Takotsubo cardiomyopathy after hypoglycemia in a patient with anorexia nervosa

Background Takotsubo cardiomyopathy, also known as “apical ballooning syndrome”, is generally precipitated by endogenous or exogenous stress. Eating disorders are associated with a variety of physical complications. Case presentation We present a case involving a 37-year-old Japanese female with anorexia nervosa. She was admitted because of emaciation with shortness of breath and tiredness, and her weight was 30.0 kg (BMI 10.5 kg/m2) at this admission. On the afternoon of the first day of hospitalization, a simple measurement caused hypoglycemia (20 mg/dL), and she lost consciousness. On the night of the second day of hospitalization, electrocardiogram showed negative T waves in II, III, aVf, and V1–6. Ultrasound echo showed hypokinesia at the apex of the heart and hypercontraction at the base of the heart. The left ventricular ejection fraction was 20%. Rest and oxygen administration gradually improved her cardiac function; the left ventricular ejection fraction also improved to 50% based on echocardiography. Finally, her weight increased to 43 kg (BMI 15.2 kg/m2) with psychiatric treatment, and she was discharged. Conclusions The present case shows the clinical features of Takotsubo cardiomyopathy induced by a hypoglycemic event in addition to underlying anorexia nervosa.

Overview of the Global Prevalence and Diagnostic Criteria of Takotsubo Syndrome

Takotsubo syndrome (TTS) is an acute and reversible abnormal condition of the heart also known as stress cardiomyopathy, apical ballooning syndrome, or broken heart syndrome. It is an uncommon disease that mostly occurs among Asians though studies have shown its occurrence in other parts of the world. The typical takotsubo syndrome patient has a unique circumferential left ventricular contraction abnormality that extends beyond a coronary artery supply territory and appears to follow the anatomical cardiac sympathetic innervation.

TAKATSUBO CARDIOMYOPATHY AFTER CAESEREAN SECTION – A CASE REPORT.

BACKGROUND : Acute cardiac complications in peripartum period provide a diagnostic challenge. Takatsubo cardiomyopathy occurs most frequently in postmenopausal women exposed to emotionalandphysicalstress. We report a case of apical ballooning syndrome, also known as Takotsubo Cardiomyopathy (TCM) or broken-heart syndrome, in a preeclamptic patient post operatively. CASE : 44 year preeclamptic primi presented with dyspnoea three hours after sub arachnoid block for caeserean. On evaluation, trans thoracic echo revealed apical ballooning with global hypokinesia along with raised NT-Pro BNP level. ECG and cardiac enzymes werenormal. She was intubated, ventilated and treated with inotropes and anti failure medications by a multidiciplinary team.She was extubated on Postoperativeday (POD) 3 and discharged on POD 13 with stable vitals. Her echo done on third month was completely normal with adequate left ventricular function. CONCLUSION : Physical, emotional stress and oestrogen deciency in immediate post partum period may be the predisposing risk factors for TCM even if regional anaesthesia is given. Trans thoracic echo plays a vital role in differenciating TCM from other peripartumcardiac complications like pulmonary thrombo embolism, peripartum cardimyopathy or acute coronary syndrome.

Takotsubo Cardiomyopathy after Hypoglycemia in a Patient with Anorexia Nervosa

BackgroundTakotsubo cardiomyopathy, also known as “apical ballooning syndrome”, is generally precipitated by endogenous or exogenous stress, and eating disorders have a variety of physical complications.Case presentationWe present a case involving a 37-year-old Japanese female with eating disorders. She was admitted because of emaciation with shortness of breath and tiredness, and her weight was 30.0 kg (BMI 10.5 kg/m2) at this admission. On the afternoon of the first hospital day, a simple measurement caused hypoglycemia of 20 mg/dL, and she lost consciousness. On the night of the second hospital day, electrocardiogram showed negative T waves in II, III, aVf, and V1-6. Ultrasound echo showed hypokinesia at the apex of the heart and hypercontraction at the base of the heart. The left ventricular ejection fraction was 20%. Rest and oxygen administration gradually improved her cardiac function; the left ventricular ejection fraction also improved to 50% based on echocardiography. Finally, her weight increased by 43kg (BMI 15.2 kg/m2) with psychiatric treatment, and she was discharged.ConclusionsThe present case shows the clinical features of Takotsubo cardiomyopathy induced by a hypoglycemic event in addition to underlying anorexia nervosa.

Takotsubo syndrome induced by brachytherapy in a patient with endocervical adenocarcinoma

Background Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential. Case report We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered ECG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed. Conclusions Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS.

COVID-19-associated takotsubo cardiomyopathy

The novel COVID-19 has had an unprecedented and devastating spread internationally. COVID-19 infection can lead to a number of cardiovascular sequelae, including heart failure, which may portend worse clinical outcomes. Here, we report a rare case of a 57-year-old woman who developed acute left ventricular systolic dysfunction with apical ballooning consistent with takotsubo cardiomyopathy (TCM), and mixed cardiogenic and septic shock in the setting of COVID-19 disease. We briefly review the pathophysiology and diagnosis of TCM (also described as apical ballooning syndrome and stress-induced cardiomyopathy). Additionally, this case highlights the importance of a multidisciplinary approach to clinical decision-making and resource allocation in diagnosis and management of critical illness in the setting of the ongoing international COVID-19 pandemic.

Takotsubo Syndrome induced by brachytherapy in a patient with endocervical adenocarcinoma.

Background: Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential. Case report: We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered ECG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed. Conclusion: Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS.

Takotsubo Syndrome Induced by Brachytherapy in a Patient with Endocervical Adenocarcinoma.

Background: Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential. Case report: We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered EKG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed. Conclusion: considering that community clinicians might be unfamiliar with TTS, this condition is likely to be underdiagnosed. Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS.

Takotsubo syndrome after induction of general anesthesia: three clinical cases

Takotsubo syndrome (stress-induced cardiomyopathy, or apical ballooning syndrome) is a rare critical condition with approximate incidence of 0.00006% and relatively favorable prognosis. It is characterized by electrocardiographic signs of myocardial ischemia, as well as by severe left ventricular failure with intact coronary vessels. The literature on postoperative development of this disease is scarce. This paper presents three documented cases of takotsubo syndrome with favorable outcomes that developed just after the induction of general anesthesia.