Variant Of Takotsubo Cardiomyopathy Research Articles

Abstract 14966: Happy Heart Syndrome: The Mid-Ventricular Variant of Takotsubo Cardiomyopathy Triggered by Pleasant Experiences

Introduction: A joyful event triggered chest pain in an elderly woman, leading to the diagnosis of a mid-ventricular variant of Takotsubo cardiomyopathy (TC). Case presentation: A 65-year-old woman experienced chest pain during a surprise retirement party. The initial electrocardiogram revealed T-wave inversions in leads V1 and V2, and her troponin I level was 6700 ng/ml. A coronary angiogram did not reveal any occlusion in the coronary arteries. However, the left ventriculogram exhibited findings consistent with the mid-ventricular variant of TC. The patient was treated with a diuretic, a beta-blocker, and an ACE inhibitor. A follow-up echocardiogram was scheduled after four weeks. Discussion: TC typically manifests with abnormal apical wall motion on the left ventriculogram, causing "apical ballooning" at end-systole and basal hyperkinesis, unrelated to specific major epicardial coronary artery distribution. Among patients presenting with symptoms resembling acute coronary syndrome (ACS), a study reported that 1.2% showed TC, with 60% exhibiting regional dysfunction in both apical and midventricular regions. In comparison, 40% had isolated dysfunction in the midventricular area. Other rare variants of TC have also been documented, including the inverted Takotsubo or basal variant, biventricular apical dysfunction, and isolated right ventricular Takotsubo syndrome. In a recent study, TC triggered by positive experiences ("happy heart syndrome"), the mid-ventricular variant was found to occur more frequently, representing 35% of the cases. The treatment for TC includes standard management of heart failure and regular follow-up echocardiography is recommended for surveillance. Conclusion: In cardiology, the often-overlooked atypical patterns of left ventricular dysfunction in Takotsubo cardiomyopathy (TC) and the challenges of diagnosing TC in patients with diverse emotional triggers pose difficulties.

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Abstract 13713: Short-Term Outcomes of Acute Mitral Regurgitation in Patients With Takotsubo Cardiomyopathy

Introduction: Takotsubo cardiomyopathy (TC) is characterized by significant transient left ventricular dysfunction that is not due to obstructive coronary artery disease. Acute mitral regurgitation (MR) has been described in previous studies as a complication of TC, but short-term outcomes are not well studied. The aim of our study was to investigate the rates and outcomes of patients diagnosed with TC with acute MR in the Veteran Affairs (VA) system. Methods: We performed a retrospective study using chart review for patients diagnosed with TC between 2005 and 2018 in the VA national database. We included patients who met the Mayo Clinic diagnostic criteria for TC. We collected data for demographics, clinical course, and outcomes. Results: 287 patients (70.7% males) were included, Median age was 64 years, 18.8% were known to have coronary artery disease, 34.1% were diabetic and 60.3% had hypertension. 96% of patients had apical variant of TC. Moderate to severe MR was present in 8.7%; of those 48% were either new or significantly worsened MR when compared to previous echocardiograms prior to TC. MR was mostly diagnosed in patients with apical TC (91.7%). There was no significant difference in the rates of diagnosis of new MR in men compared to women (3.4% vs 6% p=0.34). There was also no significant difference in the in-hospital mortality rates between patients with new moderate-severe MR vs no-trivial MR (0% vs 8.7%, p = 0.61). At 30-day follow up there was no significant difference in mortality rates in patients with moderate-severe MR compared to no-trivial MR (9.1% vs 2.5%, p = 0.22). On follow up echo for patients who survived, all patients had resolution of the MR. Conclusions: In patients diagnosed with TC with new moderate-severe MR, there was no significant difference in mortality rates in the hospital or at 30-day follow up.

Atypical variants of takotsubo cardiomyopathy: mechanistic and clinical implications.

Atypical variants of takotsubo cardiomyopathy: mechanistic and clinical implications.

Reverse Takotsubo Cardiomyopathy After Caesarean Section With Epidural Anesthesia: Initial Assessment and Follow-up

ABSTRACT Takotsubo Cardiomyopathy (TC) is a well-recognized clinical entity that mimics an acute coronary syndrome and is characterized by a transient abnormality of the apical segments of the heart. Reverse TC (RTC) is a recognized variant of TC that affects the basal segments of the left ventricle with hypercontractility of the apical myocardial segments. While classic form mostly affects postmenopausal women, RTC occurs essentially in younger females, always triggered by stress. It can also develop after medical procedures and surgery. We report a case of a 33-year-old woman with RTC after epidural anesthesia for caesarean section. Our case highlights the significance of high clinical suspicion among anesthesiologists, obstetricians and cardiologists of this variant and the important role of imaging the diagnosis and therapeutic management of the disease.

A NOVEL VARIANT OF TAKOTSUBO CARDIOMYOPATHY

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Takotsubo cardiomyopathy (TCM) is a form of nonischemic cardiomyopathy that is characterized by transient regional systolic dysfunction of the left ventricle. It often mimics acute myocardial infarction but has a minimal release of cardiac enzymes. The hallmark is an absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. In most cases of TCM, the regional wall motion abnormality extends beyond the territory perfused by a single epicardial coronary artery. Classically, TCM is associated with a ballooned left ventricular apex and basal segmental hyperkinesis. While there have been reports of atypical TCM with midventricular hypokinesia and apical sparing, here we present a novel variant in which there is left ventricular hypokinesis of the anterior, septal, and lateral segments, with preservation of motion only in the inferior wall. CASE PRESENTATION: A 56 year old female presented with recent increased stress, poor sleep, and epigastric abdominal pain with radiation to the right shoulder for 4 days. EKG showed ST elevations in V1-V4 and reciprocal ST depressions in II, III, and aVF. Troponin-T peaked to 1.250. Left heart ventricular angiogram showed a left ventricular ejection fraction (LV EF) of 10-15%, with no obstructive coronary artery disease visualized on the angiogram. Transthoracic echocardiography showed LV wall hypokinesis of the anterior, septal, and lateral segments, with preserved motion only in the inferior wall. (Fig. A - F). Follow up TTE showed improvement of LV EF to 35%. DISCUSSION: TCM is a non-ischemic cardiomyopathy with transient contractility changes, presenting in middle-aged women with acute stress. This patient’s presentation - with EKG concerning for acute ST elevation myocardial infarction, no evidence of coronary artery disease, and extensive LV cardiomyopathy - implies a diagnosis of TCM. The pathogenesis of Takotsubo cardiomyopathy is not well understood. Postulated mechanisms include catecholamine excess, coronary artery spasm, and microvascular dysfunction. It is thought that catecholamines play a role in TCM because of the correlation of the disorder with physical or emotional stress. A catecholamine surge may cause diffuse microvascular spasm or dysfunction, resulting in myocardial stunning. Catecholamines can also have a direct myocardial toxicity effect, further contributing to the cardiomyopathy. On resolution of the catecholamine surge, the myocardium recovers and LV EF improves. CONCLUSIONS: This case demonstrates a novel, as of yet unseen, variant of TCM with hypokinesis of all but the inferior wall. Such specific sparing supports etiologies of TCM not related to epicardial coronary artery distribution, and lends credence to etiologies involving stress-induced catecholamine excess causing neurogenic stunned myocardium. Reference #1: Murthy, A., Arora, J., Singh, A., Gedela, M., Karnati, P., & Nappi, A. (2014). Takotsubo Cardiomyopathy: Typical and Atypical Variants, A Two-Year Retrospective Cohort Study. Cardiology research, 5(5), 139-144. Reference #2: Velankar, P., & Buergler, J. (2012). A mid-ventricular variant of Takotsubo cardiomyopathy. Methodist DeBakey cardiovascular journal, 8(3), 37-9. DISCLOSURES: no disclosure on file for Mandeep Kainth; No relevant relationships by Sharmila Sarkar, source=Web Response No relevant relationships by Alexander Volodarskiy, source=Web Response

Variant of Takotsubo Cardiomyopathy with Co-Existent Severe Coronary Artery Disease – A Case Report

A 73 year old hypertensive female admitted with sudden onset intermittent chest pains and shortness of breath (< 24 hours after the death of her granddaughters in a road traffic accident).

Why Is Reverse Takotsubo "Reverse"?

Takotsubo cardiomyopathy (TTC) is an acute cardiac syndrome simulating myocardial infarction that is characterized by transient wall motion abnormalities in the absence of coronary artery obstruction. Reverse TTC (rTTC) is a recently described variant of TTC. This review defines and compares both forms of TTC, stating their resemblances and differences. We conducted a search of the MEDLINE database. Forty-one cases of rTTC met our eligibility criteria and were summarized in a synthesis of the demographic features, clinical characteristics, and laboratory studies. Of the 41 patients studied, 73% were women. Patients' ages ranged from 19 to 69 years and the mean age was 43. The predominant electrocardiogram finding was ST-segment depression, whereas ST-segment elevation was present in only 6 patients (14.5%). Troponin levels were raised in 92.6% of the patients, with a mean troponin I of 7.7 ng/mL. All of the patients had wall motion abnormalities on echocardiography and the mean ejection fraction was 29.3%. Of the 27 patients (66%) who had a documented angiography, 22 (81.5%) had normal coronaries and 5 (18.5%) had minor or mild obstructive coronary artery disease. Of the 41 patients, 9 (22%) died, and the mean recovery time of the ejection fraction in the survivors was 16 days. rTTC is a distinct presentation from the classic TTC. Remarkable differences exist between both forms in terms of mean age, sex, electrocardiogram presentation, troponin levels, and mortality.

Reverse Takotsubo Cardiomyopathy and Shock Supported by Continuous Hemodiafiltration in a Patient with Anorexia Nervosa

Background: Takotsubo cardiomyopathy (TC) is known as stress-induced cardiomyopathy. It is characterized by relatively benign transient systolic dysfunction of the apical segments of the left ventricle. Reverse Takotsubo cardiomyopathy (RTC) is a rare variant of TC. Here we describe a rare case of RTC and cardiogenic shock in a patient with anorexia nervosa (AN). Case presentation: A 54-year-old woman with AN showed RTC due to subarachnoid hemorrhage (SAH) stress; renal replacement therapy including continuous hemodiafiltration (CHDF) was successfully performed to maintain her cardiohemodynamic state. Conclusion: To our knowledge, this is the first documented report showing that renal replacement therapy greatly contributed to the circulation management and recovering kidney dysfunction with anuria in a patient with an eating disorder and RTC.

REVERSE TAKOTSUBO CARDIOMYOPATHY IN A YOUNG ORGAN DONOR

Takotsubo cardiomyopathy (TCM) is caused by the significant production of catecholamines that lead to myocardial hypokinesis through cardiomyocytes toxicity and coronary microvascular dysfunction. We present an organ donor who developed reverse TCM (a variant of TCM) following major head trauma. 22

Transient Mid-Ventricular Ballooning Due to Bad Dream in a Postmenopausal Woman

Mid ventricular ballooning syndrome (MBS) was diagnosed in a 55-year-old woman who was admitted to emergency room due to acute chest pain. The trigger for the chest pain was reported as “bad dream” about her husband. MBS, a variant of Tako-tsubo Cardiomyopathy is more common in postmenopausal women and the triggers have been linked to stress involving the husband. Sudden catecholamine surge during nightmare augmented by estrogen deficiency in postmenopausal women may be the underlying mechanism. There are many unanswered questions related to the etiology of MBS. With supportive treatment, prognosis is excellent.

Myocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomyopathy: Imaging evidence, presumed mechanisms, and implications for therapy.

Introduction Takotsubo cardiomyopathy (TTC) is a cardiovascular condition that mimics acute coronary syndrome because of its acute clinical presentation with chest pain, ST-segment elevation followed by T-wave inversion, myocardial enzymatic release, and left ventricular (LV) wall motion abnormalities (so-called apical ballooning) in the absence of significant coronary artery lesions on angiography. This syndrome usually affects postmenopausal women and is precipitated by physical stress, psychological triggers, or other states of adrenergic overstimulation such as administration of catecholamines, abrupt withdrawal of psychotropic drugs, and uncontrolled pain. Affected patients usually survive, showing restoration of previous cardiovascular status with electrocardiographic (ECG) normalization and recovery of ventricular function within approximately 1 month. Based on the regional distribution of LV dysfunction, the following variants of TTC have been described: 1 “typical” (akinesia of the mid-apical LV segments) and 3 “atypical,” that is, “mid-ventricular” (akinesia of the mid-LV segments), “reverse” (wall motion abnormalities confined to the basal/

A variant of Takotsubo cardiomyopathy—a case report and review of literature

Takotsubo cardiomyopathy (TCM) is a rare syndrome, and it is even more rare to find it in a premenopausal lady in the immediate postoperative period. Here, we are reporting a case of variant of TCM, along with review of existing literature. A 26-year-old lady who successfully underwent pericardiectomy went into low cardiac output on the first postoperative day. Echocardiography revealed apical ballooning with drastic reduction in left ventricular ejection fraction (LVEF). Her coronary angiography revealed normal coronaries. She was managed conservatively with inotropic support. She made remarkable recovery and her echocardiography on 7th postoperative day showed excellent recovery of apical wall motion abnormality and ejection fraction. Repeat echocardiography after 2 weeks of discharge showed complete normalization of apical ballooning and LV function. She remained well until 1 year after operation with normal LVEF. Regular follow-up is important as it may rarely recur. TCM should be kept in mind as a rare though possible complication after cardiac surgery.

Takotsubo cardiomyopathy recurrence with left ventricular apical ballooning following isolated right ventricular involvement: A case report

We report a case of Takotsubo cardiomyopathy, which involved the right ventricle at first presentation and demonstrated involvement of the left ventricle during recurrence. The patient was admitted to Kyung Hee University Hospital due to a left hip fracture, which was considered a result of physical stress. Complete recovery was confirmed by echocardiography prior to recurrence. The cause of the second event was surgery for the left hip fracture. Recurrence of Takotsubo cardiomyopathy at various cardiac locations provides evidence against the existing hypotheses that variants of Takotsubo cardiomyopathy are associated with anatomically different distributions of cardiac adrenergic receptors, the degree of stimulation by sympathetic activity and different susceptibilities to such sympathetic stimulation.

Takotsubo cardiomyopathy mid ventricle variant and cardiac arrest: chicken or the egg?

Takotsubo cardiomyopathy (TTC) is uncommon emergency condition usually precipitated by emotional or physical stress and is characterized by near-normal coronary arteries and regional wall motion abnormalities that extend beyond a single coronary vascular territory. Variants of TTC include classic apical ballooning syndrome and less commonly, mid, basal, and biventricular variants. Cardiac arrest is an uncommon complication of TTC. In the convalescence phase of TTC, prolonged QTc interval may cause cardiac arrest, but the reason for cardiac arrest in the acute phase when QTc interval is normal is unclear. We report 3 cases of mid ventricular TTC, with out-of-hospital cardiac arrest as the presenting feature. All 3 patients had normal QTc interval and were found to have normal coronary arteries on cardiac catheterization at presentation. Mid ventricular TTC was confirmed on contrast left ventriculography and echocardiography. Cardiac arrest myocarditis was ruled out by myocardial biopsy in 2 deceased patients and by cardiac magnetic resonance imaging in the one who survived.

Simultaneous Positron Emission Tomography/Magnetic Resonance Imaging Identifies Sustained Regional Abnormalities in Cardiac Metabolism and Function in Stress-Induced Transient Midventricular Ballooning Syndrome

A 70-year-old white woman with a history of hyperlipidemia, hypertension, and former smoking and a family history of premature coronary artery disease presented with acute substernal chest pain. She complained of progressive exertional dyspnea during the preceding weeks and of being under personal stress during this time. Her initial ECG showed ST-segment elevation of a maximum 0.2 mV and a reduced R-wave progression in the anteroseptal leads (V1–3). Her troponin T level was moderately elevated (0.3 ng/mL), with normal creatine kinase (CK) and CK-myocardial band (CK-MB) fraction. Cardiac catheterization was performed and showed angiographically normal epicardial coronary arteries. However, the left ventriculogram demonstrated midventricular dilatation and akinesis with a hypercontractile apex and base compatible with midventricular ballooning syndrome, a variant of Takotsubo cardiomyopathy (TTC) (Figure 1A and 1B and Movie I in the online-only Data Supplement). Transthoracic echocardiographic monitoring during the next couple of days revealed no substantial changes in midventricular akinesis. Six days after the onset of symptoms, …

A Mid-Ventricular Variant of Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TC) was initially recognized in Japan in 1990. The typical patient is a postmenopausal woman with symptoms that mimic an acute coronary syndrome generally following physical or emotional stress. The EKG will typically have dynamic ST segment changes, while the angiogram will usually show normal coronary arteries. In classic TC, the left ventriculogram typically shows akinesis and ballooning of the apex with a normal or hyperdynamic base. Several variants of TC have been described. In this case report, we describe a midventricular variant of TC in a 64-year-old Hispanic female. The patient had chest pain, shortness of breath, elevated cardiac enzymes, and ST-segment elevations in leads II, aVF, and V5-V6. Coronary angiography revealed normal coronary arteries. Left ventriculogram showed hypokinesis of the midventricular segment and hyperdynamic apical and basal regions. Although the exact mechanism of TC is unknown, several theories include loss of estrogen, catecholamine or neurohumoral stimulation, coronary artery spasm, and left ventricular outflow tract (LVOT) obstruction.

Neurogenic stunned myocardium presenting as left ventricular hypertrabeculation in childhood: A variant of Takotsubo cardiomyopathy?

To report the first case of neurogenic stunned myocardium presenting with heart left ventricle noncompaction requiring intensive care in the perioperative period of tension tumor-induced hydrocephalus. Case report and literature review. Our Institutional Review Board waived the need for consent. A 12-yr-old female with intracranial astrocytoma and hypertensive hydrocephalus presented with severe heart dysfunction and life-threatening ventricular ectopies intraoperatively. A severe heart failure developed requiring hemodynamic and ventilatory support for 10 days. Echocardiography showed a transient noncompaction aspect of the left ventricular wall, further confirmed by a cardiac magnetic resonance image. The noncompaction aspect lasted until 15 days postadmission, as was the case for the QT interval prolongation; no life-threatening ectopies were demonstrated on the subsequent Holter electrocardiogram monitoring. This report describes a unique presentation of myocardial stunning in association with an intracranial illness, namely, a hypertensive hydrocephalus complicating an intracranial neoplasm.

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.

Atypical takostubo cardiomyopathy associated with nasal packing for paranasal sinus surgery

Takotsubo cardiomyopathy (TC) is characterized by reversible left ventricular (LV) apical ballooning and no significant coronary artery stenosis. New variants of TC with localized wall motion abnormality or inversed pattern with hyperdynamic apex have been reported. We present the case of a 24-year-old female with atypical presentation of TC occurring in the setting of paranasal sinus surgery under local anaesthesia with post-surgical nasal packing. She did not demonstrate ST-segment elevation on electrocardiogram, but transient moderate LV systolic dysfunction and localized wall motion abnormality affecting basal to mid-ventricular anterior and anteroseptal wall. She rapidly and completely recovered without sequelae.