Reversible Cardiomyopathy Research Articles

Pancytopenia and reversible cardiomyopathy - complications of thyrotoxicosis: case report

Pancytopenia and reversible cardiomyopathy - complications of thyrotoxicosis: case report

MON-404 Reversible Dilated Cardiomyopathy in a Severe Case of Cushing’s Disease

Introduction: Patients with Cushing’s syndrome (CS) present a higher mortality compared with the general population mainly due to cardiovascular and infectious diseases. Major forms of cardiac involvement include left ventricular hypertrophy, myocardial ischemia, and, more rarely, reversible dilated cardiomyopathy. This last condition is not fully understood, but it seems to be related to the direct action of cortisol, promoting increase of myocardial responsiveness to several factors involved in myocardial remodeling. Case report: A 18 yrs-old, male, was admitted with a four years clinical picture of progressive weight gain, moon face with plethora, proximal weakness with muscular atrophy, diffuse cutaneous violaceous striae, depressive symptoms and fragility fractures. Arterial hypertension started three years after. Two months before admission, he presented dyspnea, orthopnea and anasarca. At admission, tachycardia, tachypnea, arterial pressure of 170X100 mmHg, oxygen saturation of 83%, bilateral thoracic crackling, diffuse edema reaching inguinal region and BMI of 38.3 kg/m2. Hormonal analyses confirmed severe ACTH-dependent CS and pituitary MRI disclosed an expansible lesion of 1.6 cm suggestive of macroadenoma. Initial transthoracic echocardiography showed dilated left cavities, normal myocardial thickness but with moderate systolic dysfunction due to diffuse hypokinesia with ejection fraction (EF) of 45%. Patient was submitted to pharmacological approach to treat heart failure (HF) with furosemide, carvedilol, enalapril and spironolactone. Other etiologies for myocardiopathy such as infectious, autoimmune and metabolic diseases were excluded. Successful pituitary surgery was done in November 2016. The patient presented progressive improve of cardiac symptoms after all the treatments but mainly after pituitary surgery. Subsequent echocardiography 15 months after showed normal cardiac cavities, normal left ventricle and myocardial thickness and preserved global and segmental systolic function, EF of 56%. In the last evaluation (two years after surgery), the patient was using oral hydrocortisone twice/day and losartan Conclusion: Dilated cardiomyopathy is an uncommon clinical morbidity of CS. However, the immediate recognition of this condition and its effective treatment including control of hypercortisolism may reverse this life-threatening clinical condition

Brain functional connectivity is altered in patients with Takotsubo Syndrome

Takotsubo syndrome (TTS) is an acute, reversible cardiomyopathy. The central autonomic nervous system (ANS) is believed to play a role in this disease. The aim of the present study was to investigate the patterns of brain functional connectivity in a sample of patients who had experienced a previous episode of TTS. Brain functional connectivity, both at rest and in response to the stressful stimulus of topical cold stimulation, was explored using functional magnetic resonance imaging (fMRI), network-based statistics (NBS) and graph theory analysis (GTA) in a population consisting of eight patients with a previous episode of TTS and eight sex- and age-matched controls. At rest, a network characterized by increased connectivity in the TTS group compared to controls and comprising elements of the central ANS was identified. GTA revealed increased local efficiency, clustering and strength in regions of the bilateral hippocampus in subjects with a previous episode of TTS. When stressed by local exposure to cold, the TTS group differed significantly from both a pre-stress baseline interval and from the control group, showing increased connectivity in a network that included the left amygdala and the right insula. Based on the results, patients with TTS display a reorganization of cortical and subcortical networks, including areas associated with the emotional response and autonomic regulation. The findings tend to support the hypothesis that a deregulation of autonomic control at the central level plays a significant role in this syndrome.

A reversible hypocalcemic dilated cardiomyopathy caused by primary hypoparathyroidism

Dilated cardiomyopathy (DCM) is characterized by dilation and impaired contraction of one or both ventricles. Affected patients have impaired systolic function and may or may not develop overt heart failure (HF). Prognosis is generally poor without heart transplantation. We experienced a case of a 10-year-old child with dilated cardiomyopathy (DCM) accompanied by undiagnosed primary hypoparathyroidism. In our case,aggressive management of hypoparathyroidism significantly improved the manifestations of DCM. The case presentation highlights the importance of considering hypoparathyroidism as a cause of reversible myocardial dysfunction.

A UNIQUE CASE OF REVERSE TAKOTSUBO CARDIOMYOPATHY ASSOCIATED WITH CYCLIC VOMITING SYNDROME

Takotsubo cardiomyopathy is a condition associated with transient left ventricular dysfunction. One of the rare atypical variant is the reverse takotsubo cardiomyopathy. Most common etiology is stress related catecholamine release. Cyclic vomiting syndrome is a condition associated with recurrent

Premature Ductal Constriction and Reversible Early Isolated Right Ventricular Cardiomyopathy in a Neonate at Birth

AbstractCardiomyopathies are a group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually exhibit inappropriate ventricular hypertrophy or dilatation. Neonatal CMs account for about 1% of childhood cardiac disease, with an estimated incidence of 10:100,000 live births, and are responsible for 10% of all paediatric cardiac deaths [1]. Among this, transient right ventricular hypertrophy (RVH) is a rare anomaly that is seen during the neonatal period. The various causes associated with right ventricular hypertrophy are maternal diabetes, metabolic causes, NSAID use and premature constriction of ductus. Present case is interesting as no cause could be found in this case of transient RVH.

A CURIOUS CASE OF THE DILATED HEART: A CASE OF REVERSIBLE DILATED CARDIOMYOPATHY DUE TO SEVERE HYPOTHYROIDISM CAUSED BY HASHIMOTO THYROIDITIS

Dilated cardiomyopathy has varied etiology. Here we present a case of severe hypothyroidism presenting as reversible dilated cardiomyopathy. 64 yo African American female was referred to us for consideration for advanced heart failure therapies. She was in her usual state of health until 4 months

HEADACHES AND HEARTBREAK

Takotsubo cardiomyopathy (TTC) is traditionally associated with a physical or emotional stressor, characterized by reversible ventricular dysfunction. Reverse takotsubo cardiomyopathy (rTTC) is described as hypocontractility of the basal/mid ventricular segments and is a variant of TCC, which can

A reversible cardiomyopathy caused by a high dose of doxylamine intoxication: a case report

A reversible cardiomyopathy caused by a high dose of doxylamine intoxication: a case report

Hypothyroidism as the cause of reversible dilated cardiomyopathy: A case report

Introduction. The causes of dilated cardiomyopathy can be divided into ischemic and nonischemic. Although the importance of thyroid hormones for proper functioning of the cardiovascular system is well known, dilated cardiomyopathy is a rare presentation of hypothyroidism. Case Report. This is a case report of a 38-year-old man admitted to the Intensive Cardiac Care Unit with signs and symptoms of advanced heart failure. Dilated cardiomyopathy was established by echocardiography, while blood test showed highly elevated levels of thyroid stimulating hormone and decreased levels of free triiodothyronine and free thyroxine. The ejection fraction was significantly improved with levothyroxine replacement therapy. Conclusion. Hypothyroidism should always be considered as the cause of dilated cardiomyopathy. Thyroid hormone tests should be performed in all patients with dilated cardiomyopathy.

Acute Pancreatitis Complicated by Stress Cardiomyopathy With Persistent Apical Akinesis: A Case Report and Literature Review

Takotsubo cardiomyopathy or stress cardiomyopathy is a transient reversible cardiomyopathy characterized by regional wall motion abnormalities that usually extend beyond a single epicardial vascular distribution. It is often precipitated by acute physical or emotional stressors. In this article, we present the case of a postmenopausal woman who was admitted for management of acute pancreatitis. On the second day of admission, she developed shortness of breath and electrocardiographic abnormalities. A transthoracic echocardiogram revealed left ventricular systolic dysfunction and apical akinesis, and coronary angiography revealed normal coronary arteries. She was diagnosed with takotsubo cardiomyopathy triggered by acute pancreatitis and started on guideline-directed heart failure medications. A follow-up echocardiogram 4 months later revealed persistent systolic dysfunction and apical akinesis.

Reverse Takotsubo cardiomyopathy: a comprehensive review.

Takotsubo cardiomyopathy (TTC) was first described in Japan in the 1980s. It is described as an acute but often reversible left ventricular (LV) dysfunction mainly triggered by emotional or physical stress. Multiple variants of TTC have been reported including reverse Takotsubo cardiomyopathy (rTTC) which is a variant characterized by the basal akinesis/hypokinesis associated with apical hyperkinesis that resolves spontaneously. The hallmark of rTTC is a clinical presentation similar to an acute coronary syndrome (ACS), with no evident obstructive coronary artery disease. The incidence of TTC is estimated to be 2% of all troponin-positive patients presenting with suspected ACS. The proportion of patients presenting with the rTTC variant out of all TTC patients in published literature has been variable, ranging from 1-23%. Reverse Takotsubo has been associated with younger age, less decrease in left ventricular ejection fraction (LVEF), and more neurological disease compared to the TTC. While the exact mechanism of rTTC is unknown, hypothesized mechanisms include catecholamine cardiotoxicity, coronary artery spasm, coronary microvasculature impairment, and estrogen deficiency. Patients with rTTC typically present with chest pain and/or dyspnea after an emotional or physically stressful event. rTTC can also be triggered by intracranial hemorrhage, general anesthesia, or neurological conditions. Diagnosis of rTTC requires the presence of LV basal hypokinesis/akinesis, new electrocardiogram (EKG) abnormalities or elevated cardiac troponin, and absence of obstructive coronary disease, pheochromocytoma, or myocarditis. Management of rTTC is similar to that of TTC, which is predominantly supportive with the treatment of complications. The recurrence rate of rTTC is around 10%. The most common complications of rTTC include myocarditis, pleural and pericardial effusions, and development of LV thrombi. The best predictors of mortality include decreased LVEF, development of atrial fibrillation, and neurologic disease.

Nursing interventions in the treatment of syndrome Takotsubo // Zadaci kardiološke medicinske sestre u lečenju Takotsubo sindroma

Takostube syndrome (TS; broken heart syndrome) is described as transient reversible cardiomyopathy that occurs in older women in most cases as a result of mental or psychological suffering. It is associated with various disorders and it is defined as Takotsubo Syndrome (TS). The clinical picture is similar to acute coronary syndrome, but it must differ from acute ischemic heart disease. Ethiopathological factors have not been fully clarified, but the main role in the development of TS by catecholamine-induced spiking myocardial capillaries or the direct toxicity of catecholamines themselves.There are no strict guidelines in the implementation of health care for patients with TS. Given the great similarity in the clinical picture between acute myocardial infarction and TS, the same procedures and tasks are used in practice as in patients with acute myocardial infarction with ST elevation, while coronarography does not prove to be the opposite. The patient under suspicion of diagnosis of TS is admitted to the coronary unit.Healthcare goals for the treatment of patients with TS are identical to those in acute coronary syndrome and include: pain relief, tension reduction - anxiety, preservation of myocardial function, and prevention and treatment of complications.

Reversible dilated cardiomyopathy as a complication of adrenal cortex insufficiency: a case report

BackgroundCardiovascular manifestations associated with Addison’s disease are previously documented. We described a case of an 11-year-old girl who developed dilated cardiomyopathy as a complication to Addison’s disease. Glucocorticoid replacement therapy resulted in near-complete recovery of cardiac function. It is the first reported case of reversible cardiomyopathy as a complication of primary adrenal insufficiency in Syria.Case presentationAn 11-year-old Caucasian girl with no significant past medical history presented with abdominal pain, vomiting after meals, and a low-grade fever. A physical examination and laboratory evaluation suggested primary adrenal insufficiency. An echocardiogram showed changes consistent with dilated cardiomyopathy. Causes of primary adrenal insufficiency other than autoimmune were excluded.ConclusionsDilated cardiomyopathy is a rare complication of primary adrenal insufficiency. Proper treatment of adrenal insufficiency with glucocorticoid replacement therapy resulted in restoration of normal cardiac function.

Reversible dilative cardiomyopathy after electrical injury: a case report

BackgroundDilative cardiomyopathy is an uncommon cardiac complication of electric shock.Case presentationWe report a case of a 12-year-old German boy with a high voltage injury who developed a four-chamber dilative cardiomyopathy, which was diagnosed on the 13th week postburn. One year after the accident, echocardiography showed a normal function of his heart with 64% ejection fraction and normal cavities’ dimensions.ConclusionsDespite the fact that dilative cardiomyopathy is not very common in electrical injuries but can be fatal, a prolonged echocardiography follow-up for patients with electrical injury could be recommended. Until now this case is the first child with severe burns after electrocution, who developed a reversible dilative cardiomyopathy.

Anticoagulation and stress-induced cardiomyopathy.

Stress-induced cardiomyopathy (SCM), is a reversible cardiomyopathy characterized by transient systolic dysfunction following an acute physiologic stress. Thromboembolism occurs at a high frequency in patients with intracardiac thrombus secondary to SCM, with one systematic review reporting a rate of 33.3%. The risk of thrombus formation following SCM has been associated with left-ventricular (LV) contraction abnormalities, catecholaminergic surge, and other associated comorbidities. However, established guidelines for screening and management of intracardiac thrombus in the setting of SCM do not exist at present due to a lack of sufficient clinical trial data. The purpose of this article is to discuss the pathophysiological theory and previously documented evidence from cases of LV thrombus secondary to SCM, and to present our recommendations for management of intracardiac thrombus secondary to SCM.

REVERSIBLE NONISCHEMIC CARDIOMYOPATHY SECONDARY TO CENTRAL HYPOTHYROIDISM

SESSION TITLE: Cardiovascular Disease 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Thyroid hormones are well known to cause alterations in the cardiovascular hemodynamics. Hypothyroidism causes decreased contractility and cardiac output, bradycardia and increased systemic vascular resistance. This is secondary to changes in gene expression of enzymes involved in myocardial calcium shift, decrease beta adrenergic receptor expression and increase afterload induced by thyroid hormone deficiency. Although contractility and cardiac output are reduced in hypothyroidism, heart failure is rare due to the accompanying decrease in oxygen demand in the body. Here we are presenting a case of non-ischemic cardiomyopathy secondary to central hypothyroidism that improved with thyroid hormone replacement. CASE PRESENTATION: A 38-year-old female patient with history of adrenal insufficiency and central hypothyroidism secondary to panhypopituitarism secondary to Sheehan syndrome, presented with dyspnea and fatigue. She stated that she has not been taking her thyroid replacement therapy for a few months. On exam, BP was 128/100 and HR 66, she had distant heart sounds, no JVD and negative pulsus paradoxus, however, systolic BP dropped by 10 during inspiration. Labs showed TSH of 2 and fT4 of 0.16. EKG showed normal sinus rhythm without electrical alternans. Echo showed moderate pericardial effusion with RA collapse but no RV collapse, LVEF 30-35% and global hypokinesis of the left ventricle (Echo from 3 months earlier showed trivial pericardial effusion and LVEF 50%). She was started on her oral home dose of levothyroxine 125 mcg/day and had a nuclear stress test that showed no reversible perfusion defects. During her stay, she was hemodynamically stable and her symptoms started to improve. Repeat Echo showed marginal improvement in her LVEF with increase in RV systolic pressure. The size of the pericardial effusion was unchanged, however, respiratory variation in mitral and tricuspid inflow was less pronounced with less RA collapse. Later, her dyspnea and fatigue significantly improved and she was discharged home on oral levothyroxine 125 mcg/day. She was evaluated 5 weeks after discharge, with labs showing normal fT4 and Echo showing improved LVEF and decrease in the size of the pericardial effusion. DISCUSSION: Cardiac manifestations of hypothyroidism usually include dyspnea, fatigue, bradycardia, diastolic hypertension, edema and pericardial effusions. This is due to the effects of thyroid hormones deficiency on the heart and the vasculature. Systolic dysfunction is rare and only a few cases has been reported. Fortunately, it is usually reversible and improves with correcting the hypothyroidism. L-thyroxine (T4) is used to replace thyroid hormones and in this case, her home dose of 125 mcg/day was used. CONCLUSIONS: Thyroid function should be checked more frequently in patients presenting with cardiomyopathy specially if they have any concomitant signs and symptoms of hypothyroidism. Reference #1: Klein I, Ojamaa K. Thyroid Hormone and the Cardiovascular System. N Engl J Med. 2001 Feb 15;344(7):501-9. Reference #2: I Khochtali et al. Reversible dilated cardiomyopathy caused by hypothyroidism. Int Arch Med. 2011;4:20. Reference #3: Myung Do Seol et al. Dilated Cardiomyopathy Secondary to Hypothyroidism: Case Report with a Review of Literatures. J Cardiovasc Ultrasound. 2014 Mar; 22(1): 32-35. DISCLOSURES: No relevant relationships by Marsha Antoine, source=Web Response No relevant relationships by Housam Hegazy, source=Web Response No relevant relationships by Mili Shah, source=Web Response No relevant relationships by Bashar Sharma, source=Web Response No relevant relationships by Vikrant Tambe, source=Web Response

Association of Endocrine Conditions With Takotsubo Cardiomyopathy: A Comprehensive Review.

Takotsubo cardiomyopathy (TCMP), also known as stress cardiomyopathy or broken‐heart syndrome, is an increasingly recognized form of transient left ventricular (LV) dysfunction that is often completely reversible.1, 2, 3, 4 It is diagnosed in ≈1% to 2% of patients initially presenting with symptoms suggestive of acute coronary syndrome.2 It often presents with dyspnea, hypotension, syncope, elevated troponin levels, and ST elevations or T wave inversions on electrocardiography.1 Coronary angiography classically reveals normal coronary arteries with no significant stenosis, though bystander coronary disease could be present, which is often mild and not severe enough to account for the degree of ventricular dysfunction.1, 2 Complications can occur early in its course and include arrhythmia, thrombus formation, LV outlet tract obstruction, ventricular rupture, cardiogenic shock, and cardiac arrest.1, 3 An up to 8% mortality rate has been reported with excellent recovery in 95%.3 Classically it has been described following a physical and emotional event, with recurrence rates of 10% to 11% on revival of triggering factors.1 Several variants of TCMP have been described. The typical or apical variant consists of a hyperkinetic LV base with focal apical akinesis resulting in apical ballooning and reduced ejection fraction. Other variants such as the inverted or basal pattern (circumferential basal hypokinesis and apical hypercontractility), the mid LV variant (circumferential midventricular hypokinesis and both basal and apical hypercontractility), and the biventricular apical and right ventricular pattern have been described.1, 4 The exact pathogenesis is not fully understood with vast unanswered questions remaining, though a central role of catecholamines has been widely accepted. The stress related to metabolic dysfunction can be the initial trigger for the sympathetic surge found in this disorder. Several case reports have described its occurrence secondary to a number of endocrine disorders, though this has not been comprehensively evaluated. Here we have attempted to review all of the published reports of associations of endocrine conditions with TCMP and discuss some postulated mechanisms by which this may occur. This review will mainly focus on the potential association of pituitary, thyroid, adrenal, and estrogen metabolic disorders with this transient reversible cardiomyopathy and how hormones can impact cardiac function. This review suggests that hormonal dysregulation should be considered in patients presenting with cardiac abnormalities.

Successful use of combined blood purification techniques in splenectomised patient with septic shock in streptococcus pneumoniae infection \u2013 a case report

BackgroundSeptic cardiomyopathy represents cardiac impairment in sepsis and is a part of systemic involvement in sepsis. Cytokine storm is responsible for septic shock and for myocardial dysfunction of potentially reversible septic cardiomyopathy. Several case reports and case series demonstrated successful removal of circulating cytokines by combined blood purification techniques. In this way, septic shock and survival of septic patients improved. However, the evidences for reversal of myocardial dysfunction are rare.Case presentationWe present a patient with a history of chemotherapy for coat cell lymphoma, splenectomy and autologous bone marrow transplantation, who suffered severe pneumococcal sepsis, septic shock and septic cardiomyopathy, resistant to pharmacological therapy. Combined blood purification techniques 36 h after the start of treatment successfully decreased Interleukin-6 level, lactacidosis, the need for vasopressors to maintain normotension, improved systolic function of the left ventricle and clinical outcome.ConclusionsOur case suggests that combined blood purification techniques initiated even 36 h after the start of treatment successfully removed inflammatory cytokines, reversed circulatory failure and improved left ventricular systolic function in pneumococcal sepsis.

Echocardiographic profile of patients with cardiomyopathy

Introduction: Cardiomyopathies represent a heterogeneous group of diseases that often lead to progressive heart failure with significant morbidity and mortality. Exact epidemiological data on cardiomyopathy in Nepal are lacking. This study was done to observe the demographic and echocardiographic profile of patients with cardiomyopathy attending a medical college teaching hospital.
 Methods: Trans-thoracic two-dimensional echocardiographic study was performed by first author on all patients with cardiomyopathy over a period of six months. Patients’ demographic and echocardiographic data were collected and analyzed using SPSS version 20 software. Student t-test and Chi-square test were applied where appropriate.
 Results: A total of 60 patients were studied from October 2017 to March 2018. Mean age of all participants was 56.38 years (SD = 13.86). Mean age of males was significantly higher than that of females (60.96 yrs, SD = 13.61 versus 51.62 yrs, SD = 13.47) in dilated cardiomyopathy subgroup (p < 0.05). Of all patients, 32 (53.33%) had dilated cardiomyopathy (idiopathic) and 13 (21.66%) had ischemic cardiomyopathy.
 Conclusion: Our study highlighted significant burden of dilated cardiomyopathy. Dilated cardiomyopathy appeared in females at earlier age compared to males. Potentially reversible cardiomyopathies like alcoholic and peripartum cardiomyopathies were also present which have a probability of cure if treated properly.