Development Of Takotsubo Cardiomyopathy Research Articles

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.

Stress during MRI Causes Cardiomyopathy! Repeatedly! - A Case Report and Review of Pathogenesis

Stress cardiomyopathy is characterized by reversible wall motion abnormalities and transient systolic dysfunction in the absence of obstructive CAD or acute plaque rupture. Majority of cases involve intense emotional or physical stress triggers in post-menopausal women. Catecholamine surge, one postulated mechanism, causes acute but completely reversible myocardial dysfunction. MRI can be associated with significant stress, particularly in claustrophobic people. Our patient, with no cardiac or psychiatric history, demonstrated a stressful response to MRI developing Takotsubo cardiomyopathy (TCM) both times after the MRI in 2009 and 2013. Her anxiety likely provoked the TCM. Coronary angiography showed no obstructive disease and echocardiography showed wall motion abnormalities and systolic dysfunction, with full recovery each time confirmed on repeat echo. Patient was managed with conservative medical therapy both times. A thorough literature search failed to reveal any previously reported cases of recurrent cardiomyopathy precipitated by anxiety from MRI scan. Judicious use of anxiolytics may have averted a stressful response in our patient, perhaps preventing the development of TCM.

Development of takotsubo cardiomyopathy with severe pulmonary edema before a cesarean section

Takotsubo cardiomyopathy is an acute syndrome involving apical ballooning and consequent dysfunction of the left ventricle. Most cases of left ventricular dysfunction resolve within 1 month. We present the case of a 40-year-old woman who developed severe heart failure caused by takotsubo cardiomyopathy with severe left ventricular dysfunction during the perinatal period. Because of the presence of multiple myomas, she was scheduled to undergo a cesarean section under general anesthesia. However, after induction of general anesthesia, she had to be awakened because of the presence of a difficult airway. Because she exhibited insufficient oxygenation, she was transferred to the emergency center. Upon hospital admission, she expectorated large amounts of pink sputum, indicating severe pulmonary edema. Cesarean section was performed immediately. Echocardiography revealed severe left ventricular dysfunction. Full recovery of cardiac function required almost 1 month, after which she was discharged from the hospital without further complications. This is the first reported case of takotsubo cardiomyopathy induced by a failed intubation during a scheduled cesarean section. Takotsubo cardiomyopathy usually shows a good prognosis, but if this myopathy develops during the perinatal period, it can worsen because of excessive preload following the termination of fetoplacental circulation.

Rozvoj tako-tsubo kardiomyopatie u pacientky s endokrinně aktivním tumorem nadledviny - feochromocytomem

Tako-tsubo kardiomyopatie je charakterizovaná přechodnou dysfunkcí levé komory a je spojena s bolestí na hrudníku, EKG změnami imitujícími akutní koronární syndrom, pozitivitou kardiomarkerů při nepřítomnosti významného postižení koronárních tepen, většinou v návaznosti na předchozí stresující událost. Přesná příčina tako-tsubo není zcela jasně vysvětlena, ale pravděpodobně jde o prudký vzestup hladiny katecholaminů, který vyvolá myokardiální dysfunkci. V naší kasuistice prezentujeme případ 47leté pacientky s rozvojem tako-tsubo kardiomyopatie indukované nadprodukcí katecholaminů při feochromocytomu pravé nadledviny.

A Comprehensive Literature Search: Drugs as Possible Triggers of Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TCM) is a syndrome of transient cardiac dysfunction precipitated by intense emotional or physical stress. Excessive sympathetic stimulation is believed to be central to the pathogenesis of this condition, thus drugs with sympathetic effect could precipitate TCM. The aim of this study was to conduct a comprehensive literature search to identify drugs that could precipitate TCM. Published case reports of TCM associated with drug-used were identified by a comprehensive literature search using the Medline/PubMed database, from January 1990 to November 2010. Search terms included Takotsubo cardiomyopathy, Tako-tsubo 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". Only publications in English or Spanish, in Humans, and with links to full text were retrieved. Then, articles that recognized any drug as a possible drug-induced TCM were selected. Additionally, citation lists from identified articles were subsequently reviewed to identify additional relevant articles. Overall, 401 different references were retrieved and 42 selected. Additionally, 5 articles were identified from citation list of selected articles. Thus, 47 articles with one report of more drugs as a possible trigger of 58 cases of SCM were reviewed, in which 20 different drugs were recognized as possible drug-induced TCM. There are some reports that linked the drug-used, mainly associated to sympathetic overstimulation, with the development of TCM. Consequently, drug-induced TCM would be considered in patients with TCM, particularly those in which no clear emotional or stress trigger could be identified.

A Case Series and Review of Takotsubo Cardiomyopathy: Does Stress Really Cause the Stress Cardiomyopathy?

Objective: We sought to describe clinical characteristics of emergency department patients ultimately diagnosed with Takotsubo Cardiomyopathy (TCM) and to explore the causal role that stress may play in its pathogenesis. Methods: We performed a retrospective chart review analyzing all myocardial infarction patients with non-obstructive coronary artery disease on cardiac catheterization to assess for the presence of TCM. Various clinical data, including the pres-ence of stressors, from emergency department records were reported. We also analyzed factors from several studies (including ours) to assess the true causality of stress in the development of TCM. Results: Twelve ED patients out of 2,179 charts reviewed were identified as having TCM. Most were female, post-menopausal, and had chest pain, but only half had a specific stressful event identified in the ED. One-third of patients had no stressful event identified during their hospital stay. Several other studies suggest that stressful events are associated with increased diagnoses of TCM, but we found that causality of stress cannot be substantiated. Conclusion: Stressful events are often not identified in emergency department patients ultimately diagnosed with TCM. The causative nature of stress in the development of TCM cannot be firmly established from any existing data.

Tako-Tsubo-Kardiomyopathie

Tako-Tsubo cardiomyopathy (TTC) is a heart syndrome associated with transient contractile dysfunction. It is also referred to as "broken heart syndrome" or "transient left ventricular apical ballooning." Leading symptom is a sudden onset of chest pain, often accompanied by dyspnoea. Clinical features include new electrocardiographic changes (ST-Segment elevations, T wave inversions), moderate elevation of the cardiac enzymes and transient wall motion abnormalities in absence of significant coronary artery obstruction. Although causal treatment has not been established, TTC has a favourable prognosis with a low mortality and a complete recovery of the contractile function in nearly all cases. Although several mechanisms have been proposed, the pathophysiology is not yet fully understood. However, emotional and physical stress followed by excessive release of catecholamines might play a pivotal role in the development of TTC.

Takotsubo Cardiomyopathy after General Anesthesia for Eye Surgery

Takotsubo Cardiomyopathy after General Anesthesia for Eye Surgery

Tako-Tsubo cardiomyopathy: New insights into the possible underlying pathophysiology

Tako-Tsubo cardiomyopathy is characterised by an atypical distribution of left ventricular (LV) dysynergy with apical ballooning and compensatory basal hyperkinesis. Coronary angiography is normal. Several substrates have been put forward to explain the underlying pathophysiology such as raised catecholamine levels (due to physical or emotional stress), multivessel epicardial coronary spasm or diffuse microvascular spasm. However, the pathophysiology has not yet been fully clarified. We present a series of cases whose findings could explain the mechanism underlying this syndrome. Four consecutives patients, all female, were admitted with the clinical features typical of Tako-Tsubo syndrome. In all, severe widespread transient LV mid-apical a/dyskinesia was associated with a mid-cavity dynamic obstruction which resolved prior to the resolution of the LV wall motion abnormalities. In all cases the dynamic LV obstruction was related to localised mid-ventricular septal thickening. After improvement in wall motion, a low-dose strain/strain rate dobutamine stress-echocardiography (DSE) was performed to determine the underlying ischaemic substrate. This provoked an LV mid-cavity gradient at peak dose in all. Regional deformation changes during DSE showed the affected myocardium to have the typical response diagnostic of regional stunning. We postulate that an important unrecognised factor in the development of Tako-Tsubo cardiomyopathy is the presence of abnormal myocardial functional architecture (such as localised mid-ventricular septal thickening), which in the presence of dehydration and/or raised catecholamine levels due to physical or emotional stress, leads the development of a severe transient LV mid-cavity obstruction. This effectively sub-divides the LV into two functionally different chambers with a marked increase in wall stress in the high pressure distal apical chamber. This, in combination with the abnormal high circulating catecholamine levels, induces widespread sub-endocardial ischaemia which is unrelated to a specific coronary artery territory. With rehydration/fall in catecholamine levels the interventricular gradient resolves and distal function recovers. Low dose SR/S DSE confirms that the distal ischaemic substrate is myocardial stunning.