Mid-ventricular Takotsubo Research Articles

Midventricular Takotsubo cardiomyopathy following COVID-19 infection: diagnostic role of cardiac magnetic resonance tissue mapping

Midventricular Takotsubo cardiomyopathy following COVID-19 infection: diagnostic role of cardiac magnetic resonance tissue mapping

P319 MID VENTRICULAR TAKOTSUBO SYNDROME IN A PATIENT WITH COVID 19 PNEUMONIA: A CASE REPORT

Abstract Background Takotsubo Syndrome (TTS) is an acute and transient myocardial disfunction associated with chest pain, electrocardiographic changes and minimal myocardial enzymatic release mimicking acute myocardial infarction but without significant coronary artery disease. Physical or emotional stress play a central role in the pathogenesisof this cardiomyopathy. Several variants have been described including the classic type, reverse Takotsubo, midventricular type and focal type. Mid ventricular Takotsubo is characterized by circumferential mid–ventricular hypokinesia with hypercontractility of base and apex. This atypical variant is one of the most rare form that occurs in 15% of patients with Takotsubo syndrome. We report a Takotsubo case with mid–ventricular pattern in a postmenopausal woman with COVID–19 interstitial pneumonia. Clinical case A 56–year–old female patient was admitted to our intensive cardiac care unit for acute chest pain and dyspnea. In clinical history hypertension, dyslipidemia, anemia and schizophrenia were documented. COVID–19 molecular test was positive. CT scan showed multiple ground–glass opacities bilaterally. Hemodynamic parameters were normal but ECG showed ST–segment elevation and T waves inversion in the lateral precordial leads. Troponin–I was elevated and peaked at 1704 ng/mL. A transthoracic echocardiogram showed ballooning of the midventricular segments with hyperkinesis of the basal and apical segment. Coronary angiography showed normal coronaries. The patient was treated with beta–blockers and intravenous fluid infusion. After 10 days in hospital, echocardiography showed normalization of regional contractility and improvement of ejection fraction. The patient was discharged in good condition. Conclusions Recent studies have reported an increase in TTS incidence during the COVID–19 pandemic. SARS-CoV-2 infection induces physical and psychological stress in patients, which may lead to an increase in the risk of TTS development. The pathophysiology of COVID-19-induced TTS still remains unclear. The mortalityrate of TTS is higher (36.5%) in COVID–19 patients.

Type transition and mitral regurgitation of mid-ventricular Takotsubo in a single course.

Type transition and mitral regurgitation of mid-ventricular Takotsubo in a single course.

Abstract 14374: Clinical and Echocardiographic Characteristics of Patients Who Develop Post Liver Transplant Non-Ischemic Cardiomyopathy

Background: Non-ischemic cardiomyopathy is a well-known but poorly understood cardiac complication post orthotopic liver transplantation (OLT). Methods: We performed a nested case control study in a cohort of 590 patients who underwent OLT at Loma Linda University between 2013 - 2021. 29 (4.9%) patients developed post-OLT non-ischemic cardiomyopathy. 100 patients who did not develop cardiomyopathy were selected randomly from the cohort to serve as control group. Clinical characteristics of cases and controls were compared and echocardiograms of patients who developed cardiomyopathy reviewed. Results: Patients who developed cardiomyopathy were more likely to be female, less likely to have history of hypertension, had lower baseline hemoglobin and platelets, and higher MELD scores ( Table 1) . Mean pre-transplant ejection fraction (EF) was 69% among patients who developed cardiomyopathy. Cardiomyopathy developed on average 10 days after OLT with mean EF dropping to 26%. 24 (83%) patients had reduced EF (<40%) and 5 (17%) had mid-range EF (40-49%). Wall motion analysis revealed global hypokinesis in 11 (38%) patients, mid-ventricular takotsubo in 11 (38%) patients, apical takotsubo in 5 (17%) patients, and basal takotsubo in 2 (7%) patients (Figure 1) . 24 (83%) patients recovered EF (≥ 50%) on average of 113 days after initial diagnosis of cardiomyopathy. Conclusions: Female sex and higher MELD scores were associated with development of non-ischemic cardiomyopathy post OLT. Global hypokinesis and mid-ventricular takotsubo were the most common patterns of wall motion abnormality. EF recovery was noted in majority of patients indicating operative stress related etiology.

Echocardiography in new-onset heart failure: a mid-ventricular Takotsubo case report.

We report the case of an elderly woman with recent hip replacement surgery that presented with cardiogenic shock. The initial echocardiogram was suggestive of mid-ventricular Takotsubo cardiomyopathy, which was later confirmed due to absence of severe coronary artery disease and complete resolution of the patient's cardiac systolic dysfunction. Fluid and inotrope administration in the acute phase, and guideline-directed medical therapy for heart failure, thereafter, led to full recovery.

285 A rare case of atypical, non-triggered takotsubo recurrence

Abstract Aims Takotsubo syndrome (TTS) is an acute and reversible heart failure syndrome that, at presentation, mimics acute myocardial infarction. The most common echocardiographic manifestation is the so-called ‘apical ballooning’, but other much less common wall motion patterns have been described. The pathophysiology of the syndrome is not fully understood, but there is considerable evidence that sympathetic stimulation plays a central role. The prevalence of this syndrome is higher in post-menopausal women and in most cases, but not invariably, precipitated by an emotional or physical triggering event. A close relation between brain and circulatory system has been observed and for this reason psychiatric and neurologic disorders are often recognized as precipitating conditions. Although many risk factor persist after the acute manifestation, Takotsubo recurrences do represent an exception, especially in the absence of a clear precipitating event. Methods and results A 70-year-old woman was admitted for anginal pain associated with ischaemic electrocardiographic alterations and elevation of cardiac biomarkers. The coronary angiography with left ventriculogram and the echocardiographic findings were consistent with a diagnosis of mid-ventricular Takotsubo. Cardiac magnetic resonance confirmed the absence of an ischaemic pattern or evidence of infectious myocarditis. This case represents a recurrence of TTS, in fact two years earlier the patient was hospitalized to our division for stress cardiomyopathy with typical apical ballooning. Also in the present occasion, she had a favorable clinical course, with a complete recovery of the cardiac function at subsequent evaluations. The unicity of this case lies above all in the absence of a clear trigger event. Although, an altered mental status was present because the patient suffered from anxiety and depression on pharmacological treatment, with periods of exacerbation but not in occasion of the recurrence. Conclusions TTS is not a benign condition, with recurrence being possible even in the absence of precipitating events. Based on registry data, annual rate of Takotsubo recurrence is 1.5–1.8% and is estimated to reach 4% in life. A variable TTS pattern at recurrence is common in up to 20% of cases. Our paper reports a unique case of recurrent Takotsubo syndrome with variable patterns of ventricular involvement, with neither physical nor psychological trigger. Nevertheless, for what concerns our case, the psychiatric condition the patient suffered from, could have played a role of permanent status of sympathetic activation, that in the end elicitates the occurrence of the syndrome. A better understanding of the pathophysiology of the syndrome is needed to find evidence-based therapeutic strategies that could prevent recurrence.

Takotsubo syndrome associated with autoimmune limbic encephalitis: a case report

BackgroundCentral nervous system diseases are common triggers of Takotsubo syndrome. We herein report a rare case of Takotsubo syndrome associated with autoimmune limbic encephalitis.Case presentationA 68-year-old Japanese woman presented to our emergency room with disturbed consciousness. At admission, she showed hypoxemia. Left ventriculography showed akinesia in the middle part of the left ventricle and hyperkinesia in the apical and basal parts of the left ventricle, and the diagnosis of midventricular Takotsubo syndrome was established. However, after an improvement in disturbed consciousness and Takotsubo syndrome symptoms, her brother noticed something wrong with her behavior during his visit to the hospital. Subsequently, we consulted the neurology department 1 week after admission. Her brother revealed a history of abnormal behavior by the patient (such as mistaken entry in the wrong apartment in her building or in another person’s car) a few days prior to the onset of disturbed consciousness, suggesting disorientation of place. Brain magnetic resonance imaging showed an increased signal in the medial aspect of the temporal lobes, which was most clearly observed on the fluid-attenuated inversion recovery sequence; additionally, a cerebrospinal fluid analysis revealed mild lymphocytic pleocytosis. Finally, we established a diagnosis of midventricular Takotsubo syndrome associated with autoimmune limbic encephalitis.ConclusionsIt is presumed that the dysfunction of limbic system due to autonomic limbic encephalopathy is associated with exaggerated sympathetic stimulation. This likely resulted in Takotsubo syndrome in our patient.

Left ventricular mechanics in the acute phase of Takotsubo cardiomyopathy: distinctive ballooning patterns translate into different diastolic properties.

Although apical and midventricular Takotsubo cardiomyopathies (TTCs) share common triggers and pathophysiological features, little is known about the potential differences in left ventricular (LV) mechanistic properties between these TTC phenotypes. We sought to investigate whether LV systolic and/or diastolic function, as assessed invasively by left heart catheterization (LHC), differ according to ballooning patterns in the acute phase of TTC. One hundred and fourteen TTC patients were retrospectively identified between January 2009 and December 2015 at the University Hospital of Strasbourg, France. A comprehensive list of LV quantitative parameters was derived from LHC analysis for each patient. We examined 2 groups of patients according to ballooning patterns in the acute phase of TTC: patients with apical ballooning ("Apical group"; n = 76) and those with midventricular ballooning ("Midventricular group"; n = 38). LV minimal diastolic pressure (8.72 ± 6.72 vs. 5.02 ± 6.08mmHg; p = 0.004), LV end diastolic pressure (23.11 ± 8.32 vs. 18.84 ± 8.06mmHg; p = 0.01), and LV diastolic stiffness (LV stiffness 1: 0.29 ± 0.23 vs. 18.84 ± 8.06mmHg/mL; p = 0.04-LV stiffness 2: 0.16 ± 0.08 vs. 0.12 ± 0.05mmHg/mL; p = 0.005) were significantly higher in patients with apical TTC than in the midventricular group. Concomitantly, these findings were associated with significantly higher BNP levels in the apical group (923.91 ± 1164.53 vs. 418.71 ± 557.75pg/mL; p = 0.004) than in the midventricular group. In the acute phase of stress cardiomyopathy, the classic apical form of TTC is associated with poorer diastolic function compared to the midventricular ballooning variant, as assessed through direct invasive hemodynamic measurements using LHC.

“Dobutamine stress testing”-Triggered mid-ventricular takotsubo syndrome

Copyright © 2016, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Dear Editor,

“Dobutamine stress testing”-Triggered mid-ventricular takotsubo syndrome

“Dobutamine stress testing”-Triggered mid-ventricular takotsubo syndrome

Electrocardiogram in anterior mid-ventricular Takotsubo syndrome variant

To the Editor: I enjoyed reading the report by Demirelli et al., published in the May, 2015 issue of the Intractable & Rare Diseases Research, pertaining to a 59 year old woman with emotional stress-induced anterior mid-ventricular Takotsubo syndrome (TTS) variant (1). The authors described the electrocardiogram (ECG) as showing T-wave inversions (TWI) in leads V1–V4. A recent paper reported an ECG correlate of TTS consisting of transient low voltage QRS (LVQRS) complexes (2). These ECG changes have been attributed to TTS-induced myocardial edema (ME), as detected by cardiac magnetic resonance imaging (cMRI) (2). Also TWI has been attributed to apicobasal ME gradient, as detected by cMRI (3). The present patient had a cMRI 4 weeks after her discharge, which confirmed the absence of chronic scar changes, compatible with TTS, but such late cMRI would not be suitable for the detection of ME, an early feature of TTS. Transient LVQRS often impacts the limb ECG leads (2), while affects leads I and aVL in patients with the midventricular TTS variant (4,5). Did this patient show transient LVQRS in the V1-V4 leads, which showed TWI? Also if serial ECGs were recorded, and if there was an ECG of this patient recorded prior to her admission with TTS, and at her 4 week follow-up, were there any transient LVQRS ECG changes, and in which leads?

Takotsubo Cardiomyopathy

63-year-old woman has had 2 hospital admissions for central chest pain occurring in the setting of emotional stress over the last 11 years. Her other medical history included anxiety, hypertension, and dyslipidemia. At 52 years of age, she presented to the hospital with central chest pain after a major argument with her mother. An ECG demonstrated sinus rhythm with 1-mm ST-segment elevation in leads I and aVL. Her serum troponin I was mildly elevated at 0.63 μg/L (normal <0.03 μg/L). A coronary angiogram demonstrated no significant flow-limiting coronary artery lesions. A left ventriculogram demonstrated severe left ventricular dysfunction resulting from a large area of akinesis involving the anterior and apical wall segments. Subsequently, she developed pulmonary edema, which was treated with diuretic therapy. A transthoracic echocardiogram performed 4 days after admission demonstrated full recovery of the patient’s left ventricular dysfunction, consistent with a diagnosis of Takotsubo cardiomyopathy. She was treated with aspirin, a statin, and a calcium channel blocker. The patient had been followed up regularly with transthoracic echocardiograms, which demonstrated normal left ventricular systolic function (Movies I and II in the online-only Data Supplement). Recently, 11 years after her first hospital admission with chest pain, the patient presented to our hospital with central chest pain after arguments with her son. She experienced significant emotional stress on learning that her son was abusing illicit recreational substances. An ECG demonstrated sinus rhythm with nonspecific T-wave flattening in the lateral leads. Her serum troponin I rapidly peaked at 1.76 μg/L (normal <0.03 μg/L). A coronary angiogram demonstrated mild atheroma in the left anterior descending artery and right coronary artery only (Figure 1). A left ventriculogram demonstrated midventricular akinesis in a noncoronary distribution. Contraction in the basal and apical segments was preserved (Figure 2 and Movie III in the online-only Data Supplement). These findings were consistent with a diagnosis of midventricular Takotsubo cardiomyopathy. She was treated with a β-blocker and angiotensin receptor blocker. She remained well after discharge with recovery of left ventricular function (Movies IV and V in the online-only Data Supplement). Discussion Takotsubo cardiomyopathy frequently occurs in the setting of significant emotional or physical stress or acute medical illnesses. Some patients develop recurrent Takotsubo cardiomyopathy in the setting of further stressors, with normal left ventricular systolic function between these episodes. The factors determining recurrence are poorly understood. One proposed mechanism is an excess of catecholamine, which results in myocardial toxicity. This theory is supported by evidence of elevated plasma catecholamine levels in patients with Takotsubo cardiomyopathy compared with patients with acute myocardial infarction. 1 Therefore, β-blockers have been used as one of the key pharmacological agents in the treatment of Takotsubo cardiomyopathy. Our patient was managed with a calcium channel blocker after her first presentation, and we hypothesize that the absence of β-blockade in the initial treatment regimen may have contributed to her recurrent presentation. What is even more enigmatic is the variable pattern of ventricular involvement in recurrent cases of Takotsubo cardiomyopathy. The first cases of midventricular variant of Takotsubo cardiomyopathy in the Western literature were described in 2006. 2 Since then, various case reports have been published describing different patterns of recurrence. 3 A consistent theme appears to emerge in the cases of recurrent Takotsubo cardiomyopathy described in literature: Recurrent Takotsubo cardiomyopathy often occurred in a different ventricular region. Our patient developed acute pulmonary edema from severe left ventricular apical involvement during her first presentation. Her recurrent presentation occurred in the midventricle only. Consequently, she was not as unwell during the recurrent presentation and did not develop pulmonary edema. We hypothesize that the previous episode of apical Takotsubo cardiomyopathy protected her left ventricular apex from being involved during the recurrent episode. The mechanisms mediating this phenomenon are unclear. It may be that the first episode protected the left ventricular apex via a phenomenon analogous to regional ischemic preconditioning. 4 Transient ischemia of the left ventricular apex during the first presentation may have imprinted memory in the apical

Life-threatening ventricular arrhythmias due to atypical mid-ventricular tako tsubo cardiomyopathy in a patient with chronic QT interval prolongation under anti-psychotic medication

Life-threatening ventricular arrhythmias due to atypical mid-ventricular tako tsubo cardiomyopathy in a patient with chronic QT interval prolongation under anti-psychotic medication

Comparison of in-hospital course and long-term follow-up in apical and mid-ventricular takotsubo patients

Comparison of in-hospital course and long-term follow-up in apical and mid-ventricular takotsubo patients

Catecholaminergic polymorphic ventricular tachycardia and midventricular Takotsubo cardiomyopathy: a novel association?

Takotsubo cardiomyopathy (TTC) is a recently recognized clinical syndrome characterized by transient ventricular dysfunction in the absence of obstructive coronary artery disease. TTC primarily affects postmenopausal women; TTC in children and adolescents is only rarely reported. Furthermore, simultaneous occurrence of Takotsubo cardiomyopathy and primary electrical diseases has been previously reported in only four recent cases of female patients with congenital long QT syndrome. Here, we report the novel association of catecholaminergic polymorphic ventricular tachycardias and a midventricular type of TTC observed in a young female patient.

Mid-ventricular takotsubo: A case report

Introduction: Is mid-ventricular takotsubo really a variant? takotsubo cardiomyopathy (tcM) most commonly presents with both midventricular and apical segment hypokinesia. Less frequently, the apical segment is spared and this variant has been termed mid-ventricular takotsubo. case report: We present a case of a 66-year-old female with chest pressure and abnormal electrocardiography and positive troponin. recently her mother was placed in hospice. Echocardiogram showed severe systolic dysfunction. she underwent left heart catheterization which included left ventriculogram that showed normal coronaries and basilar and apical hyperkinesis and midventricular hypokinesia suggestive of mid ventricular takotsubo. conclusion: We suggest that takotsubo cardiomyopathy (tcM) can be thought of as a continuum in which the midventricular segment is hypokinetic first and then the apical portion becomes hypokinetic later. Moreover, mid-ventricular hypokinesia is a key to a diagnosis of tcM; regardless of the presence of apical dyskinesia. the tcM merely presents in different ways and that the mid-ventricular variant is not a different disease entity from typical tcM.

Midventricular Ballooning Takotsubo Cardiomyopathy Complicated by Transient Complete Atrioventricular Block

A 63-year-old woman had mistakenly drunk detergent stored in a plastic bottle and was transported to our hospital via ambulance due to unconsciousness. In the emergency room, the monitoring electrocardiogram showed complete atrioventricular block and temporary pacing was thus started. Left ventriculography indicated midventricular Takotsubo cardiomyopathy, although coronary angiograms showed a normal appearance. The atrioventricular block was transient, and the reduced left ventricular wall motion gradually recovered. An electrophysiological study performed before discharge showed no abnormalities in the atrioventricular conduction system. In conclusion, we experienced a case of mid-ventricular Takotsubo cardiomyopathy complicated by transient complete atrioventricular block.

Five Cases with Mid-ventricular Type Takotsubo Cardiomyopathy

Five Cases with Mid-ventricular Type Takotsubo Cardiomyopathy

Midventricular Takotsubo cardiomyopathy associated with ventricular fibrillation during general anaesthesia in a 34-year-old woman: Insight from cardiac computed tomography and magnetic resonance imaging

Midventricular Takotsubo cardiomyopathy associated with ventricular fibrillation during general anaesthesia in a 34-year-old woman: Insight from cardiac computed tomography and magnetic resonance imaging

An unusual case of mid-ventricular Takotsubo cardiomyopathy

A 48-year-old housewife presented to hospital with acute central chest pain associated with dyspnoea at rest. The chest pain had awoken her from sleep 6 h previously, was non-pleuritic and radiated to her back. She had no past history of chest discomfort or angina however, she had been ‘worrying’ recently about a daughter who was ill. Of particular note was a background of anxiety and depression, for which she was prescribed venlafaxine. She was a lifelong non-smoker. On admission, she was afebrile, normotensive (132/78 mmHg) and had a regular pulse (110 b.p.m.). Clinical examination revealed no abnormality. Initial laboratory investigations included Hb 13.4 g/dl [normal range (NR) 11.5–16.5 g/dl], leucocyte count 7.9 × 109/l (NR 4.0–10.0 × 109/l), Na+ 144 mmol/l (NR 135–145 mmol/l), K+ 4.4 …