scholarly journals Dynamic Left Intraventricular Obstruction Phenotype in Takotsubo Syndrome

2021 ◽  
Vol 10 (15) ◽  
pp. 3235
Author(s):  
Davide Di Vece ◽  
Angelo Silverio ◽  
Michele Bellino ◽  
Gennaro Galasso ◽  
Carmine Vecchione ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Systolic Function ◽  
Hemodynamic Instability ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Benign Condition ◽  
Coronary Syndrome ◽  
Lv Dysfunction ◽  
Appropriate Therapy ◽  
Selection Of

Takotsubo syndrome (TTS) is characterized by acute, generally transient left ventricular (LV) dysfunction. Although TTS has been long regarded as a benign condition, recent evidence showed that rate of acute complications and in-hospital mortality is comparable to that of patients with acute coronary syndrome. In particular, the prevalence of cardiogenic shock ranges between 6% and 20%. In this setting, detection of mechanisms leading to cardiogenic shock can be challenging. Besides a severely impaired systolic function, onset of LV outflow tract obstruction (LVOTO) together with mitral regurgitation related to systolic anterior motion of mitral valve leaflets can lead to hemodynamic instability. Early identification of LVOTO with echocardiography is crucial and has important implications on selection of the appropriate therapy. Application of short-acting b1-selective betablockers and prudent administration of fluids might help to resolve LVOTO. Conversely, inotrope agents may increase basal hypercontractility and worsen the intraventricular pressure gradient. To date, outcomes and management of patients with TTS complicated by LVOTO as yet has not been comprehensively investigated.

scholarly journals A life-threatening reverse Takotsubo syndrome in a young breastfeeding woman: a case report

2021 ◽  
Author(s):  
Carla Marques Pires ◽  
Sérgia Rocha ◽  
Nuno Salomé ◽  
Pedro Azevedo
Keyword(s):  
Cardiogenic Shock ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Presumptive Diagnosis ◽  
Lv Dysfunction ◽  
St Segment ◽  
Life Threatening ◽  
Triggering Factor ◽  
Β Blocker

Abstract Background Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction and is usually triggered by emotional, physical or combined stress. This syndrome has been increasingly recognized, although it remains a challenging and often misdiagnosed disorder. Case Summary A 36-year-old breastfeeding woman was admitted with sudden dyspnoea and oppressive chest pain. On admission she was lethargic, hypotensive and tachycardic. The electrocardiogram showed rapid atrial fibrillation and diffuse ST-segment depression. The transthoracic echocardiogram (TTE) revealed severe LV systolic dysfunction, with midventricular and basal akinesis, compensatory apical hyperkinesia and without intraventricular gradient. Emergent coronary angiogram showed normal coronary arteries. A presumptive diagnosis of reverse TTS with cardiogenic shock was made. The patient was transferred to the Intensive Care Unit after intubation and inotropic and vasopressor support was initiated. During hospitalization, rapid clinical improvement was observed. In three days, the patient was weaned from hemodynamic support and extubated. Furthermore, β-blocker and angiotensin receptor blocker were initiated and tolerated. Cabergoline was also administered to inhibit lactation. The presumptive diagnosis was further strengthened by cardiac magnetic resonance and all triggering factors were excluded. At hospital discharge she was asymptomatic and the follow-up TTE was normal, which confirmed the diagnosis of reverse TTS. DISCUSSION We present a case of a young woman, eight months after delivery, which developed a life-threatening reverse TTS without triggering factor identified. Reverse TTS is a rare variant of TTS with different clinical features and is more likely to be complicated by pulmonary edema and cardiogenic shock.

scholarly journals Inverted takotsubo syndrome complicated with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation in a patient with bilateral pheochromocytoma: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 1-5
Author(s):  
Bebiana Manuela Monteiro Faria ◽  
João Português ◽  
Roberto Roncon-Albuquerque Jr ◽  
Rodrigo Pimentel
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Lv Function ◽  
Takotsubo Syndrome ◽  
Membrane Oxygenation ◽  
Lv Dysfunction

Abstract Background Takotsubo syndrome (TS) is characterized by a transient left ventricular (LV) dysfunction and rarely presents with cardiogenic shock (CS). Inverted TS (ITS) is a rare entity associated with the presence of a pheochromocytoma. Case summary We present a case of a young woman was admitted to the emergency department due to intense headache, chest discomfort, palpitations, and breathlessness. An ITS secondary to a pheochromocytoma crisis presenting with CS was diagnosed. The patient was managed with veno-arterial extracorporeal membrane oxygenation, until recovery of LV function. On the 35th day of hospitalization, open bilateral adrenalectomy was performed. Discussion Takotsubo syndrome patients presenting with CS are challenging and clinicians should be aware of underlying causes. Specific triggers such as pheochromocytoma should systematically be considered particularly if ITS was presented. Extracorporeal life support devices could provide temporary mechanical circulatory support in patients with TS on refractory CS and help to manage complex cases with TS due to pheochromocytoma.

scholarly journals Takotsubo syndrome and pheochromocytoma: an insidious combination

2021 ◽  
Author(s):  
Stefano Maffè ◽  
Pierfranco Dellavesa ◽  
Paola Paffoni ◽  
Luca Bergamasco ◽  
Marisa Arrondini ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Systolic Function ◽  
Abdominal Mass ◽  
Clinical Status ◽  
Vena Cava ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Abdomen Ct ◽  
Retrosternal Pain

Pheochromocytoma is a rare adrenal tumor characterized by the secretion of catecholamines and vasoactive peptides. It can cause a catecholaminergic storm and lead to acute coronary syndromes. We present the case of a 53-year-old man, without any medical history, who arrived to the hospital following a spinal trauma due a fall. He presents back and retrosternal pain, with a clinical status of acute pulmonary edema, sinus tachycardia with left bundle branch block, left ventricular apical ballooning with depressed systolic function. Blood tests show a very important increase of Troponin and transaminases. A contrast chest-abdomen CT highlighted a right adrenal solid mass, with a diameter of 78mm, partial capsular laceration, compression of the inferior vena cava and the hepatic parenchyma. The clinical condition of the patient rapidly worsens from a respiratory and hemodynamic point of view, with cardiogenic shock, anuria and sepsis, refractory to all the medical treatments, until the patient died. The autopsy confirmed that the abdominal mass was a pheochromocytoma, broken after the trauma suffered. The resulting catecholaminergic storm caused a myocardial ischemia with Takotsubo syndrome, with cardiogenic shock. This unfortunate case confirms the pheochromocytoma as important risk factor for the onset of Takotsubo syndrome, and the how dramatic and severe a catecholaminergic storm can be.

Abstract 14314: Men Admitted With Takotsubo Syndrome (TTS) Have Increased In-Hospital Morbidity and Mortality: Perspectives From the National Inpatient Sample Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Louis T Vincent ◽  
Jelani Grant ◽  
Bertrand Ebner ◽  
Jennifer Maning ◽  
Paul Montana ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Skilled Nursing Facility ◽  
Hemodynamic Instability ◽  
Primary Diagnosis ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Takotsubo Syndrome ◽  
National Inpatient Sample ◽  
Increased Risk ◽  
All Cause Mortality

Introduction: Takotsubo Syndrome (TTS), also known as Stress Induced Cardiomyopathy, is characterized by reversible left ventricular dysfunction without obstructive coronary disease, and largely affects post-menopausal women. However, limited data suggest increased mortality risk in men. We sought to compare national in-hospital outcomes between men and women admitted with TTS. Methods: All patients above 18 years who were admitted with primary diagnosis of TTS between 2012-2017 were identified by International Classification of Diseases (ICD)-9 and ICD-10 diagnostic codes in the National Inpatient Sample (NIS) Database. The primary endpoint was in-hospital all-cause mortality. Secondary endpoints included in-hospital complications, total cost, and duration of hospitalization. Results: A total of 8732 patients (90.8% female) were admitted with primary diagnosis of TTS. Women with TTS were older compared to men (66.9±12.4 vs. 63.1±15.7 years, p<0.001). However, men had increased tobacco use (48.8% vs 37.2%), alcohol use (11.6% vs 3.1%), and coronary artery disease (47.0% vs 39.7%, p<0.001 for all). Prevalence of diabetes, hypertension, atrial fibrillation, anemia, and heart failure was similar between groups. Men more frequently developed cardiogenic shock (7.1% vs 4.4%, p<0.001) requiring mechanical circulatory support (2.9% vs 1.7%, p=0.01), and had greater all-cause mortality compared to women (2.5% vs 1.4%, p=0.01). Using a multivariate regression model to adjust for age, race, substance use, and comorbidities, male gender (OR 2.12, 95% CI [1.69-2.68], p<0.001) and cardiogenic shock (OR 15.1, 95% CI [12.6-18.0], p<0.001) were associated with increased all-cause mortality. Lastly, men experienced greater length and cost of stay (4.0±4.2 vs. 3.6±3.6 days, and $56,428 vs. $46,908), fewer routine discharges (74.3% vs. 77.6%), and greater need for skilled nursing facility (11.6% vs. 9.2%, p<0.001 for all). Conclusion: TTS occurs predominantly in women but carries increased risk of in-hospital mortality in men, especially when complicated by cardiogenic shock. Perhaps improved risk stratification and early identification of patients with signs of shock or hemodynamic instability may help to improve outcomes.

An Atypical Presentation of Acute Coronary Syndrome

2012 ◽  
Vol 8 (1) ◽  
pp. 67
Author(s):  
Syed Khurram Mushtaq Gardezi ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

scholarly journals Takotsubo syndrome after mitral valve surgery: a case report

2020 ◽  
Author(s):  
Ana Devesa ◽  
Rafael Hernández-Estefanía ◽  
José Tuñón ◽  
Álvaro Aceña
Keyword(s):  
Mitral Valve ◽  
Fatal Outcome ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Lv Function ◽  
Partial Recovery ◽  
Takotsubo Syndrome ◽  
Left Circumflex Artery ◽  
Coronary Syndrome

Abstract Background Takotsubo syndrome is a frequent entity; however, it has never been described after a mitral valve surgery. Case summary  We present the case of a 79-year-old woman, with background of atrial fibrillation and a left atrial appendage closure device, who was admitted for elective mitral valve replacement, because of asymptomatic severe primary mitral regurgitation. Biologic mitral valve was implanted without incidences, but in the postoperative, she developed cardiogenic shock. Electrocardiogram (ECG) showed inverted T waves in precordial leads and an echocardiography showed severe left ventricular (LV) dysfunction with mid to distal diffuse hypokinesis, and better contractility in basal segments. Troponin levels were mildly elevated. With the suspicion of a postoperative acute coronary syndrome, a coronary angiography was performed and showed no significant coronary lesions. The haemodynamic situation was compromised for the next 48 h, in which vasoactive support and intra-aortic balloon counterpulsation were implemented. After 48 h, the haemodynamic situation suddenly improved. The ECG was normalized, and a control echocardiogram showed partial recovery of the LV function with resolution of regional wall motion abnormalities. The patient could be discharged at 1 week. The clinical picture was interpreted as a stress cardiomyopathy after mitral valve surgery. Discussion  Takotsubo syndrome is a threatening condition; complications in acute phase could lead to a fatal outcome. Mitral valve surgery has to be considered as a trigger for this entity, after excluding coronary involvement, specially of left circumflex artery.

scholarly journals New onset of atrial fibrillation in cardiogenic shock

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
H Santos ◽  
T Vieira ◽  
J Fernandes ◽  
AR Ferreira ◽  
M Rios ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiogenic Shock ◽  
Linear Regression Analysis ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
The Impact ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The development of cardiogenic shock (CS) is associated with worse prognosis, and can produce several hemodynamic manifestations. Then, is not surprised the manifestation of new-onset atrial fibrillation (AF) in these patients. Purpose Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of new-onset of AF in CS. Methods Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. 222 patients with CS are included, 40 of them presented new onset of AF. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate predictors of new-onset AF in CS patients. Results CS patients without AF had a mean age of 61.08 ± 13.77 years old, on the other hand new-onset of AF patients in the setting of CS had a mean age of 67.02 ± 14.21 years old (p = 0.016). Nevertheless, no differences between the two groups was detected regarding the sex cardiovascular history (namely arterial hypertension, diabetes, dyslipidemia, obesity, smoker status, alcohol intake, previous acute coronary syndrome, history of angina, previous cardiomyopathy), neoplasia history, cardiac arrest during the CS, clinical signs at admission (like heart rate, blood pressure, respiratory rate), blood results (hemoglobin, leukocytes, troponin, creatinine, C-Reactive protein), left ventricular ejection fraction and the culprit lesion. New-onset of AF in CS patient had not impact in mortality rates. Multiple logistic regression reveals that only age was a predictor of new onset of AF in CS patients (odds ratio 1.032, confident interval 1.004-1.060, p = 0.024). Conclusions Age was the best predictor of new-onset AF in CS patients. The presence of this arrhythmia can have a hemodynamic impact, however, seems not influenced the final outcome.

Abstract P024: Pharmacological Treatment of Hypertension and Lv Dysfunction Predictors in ESRD Patients With AV Fistula

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Sayed Tariq ◽  
James Anderson ◽  
Rohit Dhingra ◽  
Mikhail Torosoff
Keyword(s):  
Systolic Function ◽  
Beta Blockers ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Channel Blockers ◽  
Ca Channel ◽  
Av Fistula ◽  
Fistula Surgery ◽  
Lv Dysfunction ◽  
Ca Channel Blockers

Background: Effects of anti-hypertensive medications on left ventricular dimensions and systolic function in patients with arterio-venous (AV) fistulas have not been well investigated. Material and Methods: Medical charts and echocardiograms of 346 patients with AV fistula were reviewed. Of 346, 149 patients had TTE prior to the AV fistula surgery, 197 had TTE after the AV fistula surgery, and 76 patients had TTE before and after the AV fistula surgery. Data on medication use was available in 314 patients. ANOVA, chi-square, and logistic regression tests were employed. Results: In patients scheduled for AV fistula placement, 20% (31/149) patients had systolic dysfunction and 15% (22/142) had increased LV end-diastolic dimensions (LVEDD). Moderate systolic LV dysfunction was observed in 6% (9/149) and additional 8% (12/149) had severe LV dysfunction. Increased LVEDD with some LV dysfunction was noted in 27% (38/142).Following the AV fistula placement, 18% (36/197) of patients had systolic dysfunction and 12% (22/187) had increased LV end-diastolic dimensions (LVEDD). Moderate or severe systolic LV dysfunction was observed in 6% (5/197). LV systolic dysfunction or dilatation was noted in 23% (43/187). Of 314 patients, 63% were on beta-blockers (BB), 25% were on ACE inhibitor or an ARB , 43% on calcium-channel blocker , and 15% on alpha-antagonist . BB, ACEi-ARB, or AA were not associated with increased LVEDD or systolic dysfunction before or after the AV fistula placement. Prior to AV fistula, CCB treatment was not related to LV dilatation (36% in each group, p=0.981) Post AV fistula, CCB treatment was associated with increased LV dimensions (71% vs. 46%, p=0.029) but not LV systolic dysfunction (49% in LV dysfunction vs. 38% in the rest, p=0.446) . This association persisted after adjustment for co-morbidities and demographic parameters. Conclusions: LV systolic dysfunction and/or dilatation are common in patients undergoing AV fistula surgery. Despite decreased use of Ca-channel blockers in patients with LV dysfunction prior to AV fistula, Ca-channel blockers are associated with increased LV dimensions post AV fistula, and probably should be avoided in this vulnerable patient population.

Elderly woman presenting with multivessel coronary artery disease and Takotsubo syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e242367
Author(s):  
Hari Vivekanantham ◽  
Martin Scoglio ◽  
Philipp Suter ◽  
Stephane Cook ◽  
Yann Roux ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Takotsubo Syndrome ◽  
Left Main ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Left Anterior Descending Artery ◽  
Artery Disease

Takotsubo syndrome is an acute and often reversible condition, with initial presentation mimicking acute coronary syndrome. Typically, patients present with left ventricular regional wall motion abnormalities, without a corresponding coronary artery obstruction on angiography. Coexistence of a coronary artery disease is possible and may render the distinction between the two entities particularly challenging. We report the case of a 94-year-old woman with chest pain after an emotional upset and acute myocardial injury. Transthoracic echocardiogram (TTE) revealed a severely reduced left ventricular ejection fraction (LVEF) with apical ballooning. Coronary angiogram showed significant stenosis of the distal left main coronary artery and of the mid-left anterior descending artery, as well as a 30%–50% stenosis of the mid-distal right coronary artery. Revascularisation was deferred and antiplatelet as well as heart failure therapy begun. A repeat TTE 6 days later revealed a quasi-normalised LVEF. Ultimately, percutaneous coronary revascularisation of the left main and left anterior descending artery was performed, with favourable outcome at 6-month follow-up.

scholarly journals Takotsubo Syndrome: Contemporary Views on the Pathogenesis, Prevalence and Prognosis

2018 ◽  
Vol 14 (4) ◽  
pp. 598-604 ◽  
Author(s):  
A. S. Shilova ◽  
A. O. Shmotkina ◽  
A. A. Yafarova ◽  
M. Yu. Gilyarov
Keyword(s):  
Genetic Predisposition ◽  
Randomized Clinical Trials ◽  
Myocardial Dysfunction ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Reversible Left Ventricular Dysfunction

Takotsubo syndrome (TTS) is a reversible left ventricular dysfunction characterized by local apical hypokinesia usually triggered by a physical or emotional stress. According to the last available data TTS may represent 2% of all admissions for acute coronary syndromes. Despite the reliable prevalence, diagnosis of TTS remains difficult. The initial presentation, both clinically and electrocardiographically, is similar to an acute myocardial infarction (AMI). The biomarker profile is also similar, although the peaks of troponin and creatinine kinase levels are lower, and brain natriuretic peptide levels are higher in patients with TTS compared with ST-segment elevation AMI. Modified Mayo diagnostic criteria are the most common for the diagnosis. Pathogenesis of TTS currently is not well understood. Catecholamines appear to play a central role in the pathophysiology of TTS. However, it is conceivable that some people have a genetic predisposition to stress-induced TTS. A genetic predisposition has been suggested based on the few familial TTS cases described. Despite reversible myocardial dysfunction, acute heart failure is the most common complication in the acute phase of TTS. In-hospital mortality rate is comparable to that of ST-segment elevation AMI. There are no randomized clinical trials to support specific treatment recommendations in TTS. It is believed that the tactics of managing patients with TTS hospitalized with suspicion of acute coronary syndrome should comply with the protocol of management of patients with AMI while acute coronary pathology is not excluded.

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