Form Of Takotsubo Cardiomyopathy Research Articles

Scorpion envenomation: state of the art.

Scorpion envenomation is common in the tropical and subtropical regions. It poses a major public health problem with some patients having serious clinical manifestations and severe complications including death. Old World and New World scorpions are usually contrasted because of differences in venom composition, clinical presentation and severity, and, accordingly, different therapeutic approaches. The majority of scorpion stings are either dry or result in low amounts of injected venom, thus explaining why up to 95% of scorpion stings ensue only in local signs. For a clinical envenomation to occur, it has been suggested that the interaction between the quantity of venom introduced in the body of the prey and the distribution volume should ensue in a critical threshold of scorpion toxin plasma concentration. In this case, there is a massive release of neurohormonal mediators (mainly catecholamine), with systemic vasoconstrictor effects eliciting a sharp increase in systemic arterial pressure and LV-filling pressure and decreased cardiac output. This early phase of cardiac dysfunction, also called "vascular phase", is followed by a severe cardiomyopathy, a form of Takotsubo cardiomyopathy, involving both ventricles and reversible in days to weeks. The more comprehensive understanding of the disease pathophysiology has allowed for a well-codified symptomatic treatment, thus contributing to a substantial reduction in the death toll of scorpion envenomation over the past few decades. The standard intensive-care treatment (when available) overcomes envenomation's consequences such as acute pulmonary edema and cardiogenic shock. Even though it continues to inspire many evaluative studies, immunotherapy seems less attractive because of the major role held by mediators in the pathogenesis of envenomation, and unfavorable pharmacokinetic properties to existing sera compared to venom. Meta-analyses of controlled trials of immunotherapy in severe scorpion envenomation reached similar conclusions: there is an acceptable level of evidence in favor of the use of scorpion antivenom (Fab'2) against Centruroides sp. in USA/Mexico, while there is still a need for a higher level of evidence for immunotherapy in the Old World envenomation.

Intraventricular thrombus and severe mitral regurgitation in the acute phase of takotsubo cardiomyopathy: two case reports

BackgroundTakotsubo cardiomyopathy is characterized by chest symptoms, electrocardiographic changes, and new regional wall motion abnormality in the apical segment of the left ventricle in the absence of obstructive coronary artery disease. Particularly, apical ballooning is broadly recognized as the classic form of takotsubo cardiomyopathy. Although the prognosis of most patients with takotsubo cardiomyopathy is generally favorable, complications associated with the morphological features of transient apical ballooning are not uncommon.Case presentationWe describe two cases of transient complications in postmenopausal patients with takotsubo cardiomyopathy. Intraventricular thrombus was observed in Asian patient 1, and severe mitral regurgitation was observed in Asian patient 2. These complications were confirmed by transthoracic echocardiography immediately after typical takotsubo cardiomyopathy with apical ballooning was diagnosed. Anticoagulant therapy with heparin and warfarin was continued for 1 week in patient 1. After the therapy, complete resolution of the apical thrombus and recovery of systolic function of the left ventricle was observed by follow-up transthoracic echocardiography. In patient 2, transthoracic echocardiography indicated significant mitral regurgitation, which was caused by left ventricular tethering of the anterior mitral leaflet rather than left ventricular outflow tract obstruction or systolic anterior motion. Because the hemodynamic stability in patient 2 had been preserved, she was managed with conservative treatment. After approximately 1 month, follow-up transthoracic echocardiography revealed that mitral regurgitation had almost disappeared with complete resolution of left ventricular wall motion abnormalities.ConclusionsThe presented cases indicated that important complications, such as intraventricular thrombus and severe mitral regurgitation, are associated with takotsubo cardiomyopathy in the acute phase. Because these complications are risk factors for developing a thromboembolic event or heart failure and/or pulmonary edema, timely and accurate identification of these complications is critical to achieving optimal clinical outcomes in patients with takotsubo cardiomyopathy.

Encasement of the Left Anterior Descending Coronary Artery: Association with Takotsubo Syndrome, and Diagnostic and Therapeutic Options

Myocardial bridging is a rare event, which leads to chest pain, arrhythmias and discussable takotsubo syndrome (cardiomyopathy).We collected 41 patients (33 females, mean age 68.4 years) with all forms of takotsubo cardiomyopathy in most cases and 6 cases with chest pain and echocardiographic mid-ventricular hypokinesia. Left ventricular angiography revealed apical ballooning in 30 patients, mid-ventricular ballooning in 3 cases, and basal ballooning in one case.The correct diagnosis of myocardial bridging can be best made by intravascular ultrasound (IVUS) and fractional flow reserve (FFR) with either adenosine or dobutamine injection.Beyond atherosclerosis, myocardial bridging is a prominent cause of chest pain, although ischemia is difficult to verify.

Reverse Takotsubo Cardiomyopathy, Flash Pulmonary Edema and Cardiac Arrest after Topical Nasal Phenylephrine and Mucosal Epinephrine Injection

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is characterized by acute reversible apical ventricular dysfunction and apical akinesis in the absence of obstructive coronary artery disease. Reverse-takotsubo is a variant form of takotsubo cardiomyopathy with basal and midventricular dysfunction and normal apical function. It is known to be more common in young patients. We present a case of a 14-year-old patient who developed reverse-takotsubo cardiomyopathy with flash pulmonary edema after topical nasal phenylephrine and iatrogenic epinephrine containing local anesthetic injection for a dental procedure. Patient experienced cardiac arrest but was resuscitated successfully and transferred to the cardiac intensive care unit. Postoperative echocardiogrpahy showed normal coronary arteries and mild left ventricular hypertrophy with uncertain correlation for the cardiac event, and the patient was discharged home with no complications.

Differences in ST-elevation and T-wave amplitudes do not reliably differentiate takotsubo cardiomyopathy from acute anterior myocardial infarction

BackgroundPrevious efforts to distinguish acute anterior ST-elevation myocardial infarction (anterior-STEMI) from various forms of takotsubo cardiomyopathy (TTC) by electrocardiography (ECG) have produced differing results. MethodsWe performed a retrospective comparison of acute ECGs between 48 apical and 9 mid-ventricular TTC patients, with 96 anterior-STEMI patients. ECG was recorded in acute phase (<24h from onset of pain), and analyzed for ST-changes, negative T-waves, abnormal Q-waves and QT-interval duration. Time from onset of pain to ECG was gathered from patient records. ResultsAnterior-STEMI patients had ST-elevation in lead V1 more frequently than apical (70% vs 15%, p<0.0001) or mid-ventricular TTC patients (70% vs 0%, p<0.0001), and higher ST-elevation amplitudes in leads V2–V5 (p<0.02). Lack of ST-elevation in lead V1 and ST-elevation amplitude <2mm in lead V2 distinguished TTC from anterior-STEMI patients with 63% sensitivity and 93% specificity, with 79% predictive value. ConclusionsIn patients with anterior ST-elevation and acute chest pain, lack of ST-elevation in lead V1 and ST-elevation amplitude <2mm in lead V2 suggests a TTC diagnosis. However, this criterion is not reliable enough in clinical practice to distinguish between TTC and anterior-STEMI patients.

Assessment of variant forms of Takotsubo cardiomyopathy by two-dimensional speckle tracking echocardiography

Three women without cardiac history presented with acute chest pain occurring after a stressful event. All of them had normal coronary angiogram, and left ventricular (LV) function had returned to normal at one month. The electrocardiogram (ECG) of this 34-year-old woman showed minimal T-wave changes in the anterior leads. Troponin T raised to 0.18 ng/mL (N < 0.014). Left ventriculography, showing …

Atypical form of tako-tsubo cardiomyopathy in a patient with atrial fibrillation in Wolff-Parkinson-White syndrome complicated with ventricular fibrillation: the diagnostic problems

Atypical form of tako-tsubo cardiomyopathy (TTC) is associated with regional wall motion abnormalities in basal and/or middle segments or only middle segments with sparing of apical segments or apical and basal segments. We described a case of47-year-old female with atypical form of TTC due to fast atrial fibrillation that converted into ventricular fibrillation in WPW syndrome. The echocardiogram made after direct current cardioversion revealed decreased left ventricular ejection fraction (LVEF 35%) with akinesis of inferior and posterior walls and anterior part of interventricular septum in the middle and the basal segments with hyperkinesis of apical segments. The biochemistry blood samples revealed elevated both troponin T- 0.35 ng/mL and NT-proBNP - 3550 pg/mL plasma level. The ECG showed sinus rhythm 62 bpm, shortened PQ interval 100 ms, widened QRS duration - 115 ms with delta wave, prolonged QT interval - 520 ms, QS in leads: II, III, aVF. NegativeT waves in leads: I, aVL and positive, symmetrical T waves in leads V1-V6. The coronarography revealed normal coronaryarteries. The control echocardiography after 10 days showed normal LVEF 70%, without any wall motion abnormalities. TTC was recognised based on: history of sudden stress situation before, ischaemic ECG changes, positive markers of myocardial injury, transient segmental wall motion abnormalities and normal coronary arteries. The ablation of right postero-septal accessory pathway was successfully performed.

Takotsubo cardiomyopathy: a hidden enemy of the hypovolemic patient?

Takotsubo cardiomyopathy (TCM) is an underrecognized transient left ventricular dysfunction that mimics clinically an acute coronary syndrome. It has been linked to emotional stress and several clinical entities that provoke a catecholamine surge in the blood stream. We investigated the case of a young female patient who was admitted to the intensive care unit after a significant blood loss due to miscarriage. The patient was fully monitored and was treated for the hypovolemia. A dramatic aggravation of her clinical status was directly linked to the appearance of TCM 1 hour after her admission. This study sought to assess the appearance of TCM in a hypovolemic patient. We found no reports in the literature linking these 2 clinical entities. The blood loss and the pathophysiology of hypovolemia, especially through the excess of catecholamines that are released in the blood stream, seem to provoke the appearance of a subclinical form of TCM. As a result, TCM worsened further the general condition of the patient. There is a high possibility that TCM and hypovolemia can be closely related, and therefore, the treatment of hypovolemia can be adjusted to new standards. Because it has already been proved that TCM can be induced by emotional stress and various pathological entities, further investigations are necessary.

Atypical presentation of takotsubo cardiomyopathy

Midventricular ballooning syndrome, an atypical variant of takotsubo cardiomyopathy (TCM), is characterized by transient wall motion abnormalities of the midsegment of the left ventricle with apical sparing. In contrast to the typical form of TCM, apical contractility is preserved and may even be hyperkinetic in midventricular TCM. We present a case of atypical TCM in an 86-year-old woman who had chest pain while accompanying her husband in the emergency department as he was evaluated for chest pain.

Acute global cardiac decompensation due to inverted takotsubo cardiomyopathy after skull–brain trauma—A case report

Takotsubo cardiomyopathy (TTC) usually occurs in postmenopausal women after acute physical or mental stress and typically presents with apical ballooning of the left ventricle. TTC manifests with symptoms similar to acute coronary syndrome and may be accompanied by ECG changes, so coronary angiography is mandatory to exclude acute coronary syndrome. Other forms of TTC with atypical mid-ventricular ballooning have been described. Severe cerebral damage may also go along with ECG changes such as ST segment elevation, release of cardiac enzymes and/or cardiac dysfunction and often presents similar to TTC. For that reason a recent review postulates a pathophysiological relationship between TTC and cardiac dysfunction after cerebral bleeding.

Subarachnoid haemorrhage associated with midventricular Tako-Tsubo syndrome

A new form of Tako-Tsubo cardiomyopathy has recently been described as a midventricular localisation, opposite to the apical typical form. We report the case of a patient who presented with a sudden cardiac death and an acute coronary syndrome. However, coronary arteries were normal and the left ventriculography showed a midventricular ballooning Tako-Tsubo syndrome associated with a hawk's beak. A cerebral CT scan revealed a massive subarachnoid haemorrhage in relation with a left sylvian aneurysm rupture leading to the death of the patient. This case relates for the first time, the association of a subarachnoid haemorrhage and the recently described midventricular form of Tako-Tsubo syndrome with a hawk's beak. It is an illustration of the complexity of the relationships between brain and heart.

Transient left ventricular apical ballooning syndrome — The need for a common terminology

I'm glad to hear that other colleagues agree with me that we need now a common terminology to indicate this new syndrome [1]. Pawlowski and Gil [2] proposed the name “Transient left ventricular ballooning syndrome” that can account for all forms of Tako-tsubo cardiomyopathy (both apical and non-apical involvements), simply deleting the word “apical” from the widely used name “Transient left ventricular apical ballooning syndrome”. It seems to be a

Atypical form of Tako-Tsubo Cardiomyopathy

Atypical form of Tako-Tsubo Cardiomyopathy