮であり，特徴的な所見からたこつぼ型心筋症と診断した。また同時に40℃を超える発熱を認めた。ICU入室7日目に壁運動異常が改善し，循環動態が安定すると同時に，発熱や四肢麻痺も改善傾向を示した。CIDPは類縁疾患であるGuillain-Barré症候群とは異なり重篤な自律神経障害は稀であるが，本症例では重篤な自律神経障害が生じたことで，たこつぼ型心筋症を発症した可能性が示唆された。

Is acute respiratory failure requiring mechanical ventilation associated with development of takotsubo cardiomyopathy in the critical care setting?

Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy characterized by apical or midventricular wall motion abnormalities, despite non-obstructive coronary artery disease. Its pathogenesis remains unclear however several hypotheses have been proposed, including excess catecholamine release, coronary arterial spasm, transient obstruction of the left ventricular outflow tract, and microvascular dysfunction [1–3].

Takotsubo after general anesthesia for chronic subdural hematoma: case report

Cardiologia CROATICA The goal: Takotsubo cardiomyopathy is an acute cardiovascular disease generally characterized by reversible wall motion abnormalities of the left ventricle, electrocardiographic changes and clinical presentation that can mimic myocardial infarction in the absence of an obstructive coronary artery disease. It is often precipitated by an intense acute emotional or physical stress. Our goal was to present a patient with Takotsubo cardiomyopathy which developed after the induction of general anesthesia. Patient and Methods: The patient's available medical record was used to present the clinical course of Takotsubo that developed after induction of general anesthesia. Results: We present a case of a 61-year-old woman who developed Takotsubo cardiomyopathy during operation of chronic subdural hematoma. After induction of general endotracheal anesthesia and preparation of the operative field, hemodinamic instability was detected. The ECG lead to suspect on acute myocardial infarction. Coronarography with the left ventriculography was performed indicating development of takotsubo cardiomyopathy. The patient was admitted to the cardiac intensive care unit and treated according to the ongoing hemodynamic disturbances. By the day eight, clinical recovery was observed with anterior wall hypokinesis. The patient was hemodynamically stabile with normal blood pressure and pulse. Conclusion: There are already many case reports presenting numerous possible triggering factors for Takotsubo cardiomyopathy. Severe stress, emotional or physical, can precede this disease. This is an interesting case where iatrogenic stress related to medical procedures causes transient systolic dysfunction of the heart, mimicking myocardial infarction.