Clinical presentation of takotsubo syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 1288-1294
Author(s):  
Ilan Wittstein
Keyword(s):  
Ventricular Dysfunction ◽  
Acute Stress ◽  
Plaque Rupture ◽  
Systolic Function ◽  
Coronary Thrombosis ◽  
Apical Ballooning ◽  
Cardiac Biomarkers ◽  
Takotsubo Syndrome ◽  
Characteristic Features ◽  
As Stress

Takotsubo syndrome (TTS), also known as stress cardiomyopathy, left ventricular apical ballooning syndrome, and broken heart syndrome, is a syndrome of acute heart failure and transient ventricular dysfunction that is frequently precipitated by acute emotional or physical stress. A wide variety of emotional and physical stressors have been associated with this syndrome, and while acute stress is temporally related to syndrome onset in the majority of patients, a subset of patients have no identifiable antecedent trigger at the time of presentation. The syndrome has a striking predilection for older postmenopausal women, though it has been reported in men and in younger patients as well. The incidence of TTS is higher than initially thought and accounts for up to 5–10% of women presenting with a suspected acute coronary syndrome. Several groups have proposed variable criteria for the diagnosis of TTS, but universally accepted criteria are currently lacking. While patients with TTS typically present with chest pain, dynamic electrocardiographic changes, and elevated cardiac biomarkers, characteristic features of the syndrome that help to distinguish it from an acute myocardial infarction include the absence of plaque rupture and coronary thrombosis, unique patterns of ventricular dysfunction that typically involve more than one vascular territory, and rapid and complete recovery of ventricular systolic function. While the prognosis associated with TTS is generally favourable, the condition is not benign and has been associated with serious complications such as cardiogenic shock, thromboembolic events, and life-threatening arrhythmias. This chapter will highlight the clinical features that characterize TTS and that are central to its diagnosis.

Clinical presentation of takotsubo syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 1288-1294
Author(s):  
Ilan Wittstein
Keyword(s):  
Ventricular Dysfunction ◽  
Acute Stress ◽  
Plaque Rupture ◽  
Systolic Function ◽  
Coronary Thrombosis ◽  
Apical Ballooning ◽  
Cardiac Biomarkers ◽  
Takotsubo Syndrome ◽  
Characteristic Features ◽  
As Stress

Takotsubo syndrome (TTS), also known as stress cardiomyopathy, left ventricular apical ballooning syndrome, and broken heart syndrome, is a syndrome of acute heart failure and transient ventricular dysfunction that is frequently precipitated by acute emotional or physical stress. A wide variety of emotional and physical stressors have been associated with this syndrome, and while acute stress is temporally related to syndrome onset in the majority of patients, a subset of patients have no identifiable antecedent trigger at the time of presentation. The syndrome has a striking predilection for older postmenopausal women, though it has been reported in men and in younger patients as well. The incidence of TTS is higher than initially thought and accounts for up to 5–10% of women presenting with a suspected acute coronary syndrome. Several groups have proposed variable criteria for the diagnosis of TTS, but universally accepted criteria are currently lacking. While patients with TTS typically present with chest pain, dynamic electrocardiographic changes, and elevated cardiac biomarkers, characteristic features of the syndrome that help to distinguish it from an acute myocardial infarction include the absence of plaque rupture and coronary thrombosis, unique patterns of ventricular dysfunction that typically involve more than one vascular territory, and rapid and complete recovery of ventricular systolic function. While the prognosis associated with TTS is generally favourable, the condition is not benign and has been associated with serious complications such as cardiogenic shock, thromboembolic events, and life-threatening arrhythmias. This chapter will highlight the clinical features that characterize TTS and that are central to its diagnosis.

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.

scholarly journals Prevalence and Impact of Takotsubo Syndrome in Hospitalizations for Acute Ischemic Stroke

2021 ◽  
Author(s):  
Upenkumar Patel ◽  
Rupak Desai ◽  
MOHAMMED Faisal Uddin ◽  
Hee Kong Fong ◽  
Sandeep Singh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Acute Stress ◽  
Temporal Trends ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Diagnosis Codes ◽  
Reversible Left Ventricular Dysfunction ◽  
The Impact

Background: Takotsubo Syndrome (TTS) is characterized by acute and reversible left ventricular dysfunction with apical ballooning arising during acute stress situations. Acute Ischemic Stroke (AIS) is one of the known triggers to TTS, however, the impact of TTS on in-hospital outcomes of AIS remains unexplored. Methods: We utilized data from the National Inpatient Sample (2007-2014) and using ICD-9-CM diagnosis codes to identify admissions for AIS with TTS and evaluated the temporal trends, baseline characteristics, in-hospital complications, length of stay (LOS) and all-cause mortality. Survey multivariable logistic regression was used to compute adjusted Odds Ratios (OR and 95% confidence intervals (CI). Results: An estimated 2,242 (0.4%) TTS cases were identified among AIS hospitalizations (N=43,92,471). The frequency of TTS was higher in elderly, whites and females (82.2%). After adjustment for confounders, TTS incidence in AIS was associated with higher odds of in-hospital complications including cardiogenic shock (OR8.84, CI:4.07-19.17, p<0.001), cardiac arrest (OR3.17, CI:1.57-6.42, p=0.001), and venous thromboembolism (OR1.68, CI:1.14-2.47, p=0.008). Moreover, AIS hospitalizations with TTS showed higher odds of developing respiratory failure (OR3.13, CI:2.42-4.05, p<0.001) and required mechanical ventilation/intubation (OR4.09, CI:3.14-5.32, p<0.001) more frequently compared to non-TTS cohort. The AIS-TTS cohort had longer LOS (8.59 vs 5.22 days) and the mortality was doubled (10.2% vs 5.1% p<0.001) compared to those without TTS. Conclusion: The prevalence of TTS in AIS remained ~20 times higher than the general inpatient population and it predisposed AIS patients to worse inpatient outcomes. Further studies are needed to evaluate the impact of TTS on long-term outcomes in AIS.

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.

scholarly journals Overview of the Global Prevalence and Diagnostic Criteria of Takotsubo Syndrome

2021 ◽  
Author(s):  
Shogade Taiwo ◽  
Akpabio Akpabio
Keyword(s):  
Sympathetic Innervation ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Apical Ballooning Syndrome ◽  
Takotsubo Syndrome ◽  
Syndrome Patient ◽  
Cardiac Sympathetic Innervation ◽  
The World ◽  
Uncommon Disease ◽  
As Stress

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.

scholarly journals 285 A rare case of atypical, non-triggered takotsubo recurrence

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Maddalena Widmann ◽  
Micaela Lia ◽  
Francesca Rizzetto ◽  
Domenico Tavella ◽  
Daniele Prati ◽  
...  
Keyword(s):  
Circulatory System ◽  
Apical Ballooning ◽  
Close Relation ◽  
Complete Recovery ◽  
Altered Mental Status ◽  
Cardiac Biomarkers ◽  
Takotsubo Syndrome ◽  
Benign Condition ◽  
Motion Patterns ◽  
Psychological Trigger

Abstract Aims Takotsubo syndrome (TTS) is an acute and reversible heart failure syndrome that, at presentation, mimics acute myocardial infarction. The most common echocardiographic manifestation is the so-called ‘apical ballooning’, but other much less common wall motion patterns have been described. The pathophysiology of the syndrome is not fully understood, but there is considerable evidence that sympathetic stimulation plays a central role. The prevalence of this syndrome is higher in post-menopausal women and in most cases, but not invariably, precipitated by an emotional or physical triggering event. A close relation between brain and circulatory system has been observed and for this reason psychiatric and neurologic disorders are often recognized as precipitating conditions. Although many risk factor persist after the acute manifestation, Takotsubo recurrences do represent an exception, especially in the absence of a clear precipitating event. Methods and results A 70-year-old woman was admitted for anginal pain associated with ischaemic electrocardiographic alterations and elevation of cardiac biomarkers. The coronary angiography with left ventriculogram and the echocardiographic findings were consistent with a diagnosis of mid-ventricular Takotsubo. Cardiac magnetic resonance confirmed the absence of an ischaemic pattern or evidence of infectious myocarditis. This case represents a recurrence of TTS, in fact two years earlier the patient was hospitalized to our division for stress cardiomyopathy with typical apical ballooning. Also in the present occasion, she had a favorable clinical course, with a complete recovery of the cardiac function at subsequent evaluations. The unicity of this case lies above all in the absence of a clear trigger event. Although, an altered mental status was present because the patient suffered from anxiety and depression on pharmacological treatment, with periods of exacerbation but not in occasion of the recurrence. Conclusions TTS is not a benign condition, with recurrence being possible even in the absence of precipitating events. Based on registry data, annual rate of Takotsubo recurrence is 1.5–1.8% and is estimated to reach 4% in life. A variable TTS pattern at recurrence is common in up to 20% of cases. Our paper reports a unique case of recurrent Takotsubo syndrome with variable patterns of ventricular involvement, with neither physical nor psychological trigger. Nevertheless, for what concerns our case, the psychiatric condition the patient suffered from, could have played a role of permanent status of sympathetic activation, that in the end elicitates the occurrence of the syndrome. A better understanding of the pathophysiology of the syndrome is needed to find evidence-based therapeutic strategies that could prevent recurrence.

scholarly journals Takotsubo Cardiomyopathy

2015 ◽  
Vol 10 (1) ◽  
pp. 25 ◽  
Author(s):  
Esha Sachdev ◽  
C Noel Bairey Merz ◽  
Puja K Mehta ◽  
◽  
◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Takotsubo Cardiomyopathy ◽  
Acute Stress ◽  
Plaque Rupture ◽  
Coronary Thrombosis ◽  
Coronary Microvascular Dysfunction ◽  
Coronary Syndrome ◽  
Menopausal Women ◽  
Post Menopausal

Takotsubo cardiomyopathy (TTC) is an acute, stress-induced cardiomyopathy with an increased prevalence in post-menopausal women. The syndrome is most frequently precipitated by an acute emotional or physical stressor and mimics acute myocardial infarction with symptoms, electrocardiogram (ECG) changes and cardiac troponin elevation that are indistinguishable from those caused by plaque rupture or coronary thrombosis. Diagnosis of TTC is made when coronary angiography reveals no obstructive coronary artery disease and the left ventricle demonstrates apical ballooning and basal hypercontractility. Other ventricular patterns have also been described. An abnormal myocardial response to the catecholamine surge from an emotional or a physical stressor is implicated in the pathophysiology, but the reasons for the high prevalence of TTC presentations in post-menopausal women are unknown. Several mechanisms including multi-vessel coronary vasospasm, endothelial and coronary microvascular dysfunction and direct catecholamine toxicity have been proposed. No specific guidelines for treatment of TTC have been established, but treatment is based on the American Heart Association/ American College of Cardiology guidelines for acute coronary syndrome/acute myocardial infarction and heart failure guidelines. In this review article, we discuss the characteristic clinical presentation of TTC and the commonly proposed mechanisms.

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 Computational modeling of Takotsubo cardiomyopathy: effect of spatially varying β-adrenergic stimulation in the rat left ventricle

2014 ◽  
Vol 307 (10) ◽  
pp. H1487-H1496 ◽  
Author(s):  
Sander Land ◽  
Steven A. Niederer ◽  
William E. Louch ◽  
Åsmund T. Røe ◽  
Jan Magnus Aronsen ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Takotsubo Cardiomyopathy ◽  
Troponin I ◽  
Contractile Function ◽  
Single Cells ◽  
Apical Ballooning ◽  
Calcium Sensitivity ◽  
Takotsubo Syndrome ◽  
Adrenergic Stimulation ◽  
Inotropic Effects

In Takotsubo cardiomyopathy, the left ventricle shows apical ballooning combined with basal hypercontractility. Both clinical observations in humans and recent experimental work on isolated rat ventricular myocytes suggest the dominant mechanisms of this syndrome are related to acute catecholamine overload. However, relating observed differences in single cells to the capacity of such alterations to result in the extreme changes in ventricular shape seen in Takotsubo syndrome is difficult. By using a computational model of the rat left ventricle, we investigate which mechanisms can give rise to the typical shape of the ventricle observed in this syndrome. Three potential dominant mechanisms related to effects of β-adrenergic stimulation were considered: apical-basal variation of calcium transients due to differences in L-type and sarco(endo)plasmic reticulum Ca2+-ATPase activation, apical-basal variation of calcium sensitivity due to differences in troponin I phosphorylation, and apical-basal variation in maximal active tension due to, e.g., the negative inotropic effects of p38 MAPK. Furthermore, we investigated the interaction of these spatial variations in the presence of a failing Frank-Starling mechanism. We conclude that a large portion of the apex needs to be affected by severe changes in calcium regulation or contractile function to result in apical ballooning, and smooth linear variation from apex to base is unlikely to result in the typical ventricular shape observed in this syndrome. A failing Frank-Starling mechanism significantly increases apical ballooning at end systole and may be an important additional factor underpinning Takotsubo syndrome.

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