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Chai B, Su Y, Fu N, Li Y, Shen Y. The simultaneous occurrence of paraganglioma, Takotsubo syndrome, and Markis type I coronary artery ectasia in the same patient is a rare, high-risk clinical syndrome: a case report. BMC Cardiovasc Disord 2023; 23:536. [PMID: 37924047 PMCID: PMC10625213 DOI: 10.1186/s12872-023-03577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Population-wide, paraganglioma (PGL) is uncommon. The incidence of Takotsubo syndrome (TTS) ranges from 0.5% to 0.9% and also is an exceedingly rare manifestation of PGL. Coronary artery ectasia (CAE) is also uncommon, with an incidence ranging from 1.2% to 4.9%. Herein, we present a case of PGL, TTS, and Markis type I CAE that occured in the same patient. CASE PRESENTATION A man in his early 40s was admitted to our hospital with a 16-hour history of abdominal colic. Computed tomography and laboratory examination led to the diagnosis of PGL, coronary angiography led to the diagnosis of Markis type I or Chinese type III CAE, and two echocardiographic examinations led to the diagnosis of TTS. When the patient was treated by phenoxybenzamine instead of surgery for the PGL, his blood pressure and glucose level gradually returned to normal. The CAE was treated by thrombolysis, antiplatelet medications, atorvastatin, and myocardial protection therapies. No symptoms of PGL, CAE, or TTS were seen during a 6-month follow-up, and the patient had an excellent quality of life. We confirmed that phenoxybenzamine was the cause of the TTS because paradoxical systolic motion of the apex, inferior wall, left ventricular anterior wall, and interventricular septum were similarly recovered when the PGL was treated by phenoxybenzamine. CONCLUSIONS To raise awareness of this illness and prevent misdiagnosis, we have herein presented a case of TTS that was brought on by PGL with Markis type I CAE for clinicians' reference. In addition, in clinical practice, we should consider the possibility of a concomitant coronary artery disease even if the TTS is caused by a PGL-induced catecholamine surge.
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Affiliation(s)
- Bofeng Chai
- Graduate School of Qinghai University, No. 251 Ningda Road, Xining, 810016, China
| | - Yiping Su
- Graduate School of Qinghai University, No. 251 Ningda Road, Xining, 810016, China
| | - Na Fu
- Graduate School of Qinghai University, No. 251 Ningda Road, Xining, 810016, China
| | - Yuhong Li
- Qinghai University Affiliated Hospital, No. 29 Tongren Road, Chengxi District, Xining, 810001, China
| | - Youlu Shen
- Qinghai University Affiliated Hospital, No. 29 Tongren Road, Chengxi District, Xining, 810001, China.
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Rodrigues Brás D, Semedo P, Cordeiro Piçarra B, Dionísio P, Carvalho J, Azevedo Guerreiro R, Congo K, Aguiar J. Takotsubo syndrome in a breast-feeding young woman: Highlighting the protection of oestrogens? Rev Port Cardiol 2022; 41:887.e1-887.e5. [DOI: 10.1016/j.repc.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/08/2019] [Indexed: 10/14/2022] Open
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3
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Okano Y, Yamasaki T, Imai R, Okazaki H, Higuchi Y, Shinohara T. Cardiopulmonary arrest due to bronchoscopy-induced Takotsubo syndrome in a patient with antineutrophil cytoplasmic autoantibody-associated lung disease: a case report. J Rural Med 2022; 17:181-183. [PMID: 35847748 PMCID: PMC9263952 DOI: 10.2185/jrm.2022-008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: Cardiac arrest (CA) has been observed in some patients with
Takotsubo syndrome (TTS), most of whom had CA at the initial presentation of TTS. The
objective of this report was to discuss the factors underlying the onset of this
syndrome. Case presentation: A 72-year-old woman with refractory antineutrophil
cytoplasmic autoantibody-associated lung disease was referred to our hospital. Twenty
minutes after bronchoscopic examination, cardiopulmonary arrest suddenly occurred.
Resuscitation immediately resumed her heartbeat and spontaneous breathing. Subsequent
12-lead electrocardiography, echocardiography, and left ventricular angiography revealed
TTS. Conclusion: This case indicates that bronchoscopy can cause severe TTS,
especially in patients with systemic inflammation.
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Affiliation(s)
- Yoshio Okano
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, Japan
| | - Takashi Yamasaki
- Division of Cardiovascular Disease, National Hospital Organization Kochi Hospital, Japan
| | - Ryuichiro Imai
- Department of Medicine & Cardiology, Chikamori Hospital, Japan
| | | | - Yuji Higuchi
- Division of Internal Medicine, Shimanto City Hospital, Japan
| | - Tsutomu Shinohara
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
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Oladunjoye OO, Oladiran O, Oladunjoye AO, Reddy R. A 62-Year-Old Man with Acute Alcohol Withdrawal and Stress-Induced Cardiomyopathy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928518. [PMID: 33566795 PMCID: PMC7883938 DOI: 10.12659/ajcr.928518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Stress-induced cardiomyopathy is also known as takotsubo cardiomyopathy, broken heart syndrome, and left ventricular apical ballooning syndrome. Patients may present with chest pain and electrocardiogram (EKG) changes, but without coronary artery occlusion, and a reduced ejection fraction that may undergo spontaneous reversal if the patient receives appropriate hemodynamic support. This is a case report of stress-induced cardiomyopathy associated with alcohol withdrawal in a 62-year-old man. CASE REPORT We present the case of 62-year-old man who came to the emergency room on account of nausea and vomiting after a reduction in the daily intake of alcohol. He had no chest pain or shortness of breath but had new T wave inversions in anterolateral leads on EKG, elevated troponin, and apical wall hypokinesis with ejection fraction 40% on echocardiography. He subsequently developed active symptoms of alcohol withdrawal and was managed with intravenous Lorazepam and chlordiazepoxide. With the improvement in his mental state over the next couple of days, he had a coronary angiogram which showed no coronary disease. He was diagnosed with stress-induced cardiomyopathy or takotsubo cardiomyopathy due to alcohol withdrawal. CONCLUSIONS This report describes a case of takotsubo cardiomyopathy, or stress-induced cardiomyopathy, that was believed to be associated with acute alcohol withdrawal, with spontaneous improvement in the reduced left ventricular ejection fraction following medical support.
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Affiliation(s)
- Olubunmi O Oladunjoye
- Department of Medicine, Reading Hospital, Tower Health System, West Reading, PA, USA
| | - Oreoluwa Oladiran
- Cardiovascular Division, Department of Medicine, Tower Health Medical Group, Reading Hospital, West Reading, PA, USA
| | - Adeolu O Oladunjoye
- Division of Medical Critical Care, Boston Children's Hospital, Boston, PA, USA
| | - Rajesh Reddy
- Cardiovascular Division, Department of Medicine, Tower Health Medical Group, Reading Hospital, West Reading, PA, USA
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Kishikawa R, Tanaka T, Hashimoto M, Honda K, Omori Y, Ishihara A, Kamoi Y. Percutaneous Catheter Thrombus Aspiration of Right Renal Infarction Caused by Left Ventricular Thrombi due to Takotsubo Cardiomyopathy. Int Heart J 2020; 61:400-403. [PMID: 32173705 DOI: 10.1536/ihj.19-447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Takotsubo cardiomyopathy (TC) is a temporal dysfunction of the left ventricle (LV) due to psychological or physiological stress; however, it rarely causes LV thrombus. We report a case of a 49-year-old woman who developed LV thrombi due to TC despite anticoagulation therapy. The thrombi caused acute systemic infarction, with the most severe occlusion being in the right renal artery. The patient underwent percutaneous catheter aspiration thrombectomy of the right renal artery and her renal function recovered shortly after. The results of this case suggest that catheter aspiration thrombectomy is effective in the treatment of thromboembolism in TC.
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Affiliation(s)
| | | | | | - Kei Honda
- Department of Cardiology, Showa General Hospital
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Kujime S, Hara H, Enomoto Y, Nakamura K, Yoshitama T, Noro M, Moroi M, Sugi K, Nakamura M. Analysis of Heart Rate Variability in a Patient with Takotsubo Cardiomyopathy Syndrome on the Actual Onset Day. Int Heart J 2019; 60:1444-1447. [PMID: 31666453 DOI: 10.1536/ihj.19-092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A healthy 73-year-old woman unpredictably developed Takotsubo cardiomyopathy syndrome (TTS) during Holter-electrocardiogram (ECG) recording. Thus, the complete chronological ECG data on the actual onset day of TTS were obtained. Many heart rate variability (HRV) parameters, including the low-frequency components (LF) and the high-frequency components (HF), on the actual onset day and in the healing phase were calculated. The interesting facts on the actual onset day were that the suppression of both LF and HF appeared earlier than the changes of the ECG waveform; and the LF/HF ratio remained within the normal range, although both LF and HF were markedly suppressed. The abnormality on the actual onset day was clear compared with the healing phase. It is noteworthy to obtain the chronological ECG data on the actual onset day of TTS in a healthy patient. The present data are unique in terms of being analyzed on the actual onset day. Although the HRV parameters, including LF and HF, were obviously abnormal, there is some skepticism about using HRV parameters as indices of cardiac autonomic activity. In the present case, it was concluded that the abnormality of cardiac autonomic activity contributed to the onset of TTS. These data are unlikely to ever be replicated, and we hope that this report helps elucidate the TTS mechanism.
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Affiliation(s)
- Shingo Kujime
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hidehiko Hara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Yoshinari Enomoto
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Keijiro Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | | | - Mahito Noro
- Division of Cardiovascular Medicine, Toho University Sakura Medical Center
| | - Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Kaoru Sugi
- Division of Cardiovascular Medicine, Odawara Cardiovascular Hospital
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
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Mierke J, Loehn T, Linke A, Ibrahim K. Reverse takotsubo cardiomyopathy- life-threatening symptom of an incidental pheochromocytoma: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:1-6. [PMID: 32099962 PMCID: PMC7026602 DOI: 10.1093/ehjcr/ytz195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/27/2019] [Accepted: 10/04/2019] [Indexed: 11/14/2022]
Abstract
Background Cardiogenic shock (CS) due to takotsubo cardiomyopathy (TTC) is a life-threatening condition. Therapy is challenging because of the ambivalent effects of catecholamines. Catecholamines are required to stabilize blood pressure but might aggravate TTC. Cardiac assist devices could be a suitable solution for conserving catecholamines and the prevention of TTC perpetuation. Case summary We report the case of a male patient with refractory CS and severe respiratory insufficiency as a result of a reverse TTC, which involved both ventricles. Simultaneous circulatory support with an Impella CP® and veno-arterial extracorporeal membrane oxygenation was initiated for cardiopulmonary stabilization and catecholamine weaning. A giant, incidental pheochromocytoma was diagnosed as the cause of TTC. After drug treatment and resection of the tumour, biventricular function completely recovered within 7 weeks. Discussion A rare and challenging situation is the coincidence of a nor/epinephrine-secreting tumour, such as a pheochromocytoma, and severe CS complicating TTC. Although percutaneous left ventricular assist devices (pLVAD) are highly complicated and have shown conflicting results in terms of clinical efficacy for CS, its use may prevent the perpetuation of TTC due to reduced catecholamines requirement.
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Affiliation(s)
- Johannes Mierke
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Fetscherstraße 76, 01307 Dresden, Germany
| | - Tobias Loehn
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Fetscherstraße 76, 01307 Dresden, Germany
| | - Axel Linke
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Fetscherstraße 76, 01307 Dresden, Germany
| | - Karim Ibrahim
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Fetscherstraße 76, 01307 Dresden, Germany
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Recurrent Takotsubo syndrome in a boy with Duchenne muscular dystrophy: A case report. J Cardiol Cases 2019; 20:14-19. [PMID: 31320947 DOI: 10.1016/j.jccase.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/19/2019] [Accepted: 02/22/2019] [Indexed: 11/21/2022] Open
Abstract
Takotsubo syndrome is a rare cause of reversible ventricular dysfunction that imitate an acute coronary syndrome. The entity is unusual among pediatric populations and a recurrent episode is extremely rare. We report a case of recurrent takotsubo syndrome in an eight-year-old boy with Duchenne muscular dystrophy (DMD). His chest pain episodes were aggravated by a strong emotional stimuli. During episodes of chest pain, electrocardiograms (ECG) showed ST elevation while echocardiograms showed left ventricle apical ballooning; however, a coronary angiography was normal. Serial ECG and echocardiogram revealed a spontaneous resolution of ST elevation and normalized apical contraction which were compatible with the diagnosis of takotsubo syndrome. Interestingly, serial cardiac magnetic resonance imaging demonstrated increasing subepicardial enhancement which was compatible with progression of cardiac involvement in DMD. <Learning objective: Takotsubo syndrome should be considered in pediatric patients with acute chest pain. A recurrent episode of takotsubo syndrome is rare but is possible in pediatric populations. Patients with inherited muscular dystrophy could also develop takotsubo cardiomyopathy. A growing awareness of this syndrome may help physicians to diagnose and provide an early appropriate management of children with chest pain.>.
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Kalra DK, Lichtenstein SJ, Bai C, Parekh K, Sanghani R, Tracy M, Feinstein S. Takotsubo cardiomyopathy in a man with no trigger and multiple cardioembolic complications-A rare constellation. Echocardiography 2019; 36:975-979. [PMID: 30957272 DOI: 10.1111/echo.14333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/07/2019] [Indexed: 12/14/2022] Open
Abstract
Takotsubo Cardiomyopathy (TC) is an uncommon, transient, reversible cardiomyopathy, with a classic pattern of wall-motion abnormalities, usually seen in women after an emotional stressor. Despite its increased recognition, there remain gaps in the exact mechanisms, predisposing factors, and predictors of recovery; this is particularly true for males where the condition occurs far less frequently than in females. TC typically resolves within weeks, and the prognosis is favorable compared to acute coronary syndromes. Nonetheless, about 1% of cases may be complicated by left ventricular (LV) thrombus and embolism. Herein we describe an atypical case of a man with no obvious trigger, who developed TC with left ventricular thrombus and multiple embolic complications, but subsequently showed complete and full resolution. Multimodality imaging including echocardiography, cardiac CT and cardiac MRI was instrumental in this diagnostic dilemma, as well as useful in guiding treatment options and informing prognosis.
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Affiliation(s)
- Dinesh K Kalra
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | | | - Charlotte Bai
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Keyur Parekh
- Department of Radiology, Rush University Medical Center, Chicago, Illinois
| | - Rupa Sanghani
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Melissa Tracy
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Steven Feinstein
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
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Mishra B, Prakash S, Chandra S, Gera S, Goel A, Yadav A, Dhanuka G, Yadav S. His heart broke posttransplant: A rare disease with good outcome. Indian J Nephrol 2019; 29:431-432. [PMID: 31798228 PMCID: PMC6883868 DOI: 10.4103/ijn.ijn_354_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Prestipino E, Squitieri M, Razzolini L, Pastò L, Forleo P, Amato MP. A case of Takotsubo syndrome during a multiple sclerosis brainstem relapse. Mult Scler Relat Disord 2018; 24:1-2. [DOI: 10.1016/j.msard.2018.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/29/2018] [Accepted: 05/06/2018] [Indexed: 01/27/2023]
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Horiguchi Y, Hoshi T, Yoshimatsu A, Yoshida M. Acute arterial occlusion due to left ventricular thrombus of Takotsubo cardiomyopathy in a young adult: a case report. JA Clin Rep 2018; 4:53. [PMID: 32025967 PMCID: PMC6967110 DOI: 10.1186/s40981-018-0190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Thromboembolism is a rare complication of Takotsubo cardiomyopathy. Importantly, an acute arterial occlusion needs rapid diagnosis and urgent treatment to help save the patient’s life. Here, we report a case of arterial occlusion due to ventricular thrombus of Takotsubo cardiomyopathy. Case presentation A woman in her 30s, without previous medical history, felt sudden strong pain on her right leg and was diagnosed with right femoral arterial occlusion. An emergency operation was subsequently performed to take out thrombus. The patient’s oxygenation deteriorated to 93% of hemoglobin saturation just after extubation and exacerbated in the intensive care unit. Transthoracic echocardiography revealed Takotsubo cardiomyopathy-like left ventricular wall motion abnormalities and left ventricular thrombus. Heparin treatment was immediately started. After 10 days, the thrombus disappeared and the left ventricular wall motion improved and she was discharged from the hospital. Conclusions The patient’s acute arterial occlusion in this case report was mainly caused by thrombus of cardiac origin. We suggest to routinely check echocardiography reports before surgery and perform anesthetic management carefully to better control the patient’s blood pressure and heart rhythm.
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Affiliation(s)
- Yuudai Horiguchi
- Department of Anesthesiology and Critical Care Medicine, Ibaraki Prefectural Central Hospital, 6528 Kasama, Ibaraki, 309-1793, Japan
| | - Takuo Hoshi
- Department of Anesthesiology and Critical Care Medicine, Clinical and Educational Training Center, Tsukuba University Hospital, Tsukuba, Japan.
| | - Aya Yoshimatsu
- Department of Anesthesiology and Critical Care Medicine, Ibaraki Prefectural Central Hospital, 6528 Kasama, Ibaraki, 309-1793, Japan
| | - Mika Yoshida
- Department of Anesthesiology and Critical Care Medicine, Ibaraki Prefectural Central Hospital, 6528 Kasama, Ibaraki, 309-1793, Japan
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