scholarly journals Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases

2020 ◽  
Vol 2 (11) ◽  
pp. 2102-2108 ◽  
Author(s):  
Sandeep Singh ◽  
Rupak Desai ◽  
Zainab Gandhi ◽  
Hee Kong Fong ◽  
Shriya Doreswamy ◽  
...  
Keyword(s):  
Case Reports ◽  
Hypertensive Crisis ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Complications ◽  
Time Interval ◽  
Takotsubo Syndrome ◽  
Ventricular Ejection Fraction ◽  
Successful Recovery

AbstractTakotsubo syndrome (TTS) is caused by catecholamine surge, which is also observed in COVID-19 disease due to the cytokine storm. We performed a systematic literature search using PubMed/Medline, SCOPUS, Web of Science, and Google Scholar databases to identify COVID-19-associated TTS case reports and evaluated patient-level demographics, clinical attributes, and outcomes. There are 12 cases reported of TTS associated with COVID-19 infection with mean age of 70.8 ± 15.2 years (range 43–87 years) with elderly (66.6% > 60 years) female (66.6%) majority. The time interval from the first symptom to TTS was 8.3 ± 3.6 days (range 3–14 days). Out of 12 cases, 7 reported apical ballooning, 4 reported basal segment hypo/akinesia, and 1 reported median TTS. Out of 12 cases, during hospitalization, data on left ventricular ejection fraction (LVEF) was reported in only 9 of the cases. The mean LVEF was 40.6 ± 9.9% (male, 46.7 ± 5.7%, and female, 37.7 ± 10.6%). Troponin was measured in all 12 cases and was elevated in 11 (91.6%) without stenosis on coronary angiography except one. Out of 11 cases, 6 developed cardiac complications with 1 case each of cardiac tamponade, heart failure, myocarditis, hypertensive crisis, and cardiogenic shock in 2. Five patients required intubation, 1 patient required continuous positive airway pressure, and 1 patient required venovenous extracorporeal membrane oxygenation. The outcome was reported in terms of recovery in 11 (91.6%) out of 12 cases, and a successful recovery was noted in 10 (90.9%) cases. COVID-19-related TTS has a higher prevalence in older women. Despite a lower prevalence of cardiac comorbidities in COVID-19 patients, direct myocardial injury, inflammation, and stress may contribute to TTS with a high complication rate.

Concomitant myopericarditis and takotsubo syndrome following immune checkpoint inhibitor therapy

2020 ◽  
Vol 13 (9) ◽  
pp. e235265 ◽  
Author(s):  
Nicholas Yick Loong Tan ◽  
Nandan S Anavekar ◽  
Brandon M Wiley
Keyword(s):  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Left Ventricular ◽  
Inhibitor Therapy ◽  
Left Ventricular Ejection ◽  
Cardiac Complications ◽  
Takotsubo Syndrome ◽  
Ventricular Ejection Fraction ◽  
Checkpoint Inhibitor Therapy

A 62-year-old man with metastatic hepatocellular carcinoma presented with ST elevation myocardial infarction had received one dose of nivolumab 3 weeks prior. Cardiac catheterisation was negative for obstructive coronary artery disease. He was transferred to the cardiac intensive care unit due to ventricular arrhythmias and markedly elevated troponin T levels. Transthoracic echocardiogram showed severely depressed left ventricular ejection fraction of 18% (normal 55%–70%) with mid and apical ballooning consistent with takotsubo syndrome (TTS). Intravenous glucocorticoids were administered due to suspicion for superimposed myocarditis. Cardiac MRI 3 days later showed mid-myocardial and subepicardial delayed enhancement in the inferior and lateral walls as well as apex indicative of myopericarditis. He clinically improved on steroids and was discharged with outpatient follow-up. This case highlights major cardiac complications that may arise with immune checkpoint inhibitor therapy. In addition, it emphasises the importance of assessing for concomitant myocarditis even when initial imaging suggests TTS.

scholarly journals 711 A rare case of takotsubo syndrome induced by pacemaker implantation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Antonio Strangio ◽  
Isabella Leo ◽  
Jolanda Sabatino ◽  
Letizia Rosa Romano ◽  
Sabrina La Bella ◽  
...  
Keyword(s):  
Rare Case ◽  
Troponin T ◽  
Obstructive Coronary Artery Disease ◽  
Pacemaker Implantation ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Takotsubo Syndrome ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome

Abstract Aims Takotsubo syndrome (TTS) is an acute cardiac condition characterized by a temporary wall motion abnormality of the left ventricle that mimics an acute coronary syndrome (ACS). TTS usually occurs following emotionally or physically triggering event. We report a rare case of Takotsubo syndrome following a pacemaker implantation. Methods and results A 77-year-old woman was admitted to our hospital with a third-degree atrioventricular block. She was asymptomatic with a history of hypertension, diabetes, hyperlipidaemia and extrapyramidal syndrome. Laboratory tests reported High-Sensitive cardiac Troponin T (HS-cTnT) 32.9 ng/L (ULN <14), creatine kinase muscle and brain (CK-MB) 4.1 ng/mL (ULN < 4.94) and NT-proB-type Natriuretic Peptide (NT-proBNP) 1465 pg/ml (ULN < 125). Echocardiography showed a normal left ventricular ejection fraction (EF = 58%) (Figure 2A). The patient underwent dual chamber pacemaker implantation without immediate complications. Three days later, a routine ECG showed new T wave inversions (Figure 1), in absence of symptoms. Echocardiography revealed apical akinesia, with ‘apical ballooning’ (EF 30%) (Figure 2B). Serum cardiac markers were increased (CK-MB 8.2 ng/ml, HS-cTnT 189.7 pg/ml, NT-proBNP 15 005 pg/ml. A coronary angiography excluded obstructive coronary artery disease (Figure 3). Given the impossibility of carrying out a cardiac RMI for the recent pacemaker implantation and after exclusion of other diagnoses, pacemaker implantation induced Takotsubo syndrome was suspected. Conclusions The trigger of this case of TTS was the pacemaker implantation, a relatively brief and painless procedure that, in her case could have constitute a considerable emotional and physical stress. To the best of our knowledge 13 cases of TTS after pacemaker implantation have been described to date. Of those cases, four had an asymptomatic course. Therefore, the real incidence of TTS following pacemaker implantation may be underestimated and ECG and echocardiography should always be performed after pacemaker implantation.

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 Evaluation of Cardiac Biomarkers in Dengue Myocarditis in a Tertiary Care Hospital in Eastern India

2020 ◽  
Author(s):  
Debojyoti Bhattacharjee ◽  
Jayati Roy Choudhury ◽  
Kasturi Mukherjee ◽  
Kheya Mukherjee
Keyword(s):  
Viral Infection ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Health Concern ◽  
Left Ventricular Ejection ◽  
Cardiac Complications ◽  
Care Hospital ◽  
Ventricular Ejection Fraction

Introduction: Dengue, a vector borne viral infection transmitted by Aedes mosquito has recently become a major public health concern in the tropical regions of the world. In addition to the two major life threatening complications- Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), a variety of cardiac complications have been recognised, the most common being myocarditis. Aim: To study and compare the quantity of different cardiac biomarkers in patients of Dengue Fever with and without myocarditis. Materials and Methods: This was a hospital-based retrospective observational study done in a Tertiary Care Hospital, Kolkata, West Bengal, India from June 2019 to November 2019. Dengue patients with diagnosed myocarditis on day 7 of fever based on electro and echocardiogram changes of left ventricular ejection fraction less than 50% were considered as cases (n=41). Age and sex matched dengue patients with normal electro and echocardiogram changes were considered as control (n=43). After obtaining Institutional Ethics Committee Clearance, laboratory data were collected from samples coded and assayed for markers of acute cardiac myocyte damage such as total Creatine Kinase (CK), CK-Muscle Brain (CK-MB), Troponin T (Trop T) and cardiac failure biomarker N-Terminal pro Brain Natriuretic Peptide (NT-proBNP). Statistical analysis of the data was performed using Statistical Package for Social Sciences (SPSS 20). Results: Cardiac biomarkers CK, CK-MB, Trop T and NT-proBNP levels in cases were higher compared to controls (p-value <0.05). Trop T and NT-proBNP were positively correlated to each other (r-value: 0.44). Trop T changes could also predict significantly the rise in NT-proBNP in circulation (p<0.05). Conclusion: It reconfirmed the need of routine monitoring of cardiac biomarkers in conjunction with other cardiac function tests in early diagnosis and or management of myocarditis, a severe complication of Dengue Viral Infection (DENV).

scholarly journals Takotsubo cardiomyopathy complicating a twin pregnancy at partum

2019 ◽  
Vol 7 (11) ◽  
pp. 4375
Author(s):  
B.V. Nagabhushana Rao ◽  
A. Rekha ◽  
A. Sankar Narayan ◽  
A. Manjusha
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Twin Pregnancy ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Women Authors ◽  
Ventricular Ejection Fraction ◽  
Menopausal Women ◽  
Post Menopausal

Takotsubo cardiomyopathy is a rare syndrome characterized by acute left ventricular dysfunction with regional left ventricular ballooning, mimicking myocardial infarction. This condition is often described in post-menopausal women. Authors present a case in an elderly primi with twin gestation immediately after Cesarean surgery. We discussed her presentation, investigations, diagnosis, management and outcome. 35 year female, a primi with twin pregnancy developed chest pain and shortness of breath immediately after Cesarean surgery. Her Electrocardiograph was abnormal, and Echocardiogram demonstrated abnormal apical ballooning of the left ventricle and severe dysfunction. Cardiac enzymes were elevated and chest skiagram showed pulmonary edema. She was managed in the intensive care unit with oxygen supplementation, diuretics and inotropes. She made an excellent recovery with normalization of left ventricular ejection fraction within 8 days. During the six months follow up, she was asymptomatic and left ventricular function remained normal.

Abstract 145: Use of Bromocriptine in the Management of Peripartum Cardiomyopathy: A Systematic Review

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Garly Rushler Saint Croix ◽  
Michel Ibrahim ◽  
Sandra Chaparro
Keyword(s):  
Clinical Outcomes ◽  
Case Reports ◽  
Thrombotic Event ◽  
Case Control ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
The Other ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Multicenter Rct

Background: Prolactin metabolites have been shown to possibly be cardio-toxic in humans and play a role in the pathogenesis of Peripartum Cardiomyopathy (PPCM). Some studies have demonstrated medical treatment with bromocriptine, a dopamine agonist able to inhibit prolactin, associated with standard therapy to be beneficial not only in managing symptomatology but also in the reversal of disease process. The present study was performed to systematically review the PPCM literature and determine the therapeutic effect of bromocriptine on left ventricular function and clinical outcomes. Methods: We performed a literature review to identify randomized, nonrandomized clinical studies, case series and case reports that reported the use of bromocriptine in the management of PPCM. A total of 9 databases including MEDLINE, Embase, Cochrane, DARE and Scopus containing articles from January 1, 1945 to July 31, 2016 were analyzed. Results: We were able to identify and screen 410 potentially eligible publications through the databases. Based on our exclusion criterias, 8 studies were selected: one randomized control trial (RCT), two case control studies and five case reports. We found that Bromocriptine improved left ventricular ejection fraction (LVEF) and clinical outcomes in women with acute severe PPCM and no thrombotic event was reported. The RCT (n = 20) showed an improvement of composite end point of death, NYHA Class III/IV and LVEF < 35% (35 of 100) at 6 months. LVEF went from 27% (27 of 100) to 58% (58 of 100) in the group taking bromocriptine vs 36% (36 of 100) in the other group . One of the case controls (n = 51) showed LVEF improvement of 85% (43 of 51) and full recovery in 47% (24 of 51) after 6 months +/- 3 of treatment. The other case control study (n = 115) failed to suggest a beneficial effect of bromocriptine. However, all the five case reports (n = 7) showed LV improvement. Conclusion: Peripartum Cardiomyopathy is a rare but serious condition that affects childbearing women. Targeted therapies like bromocriptine have shown promising results but a large multicenter RCT is needed to evaluate furthermore the benefits and harms of bromocriptine before it can be adopted in routine clinical use.

scholarly journals Case Report: Takotsubo Syndrome Associated With Novel Coronavirus Disease 2019

2021 ◽  
Vol 8 ◽  
Author(s):  
Sofia Ortuno ◽  
Mathieu Jozwiak ◽  
Jean-Paul Mira ◽  
Lee S. Nguyen
Keyword(s):  
Cardiac Function ◽  
Takotsubo Cardiomyopathy ◽  
Viral Infections ◽  
Troponin T ◽  
Myocardial Dysfunction ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Novel Coronavirus

Background: Takotsubo cardiomyopathy is triggered by emotional or physical stress. It is defined as a reversible myocardial dysfunction, usually with apical ballooning aspect due to apical akinesia associated with hyperkinetic basal left ventricular contraction. Described in cases of viral infections such as influenza, only few have been reported associated with novel coronavirus disease 2019 (COVID-19) in the recent pandemic.Case summary: A 79-years-old man, with cardiovascular risk factors (type 2 diabetes and hypertension) and chronic kidney disease, presented to the emergency room for severe dyspnea after 8 days of presenting respiratory symptoms and fever. Baseline electrocardiogram (ECG) was normal, but he presented marked inflammatory syndrome. He was transferred to an intensive care unit to receive mechanical ventilation within 6 h, due to acute respiratory distress syndrome. He presented circulatory failure 2 days after, requiring norepinephrine support (up to up to 1.04 μg/kg/min). Troponin T was elevated (637 ng/l). ECG showed diffuse T wave inversion. Echocardiography showed reduced left ventricular ejection fraction (LVEF 40%), with visual signs of Takotsubo cardiomyopathy. Cardiac failure resolved after 24 h with troponin T decrease (433 ng/l) and restoration of cardiac function (LVEF 60% with regression of Takotsubo features). Patient died after 15 days of ICU admission, due to septic shock from ventilator-acquired pneumonia. Cardiac function was then normal.Conclusion: Mechanisms of Takotsubo cardiomyopathy in viral infections include catecholamine-induced myocardial toxicity and inflammation related to sepsis. Differential diagnoses include myocarditis and myocardial infarction. Evidence of the benefit of immunomodulatory drugs and dexamethasone are growing to support this hypothesis in COVID-19.

scholarly journals Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Victoria L. Cammann ◽  
Jan F. Scheitz ◽  
Regina von Rennenberg ◽  
Lutz Jäncke ◽  
Christian H. Nolte ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Complete Information ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Takotsubo Syndrome ◽  
Ventricular Ejection Fraction ◽  
Cardiac Symptoms ◽  
Triggering Factor ◽  
Clinical Awareness

AbstractCardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.

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