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Abstract
Takotsubo syndrome (TTS), triggered by intense emotional or physical stress, occurring most commonly in post-menopausal women, presents as an ST-elevation myocardial infarction (MI). Cardiovascular complications occur in almost half the patients with TTS, and the inpatient mortality is comparable to MI (4-5%) owing to cardiogenic shock, myocardial rupture, or life-threatening arrhythmias. Thus, its prognosis is not as benign as previously thought, as it may cause mechanical complications (cardiac rupture) and potentially lethal arrhythmias and sudden cardiac death (SCD). Similar to MI, some patients may perish before reaching the hospital due to out-of-hospital cardiac arrest; this may lead to underestimation of the actual SCD risk. Furthermore, after discharge, some patients may develop late SCD and/or TTS recurrence that may result in SCD. There are risk factors for SCD in TTS patients, such as severe/persistent QT-interval prolongation inciting torsade-de-pointes, other ECG abnormalities (diffuse giant negative T-waves, widened QRS-complex), bradyarrhythmias, comorbidities, concurrent obstructive coronary artery disease or vasospasm, male gender, older age, severe left ventricular dysfunction, and use of sympathomimetic drugs. All these issues are herein reviewed, case reports/series and data from large cohort studies and meta-analyses are analyzed, risk factors are tabulated, and proarrhythmic effects and management strategies are discussed and pictorially illustrated.
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Affiliation(s)
| | | | - Helen Melita
- 69106Central Laboratories, Onassis Cardiac Surgery Center, Athens, Greece
| | - Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece
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Tedeschi A, Camilli M, Ianni U, Tavecchia G, Palazzini M, Cartella I, Gentile P, Quattrocchi G, Maria Spanò F, Cipriani M, Garascia A, Ammirati E. Takotsubo syndrome after BNT162b2 mRNA Covid-19 vaccine: Emotional or causative relationship with vaccination? IJC HEART & VASCULATURE 2022; 40:101002. [PMID: 35340274 PMCID: PMC8934733 DOI: 10.1016/j.ijcha.2022.101002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 01/24/2023]
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Budnik M, Piątkowski R, Ochijewicz D, Zaleska M, Grabowski M, Opolski G. Pathophysiology of Takotsubo Syndrome as A Bridge to Personalized Treatment. J Pers Med 2021; 11:jpm11090879. [PMID: 34575656 PMCID: PMC8466771 DOI: 10.3390/jpm11090879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 01/17/2023] Open
Abstract
Takotsubo syndrome (TTS) consists of transient dysfunction of the left and/or right ventricle in the absence of ruptured plaque; thrombus or vessel dissection. TTS may be divided into two categories. Primary TTS occurs when the cause of hospitalization is the symptoms resulting from damage to the myocardium usually preceded by emotional stress. Secondary TTS occurs in patients hospitalized for other medical; surgical; anesthetic; obstetric or psychiatric conditions who have activation of their sympathetic nervous system and catecholamines release- they develop TTS as a complication of their primary condition or its treatment. There are several hypotheses concerning the cause of the disease. They include a decrease in estrogen levels; microcirculation dysfunction; endothelial dysfunction and the hypothesis based on the importance of the brain-heart axis. More and more research concerns the importance of genetic factors in the development of the disease. To date; no effective treatment or prevention of recurrent TTS has been found. Only when the pathophysiology of the disease is fully known; then personalized treatment will be possible.
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Pena Escobar JA, Aung M, Amin S, Gulraiz A, Gandhi FR, Malik BH. Pathogenesis of Ventricular Arrhythmias and Its Effect on Long-Term Prognosis in Patients With Takotsubo Cardiomyopathy. Cureus 2020; 12:e11171. [PMID: 33262908 PMCID: PMC7689872 DOI: 10.7759/cureus.11171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC), also known as broken heart syndrome, stress cardiomyopathy (SCM), or apical ballooning syndrome, is a non-ischemic cardiac disease with an initial clinical presentation that is very similar to acute coronary syndrome (ACS). Ventricular arrhythmias (VAs) contribute significantly to an increase in the rates of death in patients with TTC, especially during the acute phase, in which patients with TTC are more susceptible to develop life-threatening arrhythmias (LTA) such as ventricular tachycardia (VT), ventricular fibrillation (VF), torsades de pointes (TdP), and sudden cardiac death (SCD). However, the pathophysiology of TTC and how VA occurs are still a mystery. We aim to review previous literature and discuss the possible mechanisms of VA in TTC patients. VA usually complicates the acute phase of the disease and worsens the long-term prognosis. Alterations of repolarization (negative T wave, prolonged QTc) indicate a high risk of arrhythmic events (TdP, VT, VF, and SCD). Catecholamine effect on myocardial cells and myocardial edema can create a substrate for the development of VA. Some of the most commonly proposed mechanisms for the development of VA in patients with TTC are coronary vasospasm, myocardial stunning due to catecholamines, re-entry, and triggered activity. Further prospective studies, including a more significant number of patients, are required to understand the disease's pathophysiology better and improve LTA management in patients with TTC.
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Affiliation(s)
- Julio A Pena Escobar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Myat Aung
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Saba Amin
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Azouba Gulraiz
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Fenil R Gandhi
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Shimizu M, Fujii H, Suzuki M, Yamawake N, Nishizaki M. PR deviation as a risk marker for cardiac events in patients with Takotsubo syndrome. Pacing Clin Electrophysiol 2018; 41:1652-1659. [DOI: 10.1111/pace.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 09/19/2018] [Accepted: 10/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Masato Shimizu
- Department of Cardiology; Yokohama Minami Kyosai Hospital; Yokohama Japan
| | - Hiroyuki Fujii
- Department of Cardiology; Yokohama Minami Kyosai Hospital; Yokohama Japan
| | - Makoto Suzuki
- Department of Cardiology; Yokohama Minami Kyosai Hospital; Yokohama Japan
| | - Noriyoshi Yamawake
- Department of Cardiology; Yokohama Minami Kyosai Hospital; Yokohama Japan
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Delayed Normalization of Electrocardiograms in Patients with Takotsubo Cardiomyopathy due to Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2017; 100:467-473. [PMID: 28137545 DOI: 10.1016/j.wneu.2017.01.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TCM) is caused by excessive physical and mental stress, and sometimes causes potentially fatal arrhythmias such as torsades de pointes. This study characterized the features of TCM due to aneurysmal subarachnoid hemorrhage, particularly the delayed normalization of electrocardiograms compared with that of transthoracic echocardiograms. METHODS Ten patients with TCM were selected from the 450 patients with subarachnoid hemorrhage treated in our hospital between January 2007 and November 2015. We retrospectively examined these 10 patients with regard to various factors, including durations of abnormal electrocardiographic and echocardiographic findings. RESULTS All 10 patients were women. Mean age at diagnosis was 69.3 years (range, 40-90 years). Electrocardiographic findings were as follows: inverted or flattened T waves (100%); QTc prolongation >0.45 seconds (90.0%); ST segment elevation (60.0%); and ST segment depression (20.0%). Echocardiograms showed typical findings of TCM in 9 cases and inverted TCM in 1 case. In 1 case, ventral fibrillation was observed. Normalization of electrocardiograms was consistently delayed compared with that of echocardiograms, by more than 3 weeks in at least 5 cases (50%). If follow-up of electrocardiographic parameters is discontinued at the point of normalization of wall motion and the end of the vasospasm period, fatal arrhythmia may occur in the aftermath. CONCLUSIONS This study showed a notable delay in recovery of abnormal electrocardiographic findings compared with the recovery of echocardiographic findings. Sufficient attention to persistent abnormalities on electrocardiography is warranted, even after improvements in cardiac wall motion and the vasospasm period.
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El-Battrawy I, Behnes M, Ansari U, Hillenbrand D, Haghi D, Hoffmann U, Papavassiliu T, Elmas E, Fastner C, Becher T, Baumann S, Dösch C, Heggemann F, Kuschyk J, Borggrefe M, Akin I. Comparison and outcome analysis of patients with apical and non-apical takotsubo cardiomyopathy. QJM 2016; 109:797-802. [PMID: 27341847 DOI: 10.1093/qjmed/hcw092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/19/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) is a relevant differential diagnosis in patients presenting with signs of an acute coronary syndrome. Although recent literature has highlighted some salient features of this disorder, there has been little information elucidating the differences in clinical features, electrocardiographic findings, echocardiographic data and TTC-related complications associated with the different variants of TTC. METHODS AND RESULTS Our institutional database constituted a collective of 114 patients diagnosed with TTC between 2003 and 2015 and these patients were subsequently divided into two groups based on the presence (n = 82, 72%) or absence (n = 32, 28%) of the apical form of TTC. The protocol for our proposed study was approved by the Ethics Committee of the University Medical Centre in Mannheim. It was noticed that the patients presenting with the apical form of TTC belonged to an older age group as compared to those presenting with the non-apical form (61.1 ± 8.9 years vs. 69.5 ± 11.2; P < 0.01). The QTc interval prolongation at index-event was observed to be quantifiably greater in the 'apical variant' patients group (484.8 ± 57 ms vs. 464 ± 34.1 ms; P = 0.06). With respect to cardiovascular risk factors, patients with arterial hypertension did have a higher predilection to present with the apical form (63.4% vs. 43.7%; P = 0.06), however, the impact of smoking was less pronounced in this patient group (24.4% vs. 50%, P = 0.01). Furthermore, our study highlighted a significant impact on ejection fraction (EF), with a compromised left ventricular function (36 ± 9% vs. 42.4 ± 9.7%, P < 0.01) and greater involvement of the right ventricle in the apical variant patients group (23% vs. 3%, P = 0.04). Patients with the apical form also showed a greater tendency to develop TTC-related complications such as cardiogenic shock and required longer monitoring and care in comparison. CONCLUSIONS The apical and non-apical variants of TTC are manifestations of the same syndrome. They differ significantly, however, in their clinical presentation, related complications and prognosis.
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Affiliation(s)
- I El-Battrawy
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - M Behnes
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - U Ansari
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - D Hillenbrand
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - D Haghi
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - U Hoffmann
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - T Papavassiliu
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - E Elmas
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - C Fastner
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - T Becher
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - S Baumann
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - C Dösch
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - F Heggemann
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - J Kuschyk
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - M Borggrefe
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - I Akin
- From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
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Like mother like daughter: A case report of simultaneous mother-daughter Takotsubo cardiomyopathy triggered by a house fire. Int J Cardiol 2016; 220:312-3. [DOI: 10.1016/j.ijcard.2016.06.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/27/2016] [Indexed: 11/19/2022]
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Extracorporeal membrane oxygenation support for Takotsubo syndrome and long QT after cardiac surgery. Med Intensiva 2016; 41:441-443. [PMID: 27650460 DOI: 10.1016/j.medin.2016.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/03/2016] [Accepted: 07/12/2016] [Indexed: 11/22/2022]
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El‐Battrawy I, Behnes M, Borggrefe M, Akin I. Association of a congenital long QT syndrome type 1 with Takotsubo cardiomyopathy. Clin Case Rep 2016; 4:789-92. [PMID: 27525086 PMCID: PMC4974430 DOI: 10.1002/ccr3.567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/17/2016] [Accepted: 04/03/2016] [Indexed: 11/07/2022] Open
Abstract
The occurrence of takotsubo cardiomyopathy in a patient with congenital long QT syndrome has rarely been described. This case report discusses the occurrence of a clinically overt takotsubo cardiomyopathy accompanied by congenital long QT syndrome type 1 in a female patient.
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Affiliation(s)
- Ibrahim El‐Battrawy
- First Department of MedicineUniversity Medical Centre Mannheim (UMM)Faculty of Medicine MannheimUniversity of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research) partner site MannheimMannheimGermany
| | - Michael Behnes
- First Department of MedicineUniversity Medical Centre Mannheim (UMM)Faculty of Medicine MannheimUniversity of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research) partner site MannheimMannheimGermany
| | - Martin Borggrefe
- First Department of MedicineUniversity Medical Centre Mannheim (UMM)Faculty of Medicine MannheimUniversity of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research) partner site MannheimMannheimGermany
| | - Ibrahim Akin
- First Department of MedicineUniversity Medical Centre Mannheim (UMM)Faculty of Medicine MannheimUniversity of HeidelbergMannheimGermany
- DZHK (German Center for Cardiovascular Research) partner site MannheimMannheimGermany
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Duran-Cambra A, Sutil-Vega M, Fiol M, Núñez-Gil IJ, Vila M, Sans-Roselló J, Cinca J, Sionis A. Systematic review of the electrocardiographic changes in the takotsubo syndrome. Ann Noninvasive Electrocardiol 2014; 20:1-6. [PMID: 25367822 DOI: 10.1111/anec.12228] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- A Duran-Cambra
- Cardiology Department, Hospital of the Holy Cross and Saint Paul, Biomedical Research Institute Sant Pau, Barcelona, Spain
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Abstract
Takotsubo cardiomyopathy (TTC) is an enigmatic disease with a multifactorial and still unresolved pathogenesis. Recent experimental and clinical observation has suggested a role for genetics in the pathogenesis of TTC. Ethnic as well as seasonal variation in the prevalence of TTC is well described, but it is only recently that familial cases of TTC have been reported. In recent years technological advances in exome capture and DNA sequencing have offered clinicians a new opportunity to discover genetics-related disease. This article explores the role of genetic mechanisms that might explain or modulate the pathogenesis of TTC.
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Sanchez-Jimenez EF. Initial clinical presentation of Takotsubo cardiomyopathy with-a focus on electrocardiographic changes: A literature review of cases. World J Cardiol 2013; 5:228-241. [PMID: 23888192 PMCID: PMC3722420 DOI: 10.4330/wjc.v5.i7.228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/12/2013] [Accepted: 06/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the initial presentation and demonstrate the importance of Takotsubo cardiomyopathy.
METHODS: A PubMed search using the terms “Takotsubo cardiomyopathy (TC)” and “apical ballooning syndrome” yielded 211 publications. Only those that were relevant were fully reviewed. The gender, age, precipitating stressor, main complaint at presentation, electrocardiogram (ECG) at admission and serum cardiac markers of patients diagnosed with TC, were extracted as available. The data were organized in tables and graphics, and the incidence of the disorder was calculated and analyzed.
RESULTS: A total of 250 clinical cases were examined. The predominant gender that was affected was female, with a prevalence of 87.5%. The mean age of presentation was 64 ± 14 years. The cases were divided by age into 10-year intervals. The age interval of 60-69 years showed the highest frequency of TC, accounting for 79 cases. The most common precipitating stressor was physical (50% of cases). Chest pain was the primary complaint at presentation (58.8% of cases) followed by dyspnea (30% of cases). The ST segment changes category was the most common (60%), followed by T wave changes (39.6%). Of the 60% of cases with ST segment changes, 12% had concomitant T wave changes. This means that for 27.6% of the cases, the primary abnormality in the ECG was T wave changes; 87.6% of cases with TC had a change in the ST segment, in the T wave or in both. The percentage of ECGs presenting with changes in the anterior wall was 54.4% (35.6% of ST segment elevation + 1.6% of ST segment depression + 17.2% of T wave inversion). The percentage of patients presenting with changes in the lateral segment of the heart was 46.8%, while the percentage of patients with changes in the inferior heart was 21.6% and the percentage of patients with changes in the apical region was only 16%. The prevalence of elevated creatinine kinase and/or troponin on initial presentation was 89.3%.
CONCLUSION: It is essential that every physician consider Takotsubo cardiomyopathy as a possible differential diagnosis when a patient is classified with acute coronary syndrome. To do so, it is necessary to know the clinical presentation of this syndrome in its early stages.
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KUKLA PIOTR, ZIENCIUK-KRAJKA AGNIESZKA, ABU SHAM'A RAED, JASTRZĘBSKI MAREK. To the Editor. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:918. [DOI: 10.1111/pace.12186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- PIOTR KUKLA
- Department of Cardiology & Internal Diseases; Specialistic Hospital; Gorlice; Poland
| | | | | | - MAREK JASTRZĘBSKI
- First Department of Cardiology; Interventional Electrocardiology and Hypertension University Hospital; Cracow; Poland
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Schimpf R, Meinhardt J, Borggrefe M, Haghi D. Catecholaminergic polymorphic ventricular tachycardia and midventricular Takotsubo cardiomyopathy: a novel association? Herzschrittmacherther Elektrophysiol 2013; 24:63-66. [PMID: 23549986 DOI: 10.1007/s00399-013-0248-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 01/29/2013] [Indexed: 06/02/2023]
Abstract
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.
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Affiliation(s)
- Rainer Schimpf
- Ist Department of Medicine-Cardiology, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
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Wakiya M, Hara H, Iwano M, Nakagawa T, Kayo T, Kamimura M, Ikeda N, Tamori Y, Yamamoto M, Ito S, Okazaki O, Moroi M. Complete atrioventricular block associated with not apical but midventricular ballooning. J Cardiol Cases 2013; 7:e109-e113. [PMID: 30533137 DOI: 10.1016/j.jccase.2012.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/01/2012] [Accepted: 12/17/2012] [Indexed: 11/19/2022] Open
Abstract
An 86-year-old woman was admitted to hospital with a head injury secondary to an episode of syncope associated with incontinence. Electrocardiography showed complete atrioventricular block, giant negative T waves in the precordial leads, and QT interval prolongation. Emergency coronary angiography showed no significant coronary stenosis, while left ventriculography demonstrated midventricular ballooning. Despite temporary transvenous pacing, her complete atrioventricular block persisted, but worsening of heart failure did not occur. Although left ventricular wall motion improved, complete atrioventricular block remained, so a pacemaker was implanted on day 18 after admission. There have been no previous reports of complete atrioventricular block associated with midventricular ballooning. This case demonstrates that complete atrioventricular block may persist after improvement of left ventricular wall motion in patients with midventricular ballooning and implantation of a pacemaker may be needed. <Learning objective: Some cases describe takotsubo-like cardiomyopathy with not apical but midventricular ballooning. This is the first case of midventricular ballooning and persistence of complete atrioventricular block after improvement of left ventricular wall motion that required implantation of a pacemaker.>.
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Affiliation(s)
- Momoko Wakiya
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Hisao Hara
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Mai Iwano
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Takashi Nakagawa
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Tsuyosi Kayo
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Munehiro Kamimura
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Nobutaka Ikeda
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Yuiichi Tamori
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Masaya Yamamoto
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Shingo Ito
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Osamu Okazaki
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Masao Moroi
- Division of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
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Bozeman WP, Ali K, Winslow JE. Long QT Syndrome Unmasked in an Adult Subject Presenting with Excited Delirium. J Emerg Med 2013; 44:e207-10. [DOI: 10.1016/j.jemermed.2012.02.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 12/01/2011] [Accepted: 02/25/2012] [Indexed: 10/28/2022]
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Pacha O, Kadikoy H, Amro M, Haque W, Abdellatif A. Torsades de pointes and prolonged QT syndrome in Takotsubo cardiomyopathy. J Cardiovasc Med (Hagerstown) 2012; 13:536-40. [DOI: 10.2459/jcm.0b013e328336b4a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yamada Y, Tani T, Homma M, Saito S. Two cases of torsades de pointes associated with takotsubo cardiomyopathy as the second insult. J Electrocardiol 2011; 44:806-9. [DOI: 10.1016/j.jelectrocard.2011.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Indexed: 10/18/2022]
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Golzio PG, Anselmino M, Presutti D, Cerrato E, Bollati M, Gaita F. Takotsubo cardiomyopathy as a complication of pacemaker implantation. J Cardiovasc Med (Hagerstown) 2011; 12:754-60. [DOI: 10.2459/jcm.0b013e3283403563] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Ahn JH, Park SH, Shin WY, Lee SW, Lee SJ, Jin DK, Lee HM, Eun JY. Long QT syndrome and torsade de pointes associated with Takotsubo cardiomyopathy. J Korean Med Sci 2011; 26:959-61. [PMID: 21738353 PMCID: PMC3124730 DOI: 10.3346/jkms.2011.26.7.959] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 04/01/2011] [Indexed: 12/12/2022] Open
Abstract
Prolongation of QTc interval associated with Takotsubo cardiomyopathy (TC) has previously been reported in published case series. We report an unusual case of a patient who presented with TC associated with long-QT syndrome and developed cardiac arrest secondary to torsade de pointes. Since QT prolongation and bradycardia persisted after the resolution of TC, the patient received permanent pacemaker. Since then additional event did not occur. QT prolongation and bradycardia could be persistent even after recovery of TC, and permanent pacemaker insertion may be a treatment option of long QT syndrome related with TC.
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Affiliation(s)
- Ji Hun Ahn
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sang-Ho Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Won Yong Shin
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Se Whan Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seung Jin Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Dong Kyu Jin
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Han Min Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jun Young Eun
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Madias C, Fitzgibbons TP, Alsheikh-Ali AA, Bouchard JL, Kalsmith B, Garlitski AC, Tighe DA, Estes NM, Aurigemma GP, Link MS. Acquired long QT syndrome from stress cardiomyopathy is associated with ventricular arrhythmias and torsades de pointes. Heart Rhythm 2011; 8:555-61. [DOI: 10.1016/j.hrthm.2010.12.012] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 12/07/2010] [Indexed: 11/30/2022]
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A case of transient left ventricular apical ballooning syndrome in a child: clinical features and imaging findings. Int J Cardiovasc Imaging 2010; 26:345-51. [PMID: 20857201 DOI: 10.1007/s10554-010-9685-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 08/11/2010] [Indexed: 02/01/2023]
Abstract
Transient left ventricular apical ballooning syndrome (TLVABS) is an acute cardiac disease that is characterized by transient left ventricular systolic dysfunction involving the apical region. The symptoms and electrocardiographic changes of TLVABS mimic those observed in acute myocardial infarction while obstructive coronary arterial lesions are not seen in patients with TLVABS. TLVABS usually occurs in elderly women after physical or emotional stress. However, it is very rare in children and so it not well known to pediatricians. Accordingly, TLVABS in children can be misdiagnosed as myocarditis or cardiomyopathy. We report here on a case of child who showed the typical findings of TLVABS in association with pericarditis. He presented with dyspnea and pericardial effusion, which required pericardiocentesis. After pericardiocentesis, he showed the typical echocardiographic and electrocardiographic findings of TLVABS. The MRI findings at 14 days after the initial symptoms showed normal coronary arteries and normal left ventricular function without any wall motion abnormalities. In addition, no delayed hyper enhancement was found on delayed-enhanced (DE)-MRI. We also reviewed the other reported cases of TLVABS in patients who were under the age of 40.
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Zanobetti M, Vicidomini S, Conti A, Innocenti F, Pini R. An atypical case of inverted Tako-Tsubo syndrome: case report and review of the literature. Intern Emerg Med 2010; 5:215-9. [PMID: 20424931 DOI: 10.1007/s11739-010-0389-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 03/12/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Maurizio Zanobetti
- Department of Critical Care Medicine and Surgery, University of Florence, Via delle Oblate 1, Florence, Italy.
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Abstract
Recently, an increasing number of cases of stress cardiomyopathy, mainly occurring in elderly women, have been documented in many parts of the world. In Japan, this disease is known as takotsubo cardiomyopathy (named after the fishing pot used for trapping octopus). Symptoms of this condition are akin to those of acute myocardial infarction, but no obstructive lesions are found in the coronary arteries, and left ventricular apical ballooning is present. Stress cardiomyopathy is now a well-recognized cause of acute heart failure, lethal ventricular arrhythmias, and ventricular rupture. Although the precise mechanism of onset of this condition is still controversial, two major pathogenic mechanisms have been proposed: catecholamine cardiotoxicity and neurogenic stunned myocardium. We summarize the findings of studies conducted to date on stress cardiomyopathy-from bench to bedside and bedside to bench.
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Affiliation(s)
- Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki-city, Kanagawa-prefecture, Japan.
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Takotsubo cardiomyopathy and congenital long QT syndrome in a patient with a novel duplication in the Per-Arnt-Sim (PAS) domain of hERG1. Heart Rhythm 2010; 7:260-5. [DOI: 10.1016/j.hrthm.2009.09.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 09/18/2009] [Indexed: 11/17/2022]
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Kawano H, Matsumoto Y, Arakawa S, Satoh O, Hayano M. Premature atrial contraction induces torsades de pointes in a patient of Takotsubo cardiomyopathy with QT prolongation. Intern Med 2010; 49:1767-73. [PMID: 20720356 DOI: 10.2169/internalmedicine.49.3237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although the prognosis for patients with stress-induced cardiomyopathy (Takotsubo cardiomyopathy) is relatively good, some patients with this syndrome develop torsades de pointes, which can be fatal. The present report describes a patient with Takotsubo cardiomyopathy and torsades de pointes induced by premature atrial contraction associated with QT interval prolongation, hypokalemia and hypomagnesemia.
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Affiliation(s)
- Hiroaki Kawano
- Department of Cardiology, Nagasaki Rosai Hospital, Sasebo, Japan.
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Ghosh S, Apte P, Maroz N, Broor A, Zeineh N, Khan IA. Takotsubo cardiomyopathy as a potential cause of long QT syndrome and torsades de pointes. Int J Cardiol 2009; 136:225-7. [DOI: 10.1016/j.ijcard.2008.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Accepted: 04/05/2008] [Indexed: 10/21/2022]
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Behr ER, Mahida S. Takotsubo cardiomyopathy and the long-QT syndrome: an insult to repolarization reserve. Europace 2009; 11:697-700. [PMID: 19351629 DOI: 10.1093/europace/eup081] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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A new ECG criterion to identify takotsubo cardiomyopathy from anterior myocardial infarction: role of inferior leads. Heart Vessels 2009; 24:124-30. [PMID: 19337796 DOI: 10.1007/s00380-008-1099-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Accepted: 07/31/2008] [Indexed: 12/21/2022]
Abstract
With the exception of contrast-enhanced cardiovascular magnetic resonance imaging, clear distinction of takotsubo cardiomyopathy from anterior wall myocardial infarction cannot be achieved currently by simple and noninvasive tests. The aim of this study was to examine the role of inferior ECG leads in distinguishing these two conditions. From January 2004 to June 2006, eight female patients suffering from takotsubo cardiomyopathy were identified by the Mayo Clinic criteria. The clinical and ECG features were compared with 27 consecutive sex- and age-matched patients with anterior wall myocardial infarction admitted to the Coronary Care Unit within the same period. The observed ECG features were then verified with that of 62 published cases of takotsubo cardiomyopathy. Takotsubo cardiomyopathy patients had similar left ventricular ejection fraction (35.0% +/- 5.7% vs 38.2% +/- 6.4%, P = 0.829), lower peak creatinine kinase level (461 +/- 330 U/l vs 2723 +/- 1826 U/l, P = 0.020), more ST-segment elevation in the inferior leads (50% vs 7.4%, P = 0.016), and virtually no ST-segment depression in inferior leads (0% vs 48.2%, P = 0.015) compared with patients who had anterior wall myocardial infarction. ST-segment elevation of >or=1.0 mm in lead II had 62.5% sensitivity and 92.6% specificity in detecting takotsubo cardiomyopathy. The observed ECG characteristics were comparable with those in the literature. In patients who present with anterior wall myocardial infarction, the absence of ST-segment depression or ST-segment elevation in inferior leads, especially if the ST-segment in lead II >or= III, is highly suggestive of takotsubo cardiomyopathy.
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Kukla P, Zienciuk A, Stec S, Cybulska C. Cardiac Arrest Related to Coronary Vasospasm in a Patient With Long QT1. Circ Arrhythm Electrophysiol 2009; 2:e8-e11. [DOI: 10.1161/circep.108.823690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Piotr Kukla
- From the Department of Internal Medicine, Specialist Hospital, Gorlice, Poland (P.K.); the Departments of Cardiology and Electrotherapy (A.Z.) and Biology and Genetics (C.C.), Medical University of Gdańsk, Poland; and the Department of Cardiology, Postgraduate Medical School, Warsaw, Poland (S.S.)
| | - Agnieszka Zienciuk
- From the Department of Internal Medicine, Specialist Hospital, Gorlice, Poland (P.K.); the Departments of Cardiology and Electrotherapy (A.Z.) and Biology and Genetics (C.C.), Medical University of Gdańsk, Poland; and the Department of Cardiology, Postgraduate Medical School, Warsaw, Poland (S.S.)
| | - Sebastian Stec
- From the Department of Internal Medicine, Specialist Hospital, Gorlice, Poland (P.K.); the Departments of Cardiology and Electrotherapy (A.Z.) and Biology and Genetics (C.C.), Medical University of Gdańsk, Poland; and the Department of Cardiology, Postgraduate Medical School, Warsaw, Poland (S.S.)
| | - Celina Cybulska
- From the Department of Internal Medicine, Specialist Hospital, Gorlice, Poland (P.K.); the Departments of Cardiology and Electrotherapy (A.Z.) and Biology and Genetics (C.C.), Medical University of Gdańsk, Poland; and the Department of Cardiology, Postgraduate Medical School, Warsaw, Poland (S.S.)
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Samuelov-Kinori L, Kinori M, Kogan Y, Swartzon M, Shalev H, Guy D, Ferenidou F, Mashav N, Sadeh B, Atzmony L, Kliuk-Ben-Basat O, Steinvil A, Justo D. Takotsubo cardiomyopathy and QT interval prolongation: who are the patients at risk for torsades de pointes? J Electrocardiol 2009; 42:353-357.e1. [PMID: 19261294 DOI: 10.1016/j.jelectrocard.2009.01.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Indexed: 12/22/2022]
Abstract
OBJECTIVES QT interval prolongation is prevalent among patients with Takotsubo cardiomyopathy (TC), whereas torsades de pointes (TdP) has rarely been reported in these patients. We studied all peer-reviewed reports on TC-associated QT interval prolongation and all peer-reviewed reports on TC-associated TdP to characterize the clinical circumstances leading to TdP in patients with TC. METHODS The literature search yielded 14 reports on TC-associated TdP and 26 reports on TC-associated QT interval prolongation. Overall, 15 patients with TC-associated TdP and 86 patients with TC-associated QT interval prolongation were reported. We systematically reviewed each report and recorded the risk factors for TdP as well as the clinical circumstances of TC. RESULTS The prevalence of the male sex was higher among patients with TC-associated TdP relative to patients with TC-associated QT interval prolongation (26.7% vs 5.8%; P = .01). There was a trend in the mean maximal corrected QT interval being longer among patients with TC-associated TdP relative to patients with TC-associated QT interval prolongation (679.9 +/- 230.6 vs 555.9 +/- 63.8 milliseconds; P = .06). There were no differences between patients with TC-associated TdP and patients with TC-associated QT interval prolongation in mean age, maximal troponin levels, and lowest ejection fraction. Overall, 12 (80.0%) patients with TC-associated TdP had risk factors for TdP other than the female sex and systolic dysfunction, including suspicion of congenital long QT syndrome, bradycardia, hypokalemia, recent conversion from atrial fibrillation to sinus rhythm, and using QT prolonging agents. CONCLUSIONS Men with TC-associated QT interval prolongation are at risk for TdP. Most patients with TC-associated TdP have risk factors for TdP other than the female sex and systolic dysfunction.
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Affiliation(s)
- Liat Samuelov-Kinori
- Department of Internal Medicine D, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Gotyo N, Kida M, Horiuchi T, Hirata Y. Torsade de pointes associated with recurrent ampulla cardiomyopathy in a patient with idiopathic ACTH deficiency. Endocr J 2009; 56:807-15. [PMID: 19506326 DOI: 10.1507/endocrj.k09e-080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We describe here a patient with torsade de pointes associated with recurrent ampulla cardiomyopathy, who was later proven to suffer from idiopathic AC TH deficiency. A 70-year-old man was admitted to our hospital for bacterial pneumonia. A cardiac examination performed on admission revealed ampulla cardiomyopathy, which improved spontaneously as the pneumonia was cured. Two months after discharge, he was transferred to our hospital for relapse of the pneumonia. After the second admission, the pneumonia subsided with antibiotic treatment and his general condition ameliorated gradually. However, on the 20(th) hospital day, he was found lying on the floor in a prone position in cardiopulmonary arrest. Cardiac telemetry monitoring showed torsade de pointes worsening to ventricular fibrillation, and immediate cardiac defibrillation was performed. The electrocardiogram after successful defibrillation showed inverted T waves in the chest leads with long QT intervals, and subsequent emergent coronary catherization revealed the recurrence of ampulla cardiomyopathy. Thereafter, endocrinological examinations for the diagnosis of sustained hyponatremia demonstrated secondary adrenal insufficiency caused by idiopathic AC TH deficiency. The cardiomyopathy resolved promptly after steroid hormone replacement without relapse as did the hyponatremia. Patients with ampulla cardiomyopathy or ventricular fibrillation without apparent etiology should be examined for adrenal function. If begun as soon as adrenal insufficiency is diagnosed, immediate steroid replacement therapy can prevent the deterioration and relapse of cardiac involvement.
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Affiliation(s)
- Naoki Gotyo
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Toshima Hospital, Tokyo, Japan.
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Inoue M, Kanaya H, Matsubara T, Uno Y, Yasuda T, Miwa K. Complete atrioventricular block associated with takotsubo cardiomyopathy. Circ J 2008; 73:589-92. [PMID: 19075523 DOI: 10.1253/circj.cj-08-0219] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An 82-year-old woman was admitted to the hospital due to repeated episodes of syncope with incontinence. Electrocardiography showed torsades de pointes, complete atrioventricular (AV) block, T-wave inversions and a prolonged QTc interval. Urgent coronary angiography showed no significant coronary stenosis and left ventriculography demonstrated typical abnormal wall motion of takotusbo cardiomyopathy. Electrophysiology study suggested that the damaged structure might be the bundle of His. After temporary transvenous pacing and administration of intravenous lidocaine, no recurrence of torsade de pointes was found. Symptoms of worsening heart failure were not found. Although abnormal left ventricular wall motion improved, a complete AV block remained and the patient needed pacemaker implantation on Day 18 after admission. This case demonstrated that complete AV block associated with takotsubo cardiomyopathy may persist after improvement of left ventricular wall motion, and implantation of a pacemaker may be needed.
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Affiliation(s)
- Masaru Inoue
- Division of Cardiology, Ishikawa Prefectural Hospital, 2-1 Kuratsuki-Higashi, Kanazawa 920-8530, Japan.
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Vivo RP, Krim SR, Hodgson J. It's a trap! Clinical similarities and subtle ECG differences between takotsubo cardiomyopathy and myocardial infarction. J Gen Intern Med 2008; 23:1909-13. [PMID: 18769977 PMCID: PMC2585666 DOI: 10.1007/s11606-008-0768-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 06/26/2008] [Accepted: 08/05/2008] [Indexed: 12/12/2022]
Abstract
We describe a 65-year-old woman with a history of hypertension and smoking who presented with an acute episode of chest pain precipitated by severe emotional stress. Her initial electrocardiogram done in the emergency room showed non-specific T wave changes in the lateral leads and her cardiac troponin levels were mildly elevated. Because of her clinical presentation, she was admitted with a presumptive diagnosis of acute myocardial infarction and managed with antiplatelet and anticoagulant therapy. Coronary angiogram did not reveal coronary artery disease and left ventriculography showed findings consistent with apical ballooning syndrome or takotsubo cardiomyopathy. Subsequent electrocardiograms displayed dramatic changes including T wave inversions, QT interval prolongation and U waves. The patient remained asymptomatic and recovered uneventfully. Three weeks post-discharge, an echocardiogram documented resolved left ventricular dysfunction. We describe the clinical features and highlight the electrocardiographic findings that may help differentiate takotsubo cardiomyopathy from myocardial infarction.
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Affiliation(s)
- Rey P. Vivo
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street STOP 9410, Lubbock, TX 79430–9410 USA
| | - Selim R. Krim
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street STOP 9410, Lubbock, TX 79430–9410 USA
| | - John Hodgson
- Division of Cardiology, Department of Internal Medicine, University of Pittsburgh Medical Center McKeesport, McKeesport, PA USA
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Karavidas A, Arapi S, Fotiadis J, Zacharoulis A, Matsakas E. A variant form of acute reversible cardiomyopathy: a case report. J Med Case Rep 2008; 2:74. [PMID: 18328092 PMCID: PMC2288610 DOI: 10.1186/1752-1947-2-74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 03/07/2008] [Indexed: 11/27/2022] Open
Abstract
Introduction Stress cardiomyopathy, also known as Takotsubo cardiomyopathy or left ventricular apical ballooning, has been linked to emotional or physical stress resulting in transient left ventricular dysfunction. It typically affects the mid and apical left ventricular segments. At onset, it resembles acute myocardial infarction, due to the acute onset of chest pain and ST-T segment elevation. However, there is minimal biomarker elevation and a normal coronary artery angiogram. Case presentation We report a case of a woman with transient myocardial injury after a stressful event, presenting with a variation of the affected segments. In this case, only the basal and mid portions of the left ventricle were affected, while the apex was completely spared. Coronary angiography revealed no significant occlusion and left ventricular function had recovered completely by the third day of hospitalization. Conclusion We present a variant form of stress cardiomyopathy, affecting the basal and mid segments of the left ventricle.
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Abstract
Stress cardiomyopathy is a condition caused by intense emotional or physical stress leading to rapid and severe reversible cardiac dysfunction. It mimics myocardial infarction with changes in the electrocardiogram and echocardiogram, but without any obstructive coronary artery disease. Due to the awareness created by the media and internet, every patient is aware that they should seek help immediately for chest pain. Therefore physicians should be aware of this new condition and how to diagnose and treat it, even though the causal mechanisms are not yet fully understood.
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Haghi D, Papavassiliu T, Hamm K, Kaden JJ, Borggrefe M, Suselbeck T. Coronary artery disease in takotsubo cardiomyopathy. Circ J 2007; 71:1092-4. [PMID: 17587716 DOI: 10.1253/circj.71.1092] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Significant coronary artery disease (CAD) is generally considered as an exclusion criterion for the diagnosis of takotsubo cardiomyopathy (TC). However, this may not be justified in all cases, because TC and CAD may coincide. METHODS AND RESULTS Among 821 consecutive patients who underwent urgent left heart catheterization for suspected acute coronary syndrome between December 2004 and August 2006 those with a final diagnosis of TC who also had a stenotic lesion (diameter stenosis on quantitative coronary angiography >50% and <75%) of the left anterior descending artery were evaluated. Four patients met the inclusion criteria. Previous coronary angiograms were available for 2 of these patients and showed no change in the angiographic appearance of the lesions. Intravascular ultrasound study was performed in the other 2 patients and demonstrated negative remodeling and no signs of plaque rupture, thrombus, positive remodeling or intimal dissection. CONCLUSIONS The present study supports the notion that TC and CAD are not mutually exclusive disease entities. Excluding the diagnosis of TC on the sole basis of an incidental finding of CAD may not be justified in all cases. Rather, a case-by-case decision process seems more appropriate.
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Affiliation(s)
- Dariusch Haghi
- I Medical Department, University Hospital Mannheim, Mannheim, Germany.
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Abstract
Takotsubo cardiomyopathy is a unique acute cardiac syndrome characterized by typical ischemic chest symptoms, an elevated ST segment on the electrocardiogram, and elevated cardiac disease markers. It is often misdiagnosed as acute myocardial infarction. Coronary angiography usually shows no evidence of obstructive atherosclerotic coronary artery disease. Left ventriculography and echocardiography reveal a peculiar regional systolic dysfunction with akinesis of the midventricle and apex and compensatory hyperkinesis of the basal ventricular segments. This syndrome has been shown to have a distinct temporal relationship with intense emotional stressors, and is characterized by an excellent clinical recovery when appropriate conservative measures are taken during the acute phase of the illness. In this review, we highlight the proposed pathophysiology and clinical manifestations of this recognized reversible form of myocardial failure.
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Affiliation(s)
- Sunil Dhar
- Temple University Hospital-Episcopal Division, Philadelphia, Pennsylvania 19125, USA.
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42
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Sasaki O, Nishioka T. Etiology of Takotsubo Cardiomyopathy. Circ J 2007. [DOI: 10.1253/circj.71.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Osamu Sasaki
- Division of Cardiology, Saitama Medical Center, Saitama Medical University
| | - Toshihiko Nishioka
- Division of Cardiology, Saitama Medical Center, Saitama Medical University
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