scholarly journals Case report: recurrent biventricular Takotsubo cardiomyopathy in a middle-aged man with fatal outcome after full recovery

2019 ◽  
Vol 3 (4) ◽  
pp. 1-6
Author(s):  
Elton Lian Chen Luo ◽  
Attila Kardos
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Fatal Outcome ◽  
Apical Ballooning ◽  
Airway Disease ◽  
Full Recovery ◽  
Chronic Obstructive ◽  
Middle Aged ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome ◽  
Post Intubation

Abstract Background Takotsubo cardiomyopathy (TC) usually manifests as transient apical ballooning of the left ventricle and may mimic acute coronary syndrome. Concomitant right ventricle involvement may occur in about a third of the cases. Recurrence had been observed in up to 10% of TC with variable ventricular involvement. Despite this knowledge, there had been no report of a patient with multiple biventricular TC in the literature to date. In this study, we describe a rare case of a patient who presented twice with biventricular TC. Case summary A 52-year-old man with a previous episode of biventricular TC 5 months ago presented to our hospital with a 1 day history of shortness of breath and wheeze. He was treated initially for infective exacerbation of chronic obstructive airway disease. He was eventually intubated following a trial of non-invasive ventilation. He became hypotensive post-intubation and required intensive care support. An inpatient echocardiogram revealed biventricular apical ballooning. Invasive coronary angiogram showed no coronary artery disease. A repeat echocardiogram 14 days post-admission demonstrated full recovery of both ventricles. These findings were consistent with a second biventricular TC. Two months later, he was found deceased in the community seemingly from an unrelated cause. Discussion This case describes a middle-aged gentleman who suffered recurrent biventricular TC with no consistent triggers and an unrelated fatal sequel. None of these features were typical, and to our best knowledge had not been reported before. We hypothesize that his recurrent chronic obstructive pulmonary disease exacerbations and various substance misuse might have predisposed him to this unusual presentation.

scholarly journals Ventricular Septal Perforation after Biventricular Takotsubo Cardiomyopathy Successfully Repaired with an Amplatzer Device: First Report in the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Alfredo E. Rodríguez ◽  
Carlos Fernandez-Pereira ◽  
Juan Mieres ◽  
Diego Ascarrunz ◽  
Eduardo Gabe ◽  
...  
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Apical Ballooning ◽  
Sudden Onset ◽  
Chronic Obstructive ◽  
Septal Perforation ◽  
Obstructive Pulmonary Disease ◽  
Ventricular Septal Perforation ◽  
Amplatzer Device ◽  
Occluder Device ◽  
Disorder Patient

A 79-year-old female was admitted with sudden onset dyspnea, mild oppressive chest pain, and severe anxiety disorder. Patient had history of hypertension, dyslipidemia, smoking, and chronic obstructive pulmonary disease. On admission blood pressure was 160/90 and heart rate was 130 bpm. Transthoracic echocardiography (TE) and contrast tomography showed a thin septum with an abnormal left and right ventricular contraction with an “apical ballooning” pattern and mild increase of cardiac enzymes. At the 4th day of admission, the patient presented symptoms and signs of congestive heart failure and developed cardiogenic shock. EKG showed an inversion of T waves in all precordial leads. In a new TE, a ventricular septal perforation (VSP) in the apical portion of the septum was seen. Coronary angiogram showed angiographically “normal” coronary arteries. With a diagnosis of VSP in takotsubo cardiomyopathy, a percutaneous procedure to repair the VSP was performed 11 days after admission. The VSP was closed with an Amplatzer device. TE performed 24 hours after showed significant improvement of ventricular function and good apposition of the Amplatzer device. Three days later she was discharged from the hospital. To our knowledge, this is the first reported case of a VSP in a TCM repaired percutaneously with an occluder device.

scholarly journals Frequently Recurrent Takotsubo Syndrome in COPD

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Juan Vaz ◽  
Rikard Berggren ◽  
Berne Eriksson
Keyword(s):  
Ventricular Dysfunction ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Chronic Obstructive ◽  
Acute Dyspnea ◽  
Copd Exacerbation ◽  
Takotsubo Syndrome ◽  
Unique Case ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome

Cardiovascular disease is common among patients with chronic obstructive pulmonary disease (COPD). Takotsubo syndrome (TTS) is a transient cardiac disorder that, in its typical form, involves left ventricular dysfunction with apical ballooning and mimics acute coronary syndrome (ACS). “Bronchogenic TTS” has been proposed as a specific form of TTS (during severe acute dyspnea in asthma or COPD) with atypical presentation. Recurrent TTS in COPD seems to be exceptionally rare since only a handful of clinical cases have previously been reported in the literature. Here, we present a unique case of a frequently recurrent TTS during COPD exacerbation in a 70-year-old woman, with at least 4 different episodes of TTS within 5 years. This case report exemplifies the difficulties of the diagnosis of TTS at the onset of acute COPD exacerbation. Potential pathophysiological mechanisms and therapeutic strategies are also briefly discussed.

Heart failure in Acute Coronary Syndrome: predictors and prognosis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Santos ◽  
H Santos ◽  
I Almeida ◽  
H Miranda ◽  
C Sa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Artery Bypass ◽  
Study Data ◽  
Multivessel Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
Previous Stroke ◽  
St Elevation

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Heart failure (HF) is a frequent complication of acute coronary syndromes (ACS). Therefore, it is important to access its impact on prognosis and identify patients (pts) with higher risk of HF. Objective To evaluate predictors and prognosis of HF in the setting of ACS. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Pts without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without HF; GB - pts with HF during hospitalization. Results HF occurred in 4003 (15.6%) out of 25718 pts with ACS. GB was older (74 ± 12 vs 65 ± 13, p < 0.001), had more females (36.3% vs 26.2%, p < 0.001), had higher rates of arterial hypertension (78.4% vs 69.3%, p < 0.001), dyslipidaemia (64.4% vs 61.1%. p < 0.001), previous ACS (25.6% vs 19.7%, p < 0.001,), previous HF (16.4% vs 4.1%, p < 0.001), previous stroke (11.9% vs 6.4%, p < 0.001), chronic kidney disease (CKD) (17.1% vs 5.5%, p < 0.001), chronic obstructive pulmonary disease (COPD) (7.8% vs 3.8%, p < 0.001) and longer times from first symptoms to admission (268min vs 238min, p < 0.001). GA had higher rate of smokers (28.4% vs 16.2%, p < 0.001) and higher rate of non-ST-elevation myocardial infarction (MI) (46.5% vs 43.0%, p < 0.001). GB had higher rates of ST-elevation MI (STEMI) (49.2% vs 41.1%, p < 0.001), namely anterior STEMI (58.1% vs 44.9%, p < 0.001). GB had lower blood pressure (130 ± 32 vs 140 ± 28, p < 0.001), higher heart rate (86 ± 23 vs 76 ± 18, p < 0.001), Killip-Kimball class (KKC) ≥2 (63.2% vs 6.7%, p < 0.001), atrial fibrillation (AF) (15.4% vs 5.7%, p < 0.001), left bundle branch block (7.5% vs 3.1%, p < 0.001) and were previously treated with diuretics (39.1% vs 22.1%, p < 0.001), amiodarone (2.2% vs 1.4%, p < 0.001) and digoxin (2.8% vs 0.7%, p < 0.001). GB had higher rates of multivessel disease (66.0% vs 49.5%, p < 0.001) and planned coronary artery bypass grafting (7.3% vs 6.0%, p < 0.001), reduced left ventricle function (72.3% vs 33.4%, p < 0.001) and needed more frequently mechanical ventilation (8.2% vs 0.9%, p < 0.001), non-invasive ventilation (8.7% vs 0.5%, p < 0.001) and provisory pacemaker (4.5% vs 1.0%, p < 0.001). Logistic regression confirmed females (p < 0.001, OR 1.42, CI 1.29-1.58), diabetes (p < 0.001, OR 1.43, CI 1.30-1.58), previous ACS (p < 0.001, OR 1.27, CI 1.10-1.47), previous stroke (p < 0.001, OR 1.35, CI 1.16-1.57), CKD (p < 0.001, OR 1.76, CI 1.50-2.05), COPD (p < 0.001, OR 2.15, CI 1.82-2.54), previous usage of amiodarone (p = 0.041, OR 1.35, CI 1.01-1.81) and digoxin (p < 0.001, OR 2.30, CI 1.70-3.16), and multivessel disease (p < 0.001, OR 1.64, CI 1.67-2.32) were predictors of HF in the setting of ACS. Event-free survival was higher in GA than GB (79.5% vs 58.1%, OR 2.3, p < 0.001, CI 2.09-2.56). Conclusion As expected, HF in the setting of ACS is associated with poorer prognosis. Several features may help predict the HF occurrence during hospitalizations, allowing an earlier treatment.

scholarly journals A 3D-CNN model with CT-based parametric response mapping for classifying COPD subjects

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Thao Thi Ho ◽  
Taewoo Kim ◽  
Woo Jin Kim ◽  
Chang Hyun Lee ◽  
Kum Ju Chae ◽  
...  
Keyword(s):  
Neural Network ◽  
Pulmonary Function Tests ◽  
Airway Disease ◽  
Chronic Obstructive ◽  
Respiratory Disorder ◽  
Obstructive Pulmonary Disease ◽  
Response Mapping ◽  
Small Airway Disease ◽  
3D Cnn ◽  
Parametric Response

AbstractChronic obstructive pulmonary disease (COPD) is a respiratory disorder involving abnormalities of lung parenchymal morphology with different severities. COPD is assessed by pulmonary-function tests and computed tomography-based approaches. We introduce a new classification method for COPD grouping based on deep learning and a parametric-response mapping (PRM) method. We extracted parenchymal functional variables of functional small airway disease percentage (fSAD%) and emphysema percentage (Emph%) with an image registration technique, being provided as input parameters of 3D convolutional neural network (CNN). The integrated 3D-CNN and PRM (3D-cPRM) achieved a classification accuracy of 89.3% and a sensitivity of 88.3% in five-fold cross-validation. The prediction accuracy of the proposed 3D-cPRM exceeded those of the 2D model and traditional 3D CNNs with the same neural network, and was comparable to that of 2D pretrained PRM models. We then applied a gradient-weighted class activation mapping (Grad-CAM) that highlights the key features in the CNN learning process. Most of the class-discriminative regions appeared in the upper and middle lobes of the lung, consistent with the regions of elevated fSAD% and Emph% in COPD subjects. The 3D-cPRM successfully represented the parenchymal abnormalities in COPD and matched the CT-based diagnosis of COPD.

scholarly journals Methylation of SERPINA1 gene promoter may predict chronic obstructive pulmonary disease in patients affected by acute coronary syndrome

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
John Charles Rotondo ◽  
Giorgio Aquila ◽  
Lucia Oton-Gonzalez ◽  
Rita Selvatici ◽  
Paola Rizzo ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Acute Coronary Syndrome ◽  
Pulmonary Disease ◽  
Blood Cells ◽  
Gene Promoter ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome ◽  
Copd Patients ◽  
Potential Biomarker

Abstract Background Diagnostic biomarkers for detecting chronic obstructive pulmonary disease (COPD) in acute coronary syndrome (ACS) patients are not available. SERPINA1, coding for the most potent circulating anti-inflammatory protein in the lung, has been found to be differentially methylated in blood cells from COPD patients. This study aimed to investigate the methylation profile of SERPINA1 in blood cells from ACS patients, with (COPD+) or without COPD (COPD−). Methods Blood samples were from 115 ACS patients, including 30 COPD+ and 85 COPD− according to lung function phenotype, obtained with spirometry. DNA treated with sodium bisulfite was PCR-amplified at SERPINA1 promoter region. Methylation analysis was carried out by sequencing the PCR products. Lymphocytes count in ACS patients was recorded at hospital admission and discharge. Results SERPINA1 was hypermethylated in 24/30 (80%) COPD+ and 48/85 (56.5%) COPD− (p < 0.05). Interestingly, at hospital discharge, lymphocytes count was higher in COPD− patients carrying SERPINA1 hypermethylated (1.98 × 103 ± 0.6 cell/µl) than in COPD− carrying SERPINA1 hypomethylated (1.7 × 103 ± 0.48 cell/µl) (p < 0.05). Conclusions SERPINA1 is hypermethylated in blood cells from COPD+ patients. COPD− carrying SERPINA1 hypermethylated and high lymphocytes count may be at risk of COPD development. Therefore, SERPINA1 hypermethylation may represent a potential biomarker for predicting COPD development in ACS patients.

The role of beta-agonist therapy for chronic obstructive airway disease in patients with coexistent atrial fibrillation: Literature review

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Rodríguez Miguel ◽  
◽  
Chinta Siddharth ◽  
Vittorio Timothy ◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Airway Disease ◽  
The Other ◽  
Beta Agonist ◽  
Beta Blockade ◽  
Chronic Obstructive ◽  
Agonist Therapy ◽  
Obstructive Pulmonary Disease

Background: New advances have been made in medicine, but the incidence and prevalence of Chronic Obstructive Pulmonary Disease (COPD) are evident, and it is established as the fourth cause of death in the United States representing a high cost for the healthcare system. This condition has been related to atrial fibrillation due to the changes in the lungs and vasculature. Based on this history, we seek to evaluate the outcome of AF in the patients with COPD and its relationship with medical therapy utilized to treat this pulmonary condition with the objective of establishing the relationship between the use of beta-agonist therapy for obstructive airway disease in patients with AF. Discussion: Cell receptors participate in multiple reactions and the sympathetic response is received via the alpha- and beta-receptors are related to the hemodynamic of the vasculature of the lungs and cardiovascular system. The beta-blockade agents are one of the most common medication classes used for rate control in cardiac arrhythmias, but the side effect could be COPD exacerbation; on the other hand, beta-adrenergic or beta-agonist as a therapy for this pulmonary condition could increase the heart rate leading to AF decompensation. There is a clear dilemma in our patients who have airway disease and AF since the treatment for one might worsen the other. The clear benefit in morbidity and mortality of beta-blocker therapy, especially beta1-selective, outweighs the potential for any pulmonary side-effects related to ex-acerbation of COPD or airway disease. Conclusion: There is clear data showing the evidence of the potential paradoxical side-effect between COPD and AF therapies, given the exacerbation of one due to treatment of the other, benefits versus risks should be discussed and the medical decision should be made based on them. The deteriorated cardiac condition can rapidly predispose to critical complications leading to death, which is why the use of beta-blockade agents will be chosen over possible complications with pulmonary disease. In other words, the benefit should outweigh the risk based on the best outcome for the patient. Keywords: atrial fibrillation; pulmonary disease; obstructive pulmonary disease; chronic obstructive pulmonary disease (COPD); B-Agonist; B-Block (selective; non-selective); digitalis; other antiarrhythmic.

scholarly journals Takotsubo Cardiomyopathy in a Squash Player

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Mathieu Berry ◽  
Jerome Roncalli ◽  
Olivier Lairez ◽  
Meyer Elbaz ◽  
Didier Carrié ◽  
...  
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Wall Motion ◽  
Ventricular Dysfunction ◽  
Apical Ballooning ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
The Body ◽  
Coronary Syndrome ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities

Takotsubo cardiomyopathy is usually described following acute emotional stress. We report here the case of a 48-year-old woman admitted for acute coronary syndrome after an intensive squash match. Diagnosis of Takotsubo cardiomyopathy due to acute physical stress was suspected in presence of normal coronary arteries and transitory left ventricular dysfunction with typical apical ballooning. Cardiac magnetic resonance imaging confirmed regional wall-motion abnormalities and was helpful in excluding myocardial infarction diagnosis. During squash the body is subject to sudden and vigorous demands inducing a prolonged and severe workload on the myocardium.

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