Diagnosis Of Takotsubo Cardiomyopathy Research Articles

Ventricular Tachycardia in Patients With Takotsubo Cardiomyopathy: Prevalence, Predictors, and Associated In-Hospital Adverse Events.

Introduction The purpose of this study was to determine the prevalence of ventricular tachycardia (VT) among patients admitted with takotsubo cardiomyopathy (TCM) as well as to analyze the predictors of VT and the predictors of mortality among patients admitted with TCM. Methods Data were obtained from the National Inpatient Sample (NIS) database from January 2016 to December 2019. Patients with a primary diagnosis of TCM were selected using ICD-10 code I51.81. Subsequently, the study population was divided into patients who developed VT vs. patients who did not develop this complication. We then used multivariate logistic regression to assess the predictors of VT in our patient cohort as well as the predictors of mortality among patients admitted with TCM. Results Of 40114 patients with TCM, 1923 developed VT (4.8%) during their hospital stay. Predictors of VT include atrial fibrillation (AF) (adjusted odds ratio (aOR): 1.592; 95% confidence interval (CI): 0.00-1.424; p=0.001), congestive heart failure (aOR: 1.451; 95% CI: 1.307-1.610; p=0.001), coagulopathy (aOR: 1.436; 95% CI: 1.150-1.793; p=0.001), andpatients who self-identify in the race category as Other(aOR: 1.427; 95% CI: 1.086-1.875; p=0.011). Female sex was found to be protective against VT (aOR: 0.587; 95% CI: 0.526-0.656; p=0.001). Predictors of mortality among patients admitted with TCM include, among other factors, age (aOR: 1.014; 95% CI: 1.011-1.018; p=0.001), Asian or Pacific Islander race (aOR: 1.533; 95% CI: 1.197-1.964; p=0.001), Black race (aOR: 1.242; 95% CI: 1.062-1.452; p=0.007), VT (aOR: 1.754; 95% CI: 1.505-2.045; p=0.001), and AF (aOR: 1.441; 95% CI: 1.301-1.597; p=0.001). Some comorbidities that were protective against mortality in TCM include tobacco use disorder (aOR: 0.558; 95% CI: 0.255-0.925; p=0.028) and obstructive sleep apnea (aOR: 0.803; 95% CI: 0.651-0.990; p=0.028). The female sex was found to be protective against mortality (aOR: 0.532; 95% CI: 0.480-0.590; p=0.001). Conclusion In a large cohort of women admitted with TCM,we found the prevalence of VT to be 4.8%. Predictors of VT included conditions such as AF and congestive heart failure. The female sex was found to be protective against VT and protective against mortality among patients admitted with TCM.

Takotsubo cardiomyopathy in India and its electrocardiography (ECG) comparison to myocardial infarction

BackgroundOwing to the limited research on Takotsubo Cardiomyopathy (TCM) in Asia, we aim to evaluate in detail the clinical profiles, lab parameters, investigations, and major adverse cardiovascular events (MACE) seen in patients with TCM in the Indian subcontinent. Additionally, we have compared the electrocardiographic findings of patients with TCM to those of patients with myocardial infarction (MI).ResultsThe average age of the patients affected was found to be 60 ± 11 years. Women (87.5%) and patients with hypertension (40%) were found to be at an increased risk of developing the syndrome. The most common presenting symptom was dyspnea (48%) following a trigger most commonly emotional (45%). ST elevation and significant T wave inversions were observed in 40% of patients with TCM. Echocardiography revealed a low left ventricular ejection fraction of 43 ± 9%. Coronary angiography was normal in 60%, the rest had mild/subcritical stenoses. The 6-month MACE was 20% and the mortality rate was 7.5%. Follow-up echocardiography of patients with TCM showed improvement in EF in 75% patients.ConclusionsTCM was majorly seen in postmenopausal women following an emotional trigger, but a variety of other triggers were noted. T-wave inversions in TCM follow a diffuse pattern in contrast to specific leads seen in MI. Normal or subcritical stenosis in coronaries at presentation, along with a low EF which improves on follow up provide greater evidence for the diagnosis of TCM.

Takotsubo cardiomyopathy in locally advanced rectosigmoid junction cancer: a case report

Background. takotsubo cardiomyopathy (tcm) occurs more frequently in cancer patients than in the general population. The triggers for tcm in cancer patients include not only the inflammatory state of the cancer itself, but also the significant emotional stress of a cancer diagnosis and the physical stress associated with invasive diagnostic and treatment procedures.Case presentation. We describe the case of a 54-yearold woman with histologically verified rectosigmoid junction cancer (cT4bcN2M0) complicated by acute intestinal obstruction. In the early postoperative period, a sudden drop in blood pressure, t-wave inversion and Qt-interval prolongation on ecg, decrease in the left ventricle contractility and presence of wall motion abnormalities on echocardiography (ecHo), as well as an increase in biomarkers of myocardial damage were initially regarded as acute coronary syndrome, which was subsequently excluded according to the findings of coronary angiography, which did not reveal coronary artery obstruction. taking into account the rapid and complete inverse dynamics of changes, acute myocardial infarction without coronary artery obstruction and acute myocarditis were excluded. Ultimately, the diagnosis of takotsubo cardiomyopathy was established.Conclusion. this case report indicates that cancer can be a trigger for the development of tcm; therefore, the assessment of cardiological status and timely detection of cardiac complications in cancer patients during cancer treatment is extremely important and is aimed at increasing the overall survival in this category of patients.

Abstract 17446: Trends, Disparities, and Outcomes in Patients With Takotsubo Cardiomyopathy Complicated by Cardiogenic Shock

Introduction: Cardiogenic shock (CS), a highly fatal complication, is estimated to be seen in up to 20% of patients with Takotsubo cardiomyopathy (TC). Previous studies have found patients with TC to have similar mortality rates as those with acute myocardial infarction, highlighting the potential importance of therapeutic intervention. However, the existing literature on TC is limited. Hypothesis: Minority patients with TC-CS are associated with increased mortality. Methods: All adult admissions with a diagnosis of Takotsubo Cardiomyopathy and cardiogenic shock (TC-CS) were analyzed using the National Inpatient Sample Database between January 2016 and December 2019. Outcomes included in-hospital mortality, in-hospital complications, and resource use. We used multivariate logistics and Elixhauser co-morbidities to adjust for clinical comorbidities. Results: Our study population included 37,902 patients with a diagnosis of Takotsubo cardiomyopathy. Of the sampled population, 2,455 (6.48%) experienced cardiogenic shock. Over the study time period, there was a significant increase in prevalence with TC-CS (p<0.001). Compared to patients with TC, patients with TC-CS were significantly associated with acute kidney injury (OR: 2.463, p<0.001). Controlling for baseline characteristics and Elixhauser comorbidities, Asians were at significantly higher odds of developing cardiogenic shock (OR: 1.859, p<0.001) and mortality, while Whites were at significantly decreased odds of developing cardiogenic shock (OR: 0.690, p<0.001). In addition, Asians who self-pay were at significantly higher odds (OR: 4.836, p=0.005) of developing cardiogenic shock compared with Asians holding insurance. Conclusions: Our study offers insights into the disparities connected with TC-CS. There is a statistically significant increase in the trend of incidence of CS among patients with TC, and CS is associated with significantly higher odds of mortality. Notably, Asian individuals with TC face significantly higher odds of developing CS. However, there were no significant differences in hospitalization costs between races in patients with TC-CS.

Abstract 13013: Predictors of Mortality in Elderly Patients Admitted With Takotsubo Cardiomyopathy and a History of Depression

Introduction: Takotsubo cardiomyopathy(TC) (broken heart syndrome or stress-induced cardiomyopathy) is usually a catecholamine-driven weakening of the left ventricle wall motion due to severe emotional or physical stress. It presents as an acute onset of reversible symptoms resembling acute coronary syndrome without occluded coronary arteries. As emotional stressors often trigger the condition, we aim to evaluate factors that can cause hospital death following admission for TC among elderly patients with depression. Methods: Our study group assessed mortality risk factors in patients ages ≥60 years with a diagnosis of TC and depression from the 2016-2020 National Inpatient Sample. Results: There were a total of 26375 elderly patients who had a diagnosis of TC. Amongst them, 25225 (95.6%) did not survive their hospitalization. After adjusting for variables, we found several factors that increased the odds of all-cause mortality in these patients, such as cirrhosis (aOR 2.093, p<0.01), peripheral vascular disease (PVD)(aOR 1.319, p=0.017), and events of Acute Kidney Injury (AKI)(aOR 3.072, p<0.01). Meanwhile, Females (vs. Males, aOR 0.597, p<0.01), the presence of hypertension(aOR 0.854, p=0.029), lipid disorder (aOR 0.696, p<0.01), smoking (aOR0.74, p<0.01), history of stroke (aOR 0.612, p<0.01) or history of myocardial infarction (aOR 0.536, p<0.01) showed lower odds of mortality among elderly patients admitted with TC. No disparities based on race or insurance forms were observed (Table 1). Conclusions: Our analysis found that patients ages ≥ 60 years with TC had poorer outcomes if they had cirrhosis, PVD, or AKI. While reduced odds of death were seen in females and patients with specific comorbidities such as smoking, hypertension, lipid disorder, history of stroke, or myocardial infarction, further studies, adjusting for the length of diagnosis and the medications being used, should be encouraged to expand and understand our results better.

Takotsubo Cardiomyopathy: Broken Heart Syndrome in A Tertiary Teaching & Referral Hospital in East Africa: Case Report & Literature Review

Purpose: Takotsubo cardiomyopathy (TC), also known as broken heart syndrome, refers to an abrupt and short-lived cardiac syndrome that encompasses dramatic left ventricular apical akinesia. besides mirroring acute coronary syndrome. Patients with Takotsubo cardiomyopathy (broken heart syndrome) usually present with symptoms that are similar to acute coronary syndrome. The patient commonly presents with chest pain, dyspnea, palpitation, nausea and vomiting, syncope as well as cardiogenic shock. However, Takotsubo cardiomyopathy usually occurs in association with a preceding physical or emotional stressful event.
 Methodology: A 25-year-old black female presented to the largest teaching & referral hospital in Kenya with chest pain, dyspnea, palpitations, nausea and vomiting. The patient was received in the emergency room where she was stabilized, a battery of investigations ordered and a diagnosis of TC was made after reviewing the results. She was managed as an inpatient on appropriate medication
 Findings: Patient generally responded positively to the treatment and tolerated well the surgical procedures. Follow up echocardiograms performed weekly revealed progressive reduction in size of the thrombus, which had completely resolved at 4 weeks. There was no more thrombi formation after thromboembolectomy of the left femoral artery.
 Recommendations: TC is a rescindable type of cardiomyopathy that is associated with good prognosis and an exceptional morphological characteristic of the left ventricle, that is defined by apical inflating appearance that has been recognized for nearly a quarter a century. We also recommend that patients with identified LV thrombus ought to be anticoagulated till LV function normalizes in addition to the thrombus no longer being present on echocardiogram.

Abstract WP187: Takotsubo Cardiomyopathy And Subsequent Risk Of Major Adverse Cardiovascular Events: A Cluster Analysis

Introduction: Takotsubo Cardiomyopathy (TCM) is a form of transient regional left ventricular dysfunction. The risk of MACE after TCM is poorly understood but appears to be higher. Predictors of cardiovascular (CV) events remain unclear. Methods: Retrospective study of patients admitted to London Health Sciences Centre hospitals with TCM between 2014 and 2021. Clinical data were collected. MACE during follow-up (FU) included stroke, acute coronary syndrome, admission for heart failure or CV death. Outcomes were assessed until the end of FU. A two-step cluster analysis was used to stratify patients' phenotypes. Variables for clustering included: TCM aetiology, age, sex, hypertension, dyslipidemia, smoking, previous stroke, diabetes, chronic kidney disease, ejection fraction, atrial fibrillation (AF), and antithrombotics. A Cox proportional-hazards model was used to determine the association between clusters and MACE. Results: We included 152 patients (88.8% females). Median age was 72.5 [65.5-80.0] years and aetiologies were emotional stress (31.6%), neurogenic (6.6%), acute medical conditions (23.7%), and unknown (38.2%). Overall, 80% received antithrombotic drugs post-TCM. At a median FU of 22.0 [8.2-44.5] months, 11.8% of the patients experienced a MACE. Cluster 1 (n=41) included more male patients (31.7%), and the highest rate of hypertension (100%), dyslipidemia (92.7%), smoking (31.7%), previous stroke (14.6%), and antiplatelet use (82.9%). Cluster 2 (n=21) included older patients (78 [73.5-84.5] years) with the highest prevalence of diabetes (23.8%), AF (95.2%) and anticoagulation (71.4%). Cluster 3 (n=90) included younger patients (69 [62.7-84.0] years) with the lowest burden of CV risk factors (CHA 2 DS 2 VASc 2.0 [1.0-2.2]) and antithrombotic therapy (68.9%). Cluster 1 was associated with increased risk of MACE (OR 2.9; 95%CI 1.1-7.3; p=0.02) and stroke (OR 4.9; 95%CI 1.1-20.6; p=0.02). Conclusion: CV events are relatively frequent after a diagnosis of TCM, affecting over one-tenth of patients. We identified a high-risk phenotype, predominantly characterized by male sex, a higher burden of CV comorbidities, and low anticoagulation rates, which was associated with an increased risk of MACE and stroke after TCM.

"Please keep on beating"-Participation in a Creative Workshop Offers Unexpected Benefits to Women With Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy (TCM) or "broken heart syndrome" is a rare condition that is more common in women than men, particularly those who are postmenopausal. It mimics a myocardial infarction and psychological factors have been implicated in its etiology as well as being consequences of its presentation. As part of a public engagement project we brought together 8 women (of 12 invited) previously diagnosed with TCM to facilitate a discussion, through participation in a creative workshop-based process, about their illness experience, how they made sense of it, and the meaning it had for them in their lives, and to identify areas of unmet need. Through a range of creative activities we identified that participants had high levels of unmet need in terms of information and psychosocial support. All participants enjoyed the creative process and meeting other people with a diagnosis of TCM. The workshop overall was perceived as empowering. Exploring patient narratives during artist-facilitated workshops is one approach for providing the first steps to addressing unmet need, although the importance of ensuring psychological safety cannot be over-stated.

Takotsubo Cardiomyopathy in Patients with Cancer

Takotsubo cardiomyopathy (TC) in cancer patients has been predominantly noted as a cardiotoxic complication of oncologic therapy or secondary to catecholamine overload in specific tumors such as pheochromocytomas. The underlying pathophysiological mechanisms that lead to TC are not entirely understood. The diagnosis of TC can be challenging and may be neglected during cancer treatment, given the wide range of cardiotoxic effects of antineoplastic therapies. However, TC in oncology exists more often than formerly assumed, and it should be included [...]

Case Series of Triathletes with Takotsubo Cardiomyopathy Presenting with Swimming-Induced Pulmonary Edema.

To report three cases of triathletes who presented with swimming-induced pulmonary edema (SIPE) following water immersion. They were subsequently diagnosed with Takotsubo cardiomyopathy (TCM). Retrospective case series. All cases were recreational athletes competing in mass participation triathlons between June 2018 and 2019. They were initially managed by the event medical team and subsequently at the local tertiary level hospital. Written consent was gained from all the subjects. The three triathletes were aged between 50 and 60 years, two were females, and all presented with acute dyspnoea on exiting the water. Two also presented with chest pain and haemoptysis. A diagnosis of SIPE was suspected by the medical event team on initial presentation of low oxygen saturations and clinical signs of pulmonary oedema. All were transferred to the local emergency department and had signs of pulmonary oedema on chest radiographs. Further investigations led to a diagnosis of TCM with findings of T wave inversion in anterolateral electrocardiogram leads and apical hypokinesia on transthoracic echocardiogram and unobstructed coronary arteries. This case series presents triathletes diagnosed with SIPE and TCM following the open water swim phase. It is unclear whether the myocardial dysfunction contributed to causation of SIPE or was the result of SIPE. Mass participation race organizers must be prepared that both SIPE and TCM can present in this population. Those presenting with an episode of SIPE require prompt evaluation of their cardiac and pulmonary physiology. Further research is required to ascertain the exact nature of the relationship between TCM and SIPE.

Shark Fin Electrocardiogram in the Intensive Care Unit.

Shark Fin Electrocardiogram in the Intensive Care Unit.

VENTRICULAR FIBRILLATION AS PRESENTATION FOR TAKOTSUBO CARDIOMYOPATHY

VENTRICULAR FIBRILLATION AS PRESENTATION FOR TAKOTSUBO CARDIOMYOPATHY

The Incidence of Takotsubo Cardiomyopathy in Patients with Intracerebral Hemorrhage: A US Nationwide Study.

Takotsubo cardiomyopathy (TC) is a commonly observed complication among patients with intracerebral hemorrhage (ICH); however, the incidence of TC in patients with ICH have not been investigated yet. The goal of this study was to examine the incidence of TC in ICH and identify its risk factors, incidence rate, and outcomes of TC in patients with ICH in a US nationwide scale. Data for patients with ICH between the years of 2015 and 2018 were extracted from the Nationwide Inpatient Sample and stratified based on the diagnosis of TC. Our results showed that the incidence rate of TC in ICH discharges was 0.27% (95% confidence interval [CI] 0.24-0.31). The mean age of patients with ICH developing TC was 66.28years ± 17.11. There were significantly more women in the TC group, with an odds ratio (OR) of 3.65 (95% CI 2.63-5.05). Acute myocardial infarction (OR 7.91, 95% CI 5.80-10.80) was significantly higher in the TC group. The mortality rate of patients with ICH who had TC was significantly higher (33.48%, p < 0.0001). Length of stay (mean days; 15.72 ± 13.56 vs. 9.56 ± 14.10, p < 0.0001) significantly increased in patients with ICH who had TC. Patients with intraventricular ICH (OR 2.46, 95% CI 1.88-3.22) had the highest odds of TC. Takotsubo cardiomyopathy is associated with a higher mortality, longer hospitalization period, and more acute myocardial infarctions in patients with ICH. It is illustrated that intraventricular ICH is associated with higher odds of TC.

“Blocked broken heart syndrome”: an unusual case of a complete atrioventricular block complicating a Takotsubo cardiomyopathy

BackgroundComplete heart block is considered a unique and rare complication of Takotsubo cardiomyopathy, an otherwise self-resolving disease. When this occurs, there is a double clinical dilemma: first to find out which triggered the other and second, to decide whether or not to implant a permanent pacemaker.Case presentationWe present a case of a 77 years-old female patient, with previous medical history of arterial hypertension, diabetes mellitus, dyslipidemia and bifascicular block known since 2013. She came to the emergency department after recurrent syncopal episodes. At admission a complete heart block was diagnosed, and it was implanted a single chamber temporary pacemaker. The patient remained in disproportional acute decompensated heart failure despite pacemaker implantation. She denied chest pain although referring an episode of self-limiting chest pain 2 days before, after an argument with the family. Blood analysis showed an important rise in NTproBNP and troponin levels. Transthoracic echocardiogram showed a dilated left ventricle with akinesia of apical and mid segments, hyperkinesia of basal segments and severely depressed left ventricle ejection fraction. Coronary angiography showed no significant lesions and the diagnosis of Takotsubo cardiomyopathy was suspected. During the following days, she recovered her own intrinsic rhythm. Electrocardiogram evolved with deep T-wave inversion and prolonged QT interval and transthoracic echocardiogram showed resolution of the previous alterations. Despite complete reversion of rhythm alteration, it was decided to implant a permanent pacemaker.ConclusionsWe describe a rare, life-threatening and often underdiagnosed complication of the stress cardiomyopathy. Furthermore, we performed a literature revision of this rare complication and discussed the therapeutic challenge encountered in such patients.

Takotsubo Cardiomyopathy and Trauma: The Role of Injuries as Physical Stressors.

Introduction: Physical stressors are common predisposing factors for takotsubo cardiomyopathy (TTC). However, the role of traumatic injuries in TTC has not been well defined. This study describes the characteristics of TTC in the broad spectrum of traumatic injuries using the information available in the National Trauma Data Bank (NTDB).Materials and methods: This retrospective study analyzed trauma patients ≥ 18 years old in the NTDB, from 2007 to 2018, with a diagnosis of TTC.Results: A total of 95 TTC diagnoses were found. The median age was 68 years old (interquartile range: 55-80). Patients were predominantly female (67.4%), white (88.4%), and sustained blunt mechanisms of injury (90.5%). Penetrating trauma was most common in males (16%). Most diagnoses were related to extremity trauma (53.7%), followed by head injury (26.3%). The most common severity scores were Glasgow Coma Scale (GCS) > 13 or < 8, and Injury Severity Score (ISS) < 15 or > 25. Males more commonly presented with GCS < 8 (68%), ISS > 25 (33%), high intensive care unit (ICU) admission rate (77.4%), and mechanical ventilation (51.6%). The median duration of the mechanical ventilation was eight days for both sexes. The ICU length of stay (LOS) was six days with a hospital LOS of nine days and a trend toward a longer LOS in males. The in-hospital mortality rate was 11.7% for both sexes.Conclusions: TTC in traumatic injuries is common at both ends of the severity spectrum and has different sex distribution. TTC patients are predominantly females and have more commonly extremity trauma than head injury. Males are more severely injured and under mechanical ventilation.

Impact of family history of coronary artery disease on clinical outcomes in Takotsubo cardiomyopathy

Family history of coronary artery disease (FHxCAD) is a critical risk factor for CAD, underscoring the contribution of genetic factors to disease pathogenesis and susceptibility. Takotsubo cardiomyopathy (TCM) simulates the...

Association of atrial fibrillation burden with in-hospital outcomes in patients with Takotsubo cardiomyopathy

BackgroundThe effects of atrial fibrillation (AF) and its burden on in-hospital mortality in patients with Takotsubo cardiomyopathy (TCM) are unclear. Here, we examined the effect of AF and paroxysmal AF on in-hospital outcomes in patients with TCM. MethodsWe used ICD-10 codes to retrospectively identify patients with a primary diagnosis of TCM in the National Inpatient Sample database 2016-2018. We compared in-hospital outcomes in TCM patients with and without AF before and after propensity score matching. The effect of AF burden on outcomes was assessed in patients with paroxysmal AF and no AF. ResultsOf the 4,733 patients with a primary diagnosis of TCM, 650 (13.7%) had AF, and 4,083 (86.3%) did not. Of TCM patients with AF, 368 (56.6%) had paroxysmal AF. In-hospital mortality was higher in patients with AF before (3.4% vs 1.2%, P < 0.001) and after propensity matching (3.4% vs 1.7%, P = 0.021) but did not differ between the paroxysmal AF and the no AF groups (P = 0.205). In the matched cohorts, both AF and paroxysmal AF groups were associated with a higher rate of cardiogenic shock (AF, P < 0.001; paroxysmal AF, P < 0.001), ventricular arrhythmia (AF, P = 0.002; paroxysmal AF, P = 0.02), acute kidney injury (AF, P = 0.007; paroxysmal AF, P = 0.008), and acute respiratory failure (AF, P < 0.001; paroxysmal AF, P < 0.001) compared with the no AF group. ConclusionsAlthough AF was associated with increased in-hospital mortality, paroxysmal AF did not affect in-hospital mortality, suggesting a higher AF burden is associated with worse clinical outcome in patients with TCM.

Case Report: Takotsubo cardiomyopathy in a postoperative patient without cardiological disease

Background: Takotsubo cardiomyopathy (TC) is characterized by a clinical presentation that mimics acute coronary syndrome but is reversible. Alterations of Takotsubo in patients without previous heart disease remain a challenge for diagnosis. Case report: We present a case of an 80-year-old patient from Peru. The patient underwent surgery, with the diagnosis of Chilaiditi’s syndrome. One day after surgery, she presented with dyspnea, tachycardia, and electrocardiographic changes. The diagnosis of Takotsubo syndrome with cardiogenic shock and renal failure on hemodialysis was made. She was hospitalized in the Intensive Care Unit and was managed with vasopressors and nitroglycerin. There was no cardiac lesion in the cineangiogram or occlusion of arteries. The patient was extubated and received daily dialysis until discharge. Conclusions: Takotsubo is an emotional, non-cardiac, or post-traumatic stressful event that triggers myocardial injury with segmental anomalous, the possible etiology of which is the release of an endothelial neurotransmitter caused by stress. Emergency physicians should be aware of this as even patients without previous cardiac pathologies when exposed to stressors (such as surgeries) develop emergency symptomatology similar to myocardial infarction. Thus, emergency physicians should identify any cardiac abnormalities after a stressor, as well as be prepared for the diagnosis of TC.

Acute spontaneous spinal subdural hematoma presenting with Takotsubo cardiomyopathy: a rare case report and literature review.

Spontaneous spinal subdural hematoma (SSDH) is a rare and dangerous intraspinal hematoma that usually occurs in the thoracic vertebra. The influence of early cardiovascular changes secondary to spinal cord injury is an important emergent issue.Herein, we report a case of a middle-aged woman with clinical manifestations of back pain and motion and sensory disturbances below the level of spinal cord compression. During the disease course, she also developed changes indicative of myocardial injury, such as tachycardia, markedly increased concentrations of brain natriuretic peptide and cardiac troponin I, and a decreased left ventricular ejection fraction, which were consistent with the diagnosis of Takotsubo cardiomyopathy (TTC). After the administration of supportive therapies, the symptoms of myocardial injury rapidly resolved. With the absorption of SSDH, the symptoms and clinical signs were alleviated. We also reviewed the literature on cases of concomitant SSDH and TTC.This rare case broadens the symptom spectrum of SSDH and highlights the need for clinicians to be aware of concomitant SSDH and TTC. Initial conservative treatment is a viable option for SSDH with concomitant TTC. However, urgent surgery may be a better option if the SSDH progressively enlarges and causes spinal cord compression.

Takotsubo cardiomyopathy triggered by a single dose of flecainide in patient with focal atrial tachycardia

First described in 1990, Takotsubo cardiomyopathy (TC) is a medical condition defined by acute and transient left ventricular (LV) dysfunction with a diversity of wall-motion abnormalities. TC can be induced by emotional and physical stress, as well as direct administration of catecholamines or medications which can cause a catecholamine surge. Although recorded incidences of TC have been rising over the last decade (currently 15–30 cases per 100,000 per year), this is most likely due to increased awareness and recognition of the condition. Electrocardiogram (ECG), imaging modalities such as echocardiography, coronary computed tomography angiography, cardiac magnetic resonance, and coronary angiography are important tools in the diagnosis of TC. The in-hospital mortality rate for patients admitted with TC reaches 5%. In our report, we describe a case of TC in a 30-years old female with a medical history of episodes of focal atrial tachycardia (AT) after intravenous administration of a single, maximum dose of flecainide.