Left Ventricular Apical Ballooning Syndrome Research Articles

SECONDARY TAKOTSUBO SYNDROME: AN UPDATED LITERATURE REVIEW AND CASE REPORT

Takotsubo syndrome (TTS), also commonly referred to as “stress cardiomyopathy”, “transient left ventricular apical ballooning syndrome”, “neurogenic stunned myocardium”, “broken heart syndrome” or “ampulla-shaped cardiomyopathy”, has steadily increased in prevalence since its primary identification circa 32 years ago (Sato, et al., 2020). This rare condition is characterised by an apical myocardial contractile dysfunction, without the presence of coronary artery obstruction (Prokudina et al., 2020). Despite increasing awareness among researchers and medical professionals, the precise mechanisms governing the pathophysiology of this disease are somewhat unclear (Lyon et al., 2008). Nevertheless, the association between TTS and a preceding immense, stressful trigger has been long-established (Wittstein et al., 2005). Similarly, recent evidence has shown that the connection between the heart and the nervous system plays a role in the development of this disease (Klein et al., 2017; Silva et al., 2019; Templin et al., 2019; X. Wang et al., 2020). This article presents an updated literature review on TTS with an emphasis on secondary TSS, followed by a case report on the presentation, investigation and management of an 87 year old Caucasian male with secondary TTS, occurring in the setting of a post-mechanical fall, and a right basi-cervical hip fracture. His secondary TTS is also believed to have been precipitated by the patient receiving the news of the passing away of his wife.

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Quantitative Lipidomic Analysis of Takotsubo Syndrome Patients' Serum.

Takotsubo syndrome (TTS), also known as the transient left ventricular apical ballooning syndrome, is in contemporary times known as novel acute cardiac syndrome. It is characterized by transient left ventricular apical akinesis and hyperkinesis of the basal left ventricular portions. Although the precise etiology of TTS is unknown, events like the sudden release of stress hormones, such as the catecholamines and the increased inflammatory status might be plausible causes leading to the cardiovascular pathologies. Recent studies have highlighted that an imbalance in lipid accumulation might promote a deviant immune response as observed in TTS. However, there is no information on comprehensive profiling of serum lipids of TTS patients. Therefore, we investigated a detailed quantitative lipid analysis of TTS patients using ES-MSI. Our results showed significant differences in the majority of lipid species composition in the TTS patients compared to the control group. Furthermore, the computational analyses presented was able to link the altered lipids to the pro-inflammatory cytokines and disseminate possible mechanistic pathways involving TNFα and IL-6. Taken together, our study provides an extensive quantitative lipidome of TTS patients, which may provide a valuable Pre-diagnostic tool. This would facilitate the elucidation of the underlying mechanisms of the disease and to prevent the development of TTS in the future.

Precise Single-Interval Temporal Orienting Modulates the Pre-Stimulus Alpha Phase in Frontal-Central Area

Takotsubo cardiomyopathy (Tc) is a transient left ventricular apical ballooning syndrome, with symptoms and signs of acute myocardial infarction. Tc syndrome, which occurs predominantly in postmenopausal women, is characterized by increase of sympathetic activity.Studies on the gender-specific differences in sympatho-vagal regulation and functional cerebral asymmetry (FCA) imply that female pattern of dominance is characterized by the left hemisphere, which is believed to have parasympathetic predominance, whereas male pattern indicates dominance of the right hemisphere, which is believed to have sympathetic predominance. Fluctuating levels of female sex steroids are supposed to change FCA, modulating transcallosal inter-hemispheric inhibition across the menstrual cycle. The findings suggest that FCA is enhanced during the low steroid phase (menstrual phase), whereas, during high estrogen and/or progesterone phases (follicular and luteal phase) FCA is reduced. This theory is in line with concept of decreased magnitude of inter-hemispheric cortical lateralization in premenopausal women compared to men and postmenopausal women.Therefore, if postmenopausal women are more lateralized for a variety of cerebral functions, they have less balanced equilibrium between the right-sided sympathetic and left-sided parasympathetic predominance. Decrease of endogenous female sex steroid levels in postmenopausal women leads to reduced influence of estrogens to the left hemisphere, which is believed to have parasympathetic predominance. If both of these mechanisms result in sympatho-vagal imbalance, increasing sympathetic system activity in postmenopausal women, it seems reasonable why postmenopausal women became more susceptible to sympathetically-mediated syndromes such as Takotsubo cardiomyopathy.

An Atypical Presentation of Takotsubo Cardiomyopathy Causing Torsades de Pointes

Torsades de Pointes (TdP) may have an acquired or congenital cause [ [1] Ritter J.M. Cardiac safety, drug-induced QT prolongation and torsade de pointes (TdP). Br J Clin Pharmacol. 2012; 73: 331-334 Crossref PubMed Scopus (17) Google Scholar ]. The most common acquired causes include medications and electrolyte abnormality. Takotsubo cardiomyopathy (TC) is a reversible form of ventricular dysfunction characterised by apical akinesis and absence of coronary artery disease, associated with emotional and physical stressors. TC is often associated with abnormal repolarisation including QT prolongation [ [2] Ahn J.H. Park S.-H. Shin W.Y. Lee S.W. Lee S.J. Jin D.K. et al. Long QT syndrome and torsade de pointes associated with Takotsubo cardiomyopathy. J Korean Med Sci. 2011; 26: 959-961 Crossref PubMed Scopus (13) Google Scholar ]. However, TdP has rarely been described in TC [ [3] Samuelov-Kinori L. Kinori M. Kogan Y. Swartzon M. Shalev H. Guy D. et al. Takotsubo cardiomyopathy and QT interval prolongation: who are the patients at risk for torsades de pointes?. J Electrocardiol. 2009; 42: 353-357.e1 Crossref PubMed Scopus (60) Google Scholar , [4] Denney S.D. Lakkireddy D.R. Khan I.A. Long QT syndrome and torsade de pointes in transient left ventricular apical ballooning syndrome. Int J Cardiol. 2005; 100: 499-501 Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar ]. Furthermore, TC is usually associated with modestly elevated troponin [ [5] Pirlet C. Pierard L. Legrand V. Gach O. Ratio of high-sensitivity troponin to creatine kinase-MB in takotsubo syndrome. Int J Cardiol. 2017; 243: 300-305 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar , [6] Gopalakrishnan P. Zaidi R. Sardar M.R. Takotsubo cardiomyopathy: Pathophysiology and role of cardiac biomarkers in differential diagnosis. World J Cardiol. 2017; 9: 723-730 Crossref PubMed Google Scholar ].

TAKOTSUBO CARDIOMYOPATHY SECONDARY TO ACUTE BACTERIAL MENINGITIS

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Infection and sepsis are not uncommon causes of cardiomyopathy due to a decrease in ventricular function. Cardiovascular dysfunction in sepsis can be seen as septic cardiomyopathy, Takotsubo cardiomyopathy, refractory shock or myocardial injury. A study showed that Takotsubo cardiomyopathy was present in 0.15% of admissions with severe sepsis. It should be considered in the differential diagnosis of acute coronary syndrome especially post-menopausal women with preceding stressful events. We present a case of bacterial meningitis leading to Takotsubo’s cardiomyopathy in the setting of CSF leak. CASE PRESENTATION: A 67-year-old woman with no past medical history presented to the emergency department with diarrhea, vomiting, and confusion. On arrival, she was hypotensive to 87/66mmHg, tachycardic 116bpm and hypoxic to 83% on room air. Laboratory evaluation was significant for leukocytosis of 29.2 k/ul, troponin 5.02 ng/ml, lactic acid 2.9 mmol/l, BNP 788 pg/ml. Cerebrospinal fluid showed a white blood cell count of 5011 (91% neutrophils), protein 791 mg/dl, glucose 95 mg/dl. She was admitted with a diagnosis of an NSTEMI, acute meningeal encephalitis and treated with aztreonam, vancomycin, doxycycline, and dexamethasone. Cultures revealed streptococcus viridians and treatment was narrowed to ceftriaxone. Facial CT showed a possible area of dehiscence concern for possible CSF leak. No significant coronary artery disease on the angiogram Echocardiogram was consistent with Takotsubo cardiomyopathy. The patient's cardiomyopathy was treated with goal-directed medical therapy with complete resolution of symptoms. DISCUSSION: Takotsubo cardiomyopathy is defined as a transient regional left ventricular systolic dysfunction without obstructive coronary artery disease and usually triggered by emotional or physical stress. During sepsis, there is an activation of the sympathoadrenergic system with rapid elevation in circulating catecholamine levels. Pathogenesis is related to myocardial stunning, catecholamine toxicity, impaired myocyte metabolism. According to Mayo Clinic criteria there should be: 1) transient hypokinetic, akinesias or dyskinesia of the LV midsegments, 2) absence of CAD, 3) EKG abnormalities or troponin elevation, 4) absence of pheochromocytoma or myocarditis. Patients can present with mild to moderate congestive heart failure or hypotension due to a reduction in stroke volume. The mean age of presentation ranges from around 60 to 75 years. The prognosis is excellent, mortality from 0%-8% and a recurrence occurs in <10% of patients. The treatment is based on the management of the underlying etiology and supportive cardiovascular care. CONCLUSIONS: Patients with suspected TTC need to be work up to rule out ACS with coronary angiogram. Takotsubo’s cardiomyopathy has a good prognosis with recovery on the EF and cardiac function once infection or physical stress disappears. Reference #1: De Giorgi, A., Fabbian, F., Pala, M., Parisi, C., Misurati, E., Molino, C., et al. (2015). Takotsubo Cardiomyopathy and Acute Infectious Diseases: A Mini-Review of Case Reports. Angiology, 66(3), 257–261. Reference #2: Pilgrim, TM, Wyss, TR. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: a systematic review. Int J Cardiol. 2008;124(3):283–292. Reference #3: Prasad, A, Lerman, A, Rihal, CS. Apical ballooning syndrome (tako-tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008;155(3):408–417. DISCLOSURES: No relevant relationships by Daniel Colon Hidalgo, source=Web Response No relevant relationships by Diana Estefania Espinoza Barrera, source=Web Response No relevant relationships by Hugues Orozco, source=Web Response No relevant relationships by Jose Zabala-Genovez, source=Web Response

Takotsubo cardiomyopathy: queries of the current era.

: Takotsubo cardiomyopathy (TTS), also known as left ventricular apical ballooning syndrome, is an acute, usually reversible heart failure syndrome that most often affects postmenopausal women experiencing an emotionally stressful event. It is characterized by sudden left ventricular dysfunction and wall motion abnormalities involving the apical and mid segments. TTS has been increasingly recognized in recent years, and more and more information about the pathophysiology, diagnosis, and treatment of these patients has been reported. However, much is still unknown. TTS has a wide variety of clinical subtypes and has been described in several clinical contexts. Moreover, TTS simulates ST-segment elevation myocardial infarction and acute myocarditis, and it can be difficult to obtain a certain diagnosis. As a result, clinical decisions are challenging, and many patients currently receive an inappropriate management strategy. The aim of this review is to critically analyze the evidence about this disease reported in the literature, with particular focus on the pathophysiological processes, the diagnostic elements that can help the clinician differentiate it from other diseases, and the best management of these patients.

Apical ballooning (Takotsubo) syndrome in the setting of chronic alcohol-induced hyponatremia

Takotsubo cardiomyopathy is also known as stress induced cardiomyopathy and transient left ventricular apical ballooning syndrome. There have been few case reports where hyponatremia was implicated as a trigger for stress-induced cardiomyopathy. We report the unusual case of a 79-year-old African American woman without any discernible recent stressors who presented atypically with generalized fatigue and was found to have severe hyponatremia (from chronic alcohol use and thiazide diuretics) and significantly elevated Troponin. Her echocardiogram and cardiac catheterization revealed typical features of apical ballooning syndrome.

Left ventricular apical ballooning syndrome.

The transient left ventricular apical ballooning syndrome, also known as Takotsubo cardiomyopathy, is characterized by transient left ventricular dysfunction in the absence of obstructive epicardial coronary disease. Although the syndrome has been reported in Japan since 1990, it is rare in other regions. Rapid recognition of the syndrome can modify the diagnostic and therapeutic attitude i.e. avoiding thrombolysis and performing catheterization in the acute phase.

Takotsubo cardiomyopathy in a patient with dengue fever

Takotsubo cardiomyopathy is referred to a transient, stressinduced cardiomyopathy, or a transient left ventricular apical ballooning syndrome. Its postulated pathogenesis includes excess secretion of catecholamine, coronary artery spasm, or focal myocarditis. It may occur after surgery or acute medical condition such as acute emotional stress or septicemia. Association with acute dengue virus infection was rarely reported in the literature. A 72-year-old woman with hypertension and diabetes mellitus suffered from general malaise and poor appetite in recent days. She experienced cold sweating and then had an attack of syncope in the morning of admission on August 5, 2015. She denied having fever, chest tightness, productive cough, or tarry stool passage. Her electrocardiogram showed sinus bradycardia, inverted T wave changes (V3eV6), and prolonged QT interval (QTcZ 597 milliseconds; Figure 1A). Elevated cardiac enzymes including total creatine kinase, 312e341 IU/L (normal, 29e168 IU/L); creatine kinase MB form, 13.0e18.4 ng/mL (normal, <5.1 ng/mL); and hs-troponin I, 7848.8e8499.3 pg/mL (normal, <26.2 pg/mL) were noted. Non-ST-elevated acute myocardial infarction (NSTEMI) was impressed. Initially, dual antiplatelet agents (aspirin and ticagrelor) were given. However, laboratory data of blood obtained before the antiplatelet therapy revealed the following:

Sinus surgery complicated by ventricular fibrillation in a young patient: Inverted (reverse) Takotsubo cardiomyopathy.

Takotsubo cardiomyopathy (TTC), also known as left ventricular apical ballooning syndrome or stress cardiomyopathy, is characterized by transient left ventricular systolic dysfunction and the absence of obstructive lesion in the epicardial coronary arteries. The most common presentation is acute substernal chest pain, although occasionally dyspnea and syncope, and rarely shock with ST-segment elevation and elevated cardiac biomarkers have been observed. Inverted (reverse) TTC is a rare pattern characterized hypokinesis of the basal and midventricular segments. Presently described was case of a 27-year-old woman with ventricular fibrillation following endoscopic nasal sinus surgery.

Stress-induced cardiomyopathy.

Reversible stress-induced cardiac dysfunction is frequently seen as a complication of a multitude of acute stress states, in particular neurologic injuries. This dysfunction may be difficult to distinguish between that caused by myocardial ischemia and may impact both the treatment strategies and prognosis of the underlying condition. Critical care practitioners should have an understanding of the epidemiology, pathophysiology, clinical characteristics, precipitating conditions, differential diagnosis, and proposed treatments for stress-induced cardiomyopathy. MEDLINE database search conducted from inception to August 2014, including the search terms "tako-tsubo," "stress-induced cardiomyopathy," "neurogenic cardiomyopathy," "neurogenic stress cardiomyopathy," and "transient left ventricular apical ballooning syndrome". In addition, references from pertinent articles were used for a secondary search. After review of peer-reviewed original scientific articles, guidelines, and reviews resulting from the literature search described above, we made final selections for included references and data based on relevance and author consensus. Stress-induced cardiomyopathy occurs most commonly in postmenopausal women. It can be precipitated by emotional stress, neurologic injury, and numerous other stress states. Patients may present with symptoms indistinguishable from acute coronary syndrome or with electrocardiogram changes and wall motion abnormalities on echocardiogram following neurologic injury. Nearly all patients will have an elevated cardiac troponin. The underlying etiology is likely related to release of catecholamines, both locally in the myocardium and in the circulation. Differential diagnosis includes myocardial infarction, myocarditis, neurogenic pulmonary edema, and nonischemic cardiomyopathy. Although the natural course of stress-induced cardiomyopathy is resolution, treatment strategies include sympathetic blockade and supportive care. Stress-induced cardiomyopathy may mimic myocardial infarction and is an important condition to recognize in patients with underlying stress states, particularly neurologic injuries.

A possible relationship between Takotsubo cardiomyopathy and female sex steroid-related modulation of functional cerebral asymmetry

Takotsubo cardiomyopathy (Tc) is a transient left ventricular apical ballooning syndrome, with symptoms and signs of acute myocardial infarction. Tc syndrome, which occurs predominantly in postmenopausal women, is characterized by increase of sympathetic activity.Studies on the gender-specific differences in sympatho-vagal regulation and functional cerebral asymmetry (FCA) imply that female pattern of dominance is characterized by the left hemisphere, which is believed to have parasympathetic predominance, whereas male pattern indicates dominance of the right hemisphere, which is believed to have sympathetic predominance. Fluctuating levels of female sex steroids are supposed to change FCA, modulating transcallosal inter-hemispheric inhibition across the menstrual cycle. The findings suggest that FCA is enhanced during the low steroid phase (menstrual phase), whereas, during high estrogen and/or progesterone phases (follicular and luteal phase) FCA is reduced. This theory is in line with concept of decreased magnitude of inter-hemispheric cortical lateralization in premenopausal women compared to men and postmenopausal women.Therefore, if postmenopausal women are more lateralized for a variety of cerebral functions, they have less balanced equilibrium between the right-sided sympathetic and left-sided parasympathetic predominance. Decrease of endogenous female sex steroid levels in postmenopausal women leads to reduced influence of estrogens to the left hemisphere, which is believed to have parasympathetic predominance. If both of these mechanisms result in sympatho-vagal imbalance, increasing sympathetic system activity in postmenopausal women, it seems reasonable why postmenopausal women became more susceptible to sympathetically-mediated syndromes such as Takotsubo cardiomyopathy.

Transient left ventricular apical ballooning syndrome in a patient with allopurinol induced skin rash: A case report

Introduction: Transient left ventricular (LV) apical ballooning syndrome is characterized by a transient systolic dysfunction of the left ventricular apex. The syndrome, also known as Takotsubo cardiomyopathy (TT-CMP), was first described in Japan in 1991 [1]. Its original name is derived from the typical shape of the left ventricular apex which mimics a traditional Japanese octopus-trap, called a Takotsubo. TT-CMP is thought to be associated with emotional or physical stress. This led to the hypothesis that the myopathy is caused by catecholamine-induced coronary spasms with transient myocardial ischemia.

Incidence and clinical characteristics of takotsubo cardiomyopathy post-aneurysmal subarachnoid hemorrhage

Takotsubo cardiomyopathy (TCMP), also known as stress-induced cardiomyopathy, broken heart syndrome or apical ballooning syndrome, is an increasingly recognized syndrome characterized by reversible left ventricular (LV) dysfunction, electrocardiographic (ECG) changes and release of myocardial enzymes that mimic myocardial infarction in the absence of obstructive coronary artery disease (CAD) [ [1] Tsuchihashi K. Ueshima K. Uchida T. et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. J Am Coll Cardiol. 2001; 38: 11-18 Abstract Full Text Full Text PDF PubMed Scopus (1333) Google Scholar ], attributed to a surge in catecholamine levels precipitated by an acute physical or emotional stressor [ 2 Pilgrim T.M. Wyss T.R. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: a systematic review. Int J Cardiol. 2008; 124: 283-292 Abstract Full Text Full Text PDF PubMed Scopus (387) Google Scholar , 3 Wittstein I.S. Thiemann D.R. Lima J.A.C. et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005; 352: 539 Crossref PubMed Scopus (2324) Google Scholar ]. Stress-induced cardiomyopathy following subarachnoid hemorrhage (SAH) has been described primarily in case reports and small case series [ 2 Pilgrim T.M. Wyss T.R. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: a systematic review. Int J Cardiol. 2008; 124: 283-292 Abstract Full Text Full Text PDF PubMed Scopus (387) Google Scholar , 4 Caretta G. Vizzardi E. Rovetta R. et al. The link between intracranial haemorrhage and cardiogenic shock: a case of takotsubo cardiomyopathy. Acta Cardiol. 2012 Jun; 67: 363-365 PubMed Google Scholar ], but data from larger series are lacking. The aim of this study was to report the incidence and describe the clinical characteristics of patients with non-traumatic SAH and evidence of TCMP.

Síndrome de discinesia apical transitoria durante ecocardiografía de estrés con dobutamina

The transient left ventricular apical ballooning syndrome, also known as Tako-Tusbo syndrome, has an acute onset, is more common in postmenopausal women, and is characterized by transient left ventricular apical ballooning, chest pain, electrocardiographic abnormalities, and slight elevation of markers for myocardial injury, mimicking a myocardial infarction in patients with no significant coronary lesions. However, before making the diagnosis, other causes of reversible left ventricular dysfunction must be ruled out, such as subarachnoid hemorrhage, pheochromocytoma crisis, acute myocarditis, or the presence of tachycardiomyopathy. The case is presented of a patient who developed ST elevation electrocardiographic changes with apical transient dyskinesia during dobutamine stress echocardiography.

Apical myocardial infarction with bizarre coronary images mimicking left ventricular apical ballooning syndrome: a case report

IntroductionAlthough several etiopathogenetic mechanisms have been proposed, the causes of left ventricular apical ballooning syndrome are still controversial.Case presentationA 51-year-old Japanese woman consulted the emergency room complaining of the sudden onset of anterior chest pain while shopping. We initially suspected her disease as left ventricular apical ballooning syndrome based on her clinical background and laboratory examinations. However, the initial coronary angiogram demonstrated diffuse lesions in her distal left anterior descending coronary artery, and she was finally diagnosed with apical myocardial infarction. The blood flow in her distal left anterior descending coronary artery had markedly improved in the chronic phase. If the reduced blood flow in her distal left anterior descending coronary artery was induced by coronary vasospasm and the vasospasm was relieved before the coronary angiogram was performed, this case must be diagnosed as left ventricular apical ballooning syndrome.ConclusionWe think this case may promote discussion regarding the pathophysiology of left ventricular apical ballooning syndrome.

Diagnosis of Takotsubo cardiomyopathy.

Takotsubo cardiomyopathy, also known as left ventricular apical ballooning syndrome and stress-induced cardiomyopathy, is typically characterized by transient systolic dysfunction of the apical and mid-segments of the left ventricle, in the absence of obstructive coronary artery lesions. Patients may present with symptoms and signs of acute coronary syndrome, and the provider is challenged to differentiate between these conditions. In this review, we guide the reader through the diagnostic pathway, focusing on differential diagnoses and diagnostic criteria for takotsubo cardiomyopathy.

Takotsubo Cardiomyopathy Induced Intraoperative and Postoperative Cardiac Arrests

Takotsubo cardiomyopathy (TC) is a transient left ventricular apical ballooning syndrome which results in an acute, reversible, left ventricular dysfunction. Unlike a myocardial ischemia, TC is not due to coronary artery stenosis. Initially the syndrome was described by a series of five Japanese patients in 1991 [1] and there have been multiple subsequent reports. The syndrome received its name from an octopus trap (tako-tsubo) which is a wide pot that has a narrow opening. This trap resembles the left ventricle of a patient with TC during systole as the apex is rounded and balloons out despite a hypercontractile and narrow base. TC has also been called “broken heart syndrome” because it is usually associated with a stressful event. Although recurrent cases of TC have been reported, this is the first presentation of a patient that experienced recurrent TC induced cardiac arrest in the same perioperative period.

Takotsubo Syndrome After Mitral Valve Replacement: Case Report and Brief Review of the Literature

TRANSIENT LEFT VENTRICULAR apical ballooning syndrome, also known as Takotsubo or stress-induced cardiomyopathy, is a cardiac disease characterized by transient left ventricular dysfunction, electrocardiographic changes mimicking an acute coronary syndrome, and release of myocardial cellular necrosis enzymes in the absence of significant lesions of coronary arteries.1 Takotsubo cardiomyopathy in the perioperative period increasingly is being recognized, but its association with cardiac surgery remains a rare event.