scholarly journals 059 Takotsubo cardiomyopathy and myasthenic crises: a case series

2019 ◽  
Vol 90 (e7) ◽  
pp. A19.2-A19
Author(s):  
Matthew Katz ◽  
Stephen Walsh ◽  
Benjamin Tsang ◽  
Pamela McCombe ◽  
Arman Sabet
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Acute Stress ◽  
Significant Coronary Artery Disease ◽  
Case Series ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Myasthenic Crisis ◽  
List Type ◽  
Coronary Syndrome ◽  
Cardiac Status

IntroductionTakotsubo cardiomyopathy (TCM) is an acute, reversible cardiomyopathy that can mimic acute coronary syndrome.1 It is characterised by left ventricular dysfunction, electrocardiogram (ECG) changes and transient apical ballooning in the absence of significant coronary artery disease.1 It is usually triggered by acute stress with catecholamine surge but the exact pathogenesis is not known.1 Takotsubo cardiomyopathy has been described in patients with myasthenic crisis. We present the first and largest case series of four patients with TCM in the setting of myasthenic crisis and discuss possible causes.MethodsTwo patients from each tertiary neurologic centre were identified by their treating neurologist for inclusion in the series. We performed a review of their case notes with respect to history, examination, investigations and management. A brief literature review was also completed.ResultsThe mean age was 78 with a 1:1 female to male ratio. Three of the patients were newly diagnosed with myasthenia gravis (MG) at the time of their TCM. All patients were AChRab positive. One patient had a previous thymectomy but the others had no evidence of thymoma.On review of the literature most cases of TCM in myasthenic crisis occurred in older females. Abnormalities of the ECG were universal. Most cases did not have a thymoma or history of thymectomy.ConclusionTakotsubo cardiomyopathy may be easily overlooked in those presenting with myasthenic crises as they share overlapping clinical features. Rigorous attention to the cardiac status of these patients, especially the ECG, may help to avoid missing this important diagnosis.ReferenceAkashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation 2008;118:2754–2762.

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.

Management of airway obstruction with nebulised adrenaline resulting in takotsubo cardiomyopathy: case report

2016 ◽  
Vol 130 (9) ◽  
pp. 883-886 ◽  
Author(s):  
F Keshtkar ◽  
O T Dale ◽  
W O Bennett ◽  
C E Hall
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
Takotsubo Cardiomyopathy ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Coronary Syndrome ◽  
Wave Inversion ◽  
Acute Airway Obstruction ◽  
Artery Disease ◽  
High Index Of Suspicion

AbstractBackground:Takotsubo cardiomyopathy has been associated with the use of catecholamines; however, its development after the use of nebulised adrenaline for the management of acute airway obstruction has not previously been described.Case report:A 66-year-old man with squamous cell carcinoma of the larynx, with tumour–node–metastasis staging of T3N2cM0, confirmed by biopsy and computed tomography, presented to the emergency department with acute airway obstruction. He was treated twice with nebulised adrenaline and intravenous dexamethasone. After a period of 24 hours, cardiac rhythm changes were noted on telemetry. A 12-lead electrocardiogram showed widespread T-wave inversion and QT prolongation suggestive of an acute coronary syndrome. Coronary angiography demonstrated no coronary artery disease, but left ventricular angiography showed marked apical ballooning and apical wall akinesia consistent with a diagnosis of takotsubo cardiomyopathy.Conclusion:Takotsubo cardiomyopathy can mimic true ischaemic heart disease and the diagnosis requires a high index of suspicion in patients managed with nebulised adrenaline.

scholarly journals Management of Takotsubo cardiomyopathy before non-cardiac surgery: A case report

2021 ◽  
Vol 29 (2) ◽  
pp. 271-274
Author(s):  
Tayfun Gürol
Keyword(s):  
Acute Coronary Syndrome ◽  
Takotsubo Cardiomyopathy ◽  
Orthopedic Surgery ◽  
Systolic Dysfunction ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Enzyme Release ◽  
Coronary Syndrome ◽  
Electrocardiographic Changes ◽  
Apical Balloon Syndrome

Takotsubo cardiomyopathy (left ventricular apical balloon syndrome) is characterized by transient apical ballooning, leading to apical systolic dysfunction. This syndrome typically mimics acute coronary syndrome in terms of electrocardiographic changes and cardiac enzyme release. Although its exact pathophysiology is still unclear, it is thought to be due to stress related to the catecholaminergic discharge. It is usually seen on postmenopausal women. Herein, we report a 78-year-old female patient with Takotsubo cardiomyopathy admitted to the orthopedic surgery clinic due to a femoral fracture and had no complication after surgery.

scholarly journals Takotsubo cardiomyopathy in elderly female trauma patients: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Vishal Patel ◽  
Shuli Levy ◽  
Iqbal Malik ◽  
Michael B. Fertleman ◽  
Louis J. Koizia
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Operative Management ◽  
Left Ventricular ◽  
Trauma Patients ◽  
Coronary Syndrome ◽  
The Impact

Abstract Background Takotsubo cardiomyopathy is a syndrome characterized by acute left ventricular wall motion abnormalities leading to left ventricular systolic dysfunction. It remains an important differential diagnosis for acute coronary syndrome. Case presentations Here we describe three cases of Takotsubo cardiomyopathy occurring in three Caucasian female trauma patients (aged 79, 81, and 82 years old) and the impact on their clinical course. Conclusions For patients requiring surgical management, delays in the diagnosis of Takotsubo cardiomyopathy may lead to postponement of urgent operative management. This delay in surgery likely impacts on length of hospital stay, leading to an increasing morbidity and mortality.

scholarly journals Electrocardiographic Findings in Takotsubo Cardiomyopathy: ECG Evolution and Its Difference from the ECG of Acute Coronary Syndrome

2014 ◽  
Vol 8 ◽  
pp. CMC.S14086 ◽  
Author(s):  
June Namgung
Keyword(s):  
Acute Coronary Syndrome ◽  
Takotsubo Cardiomyopathy ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Qtc Interval ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Wave Inversion ◽  
St Segment

Background Electrocardiogram (ECG) manifestations of takotsubo cardiomyopathy (TC) produce ST-segment elevation or T-wave inversion, mimicking acute coronary syndrome (ACS). We describe the ECG manifestation of TC, including ECG evolution, and its different points from ACS. Methods We studied 37 consecutive patients (age 67 ± 15 years, range 23-89, M:F = 12:25) from March 2004 to November 2012 with a diagnosis of TC who were proven to have apical ballooning on echocardiography or left ventricular angiography and normal coronary artery. We analyzed their standard 12-lead ECGs, including rate, PR interval, QRS duration, corrected QT (QTc) interval, ECG evolutions, and arrhythmia events. Results Two common ECG findings in TC were ST-segment elevation (n = 13, 35%) and T inversion (n = 24, 65%), mostly in the precordial leads. After ST-segment resolution, in a few days (3.5 days), diffuse and often deep T-wave inversion developed. Eight patients (22%) had transient Q-waves lasting a few days in precordial leads. No reciprocal ST-segment depression was noted. T-wave inversion continued for several months. QT prolongation (>440 milliseconds) was observed in 37 patients (97%). There were no significant life-threatening arrhythmias except atrial fibrillation (n = 6, 16%). Conclusion There are distinct differences between the ECGs of TC and ACS. These differences will help to differentiate TC from ACS.

scholarly journals ‘Acute micro-coronary syndrome’: detailed coronary physiology in a patient with Takotsubo cardiomyopathy

2019 ◽  
Vol 12 (8) ◽  
pp. e229618
Author(s):  
Andrew J Morrow ◽  
Sabrina Nordin ◽  
Patrick O’Boyle ◽  
Colin Berry
Keyword(s):  
Myocardial Infarction ◽  
Takotsubo Cardiomyopathy ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Fractional Flow ◽  
Coronary Physiology ◽  
Coronary Syndrome ◽  
Flow Reserve

Takotsubo cardiomyopathy (TC), otherwise known as stress cardiomyopathy, is characterised by acute, transient left ventricular systolic dysfunction with apical ballooning in the absence of obstructive epicardial coronary stenosis. The presentation of TC mimics that of acute myocardial infarction. More recently there has been a shift towards thinking of TC as a ‘microvascular acute coronary syndrome’. Our case is of an 82-year-old woman who presented with TC mimicking acute anterior ST elevation myocardial infarction in the context of sepsis. Slow flow noted in the left anterior descending artery prompted us to perform coronary physiology. Her fractional flow reserve was 0.91, with an index of myocardial resistance of 117 and a coronary flow reserve of 1.6. In combination these results are indicative of microvascular coronary dysfunction in the absence of significant epicardial stenosis.

scholarly journals 649 Clinicians miss diagnosis: it wasn’t a tako-tsubo syndrome, nowadays it is a recurrent tako-tsubo syndrome

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Simone Angius ◽  
Luca Fazzini ◽  
Federico Balata ◽  
Alessandra Gioi ◽  
Francesca Valeria Contini ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Mayo Clinic ◽  
Combined Therapy ◽  
Significant Coronary Artery Disease ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Coronary Syndrome ◽  
Normal Left Ventricular ◽  
Syndrome Diagnosis ◽  
Artery Disease

Abstract Aims Tako-Tsubo syndrome is an usual form of acute cardiomyopathy characterized by reversible left ventricle apical ballooning which occurs in the absence of significant coronary artery disease. Rarely an increase in catecholamines due to pheochromocytoma could lead to Tako-Tsubo syndrome. Here we report a clinical case of undetected pheochromocytoma which led to Tako-Tsubo syndrome in an adult female patient. Methods and results A 60 years old female presented at our emergency department with chest pain, increase in cardiac troponin levels and hypo-akinesia of the apical segments at the echocardiography. She was admitted with acute coronary syndrome suspicious. He had history of acute coronary syndrome with non-obstructive coronary arteries (MINOCA) in the 2017. Coronary angiography performed at 24 h from admission, again showed non-obstructive coronary disease, whereby we reviewed the previous MINOCA diagnosis into recurrence Tako-Tsubo syndrome diagnosis. During hospitalization she presented parossistic sinus tachycardia refractory to beta-blocker and ivabradine combined therapy. Cardiac magnetic resonance was performed and confirmed Tako-Tsubo syndrome, furthermore showed a surrenalic mass. Contrast-enhanced abdomen computed tomography and high levels of metanephrines suggested pheochromocytoma diagnosis. One month later she underwent left surrenectomy surgery. Histological examination confirmed pheochromocytoma. The last echocardiography didn’t show kinesia abnormalities with normal left ventricular function. Conclusions Our case illustrates the importance of understanding the correlation between Tako-tsubo syndrome and pheochromocytoma, especially in patients with increased activity of the sympathetic nervous system. Until recently, according to Tako-Tsubo syndrome Mayo Clinic criteria, our patient wouldn’t had receive a Tako-Tsubo syndrome diagnosis because pheochromocytoma was an exclusion criteria. Since 2018, Inter-TAK criteria replaced Mayo Clinic criteria including Tako-Tsubo syndrome expression of pheochromocytoma. Referring to our annoying title we always have to consider Tako-Tsubo syndrome into MINOCA differential diagnosis.

scholarly journals Transient Left Ventricular Apical Ballooning (Takotsubo Cardiomyopathy): Mimicking Acute Coronary Syndrome

2012 ◽  
Vol 7 (2) ◽  
pp. 91-95
Author(s):  
Mohammad Razib Ahsan ◽  
Md Mukhlesur Rahman ◽  
AKM Mohiuddin Bhuiyan ◽  
Md Khurshed Ahmed ◽  
Md Abu Siddique ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Takotsubo Cardiomyopathy ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Coronary Syndrome

No abstract available DOI: http://dx.doi.org/10.3329/uhj.v7i2.10848 University Heart. Journal Vol. 7, No. 2, July 2011  

scholarly journals Inferior ST-Elevation Myocardial Infarction Associated with Takotsubo Cardiomyopathy

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Oliver Koeth ◽  
Uwe Zeymer ◽  
Rudolf Schiele ◽  
Ralf Zahn
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Takotsubo Cardiomyopathy ◽  
Clinical Symptoms ◽  
Significant Coronary Artery Disease ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
St Elevation ◽  
Artery Disease

Takotsubo cardiomyopathy (TCM) is usually characterized by transient left ventricular apical ballooning. Due to the clinical symptoms which include chest pain, electrocardiographic changes, and elevated myocardial markers, Takotsubo cardiomyopathy is frequently mimicking ST-elevation myocardial infarction in the absence of a significant coronary artery disease. Otherwise an acute occlusion of the left anterior descending coronary artery can produce a typical Takotsubo contraction pattern. ST-elevation myocardial infarction (STEMI) is frequently associated with emotional stress, but to date no cases of STEMI triggering TCM have been reported. We describe a case of a female patient with inferior ST-elevation myocardial infarction complicated by TCM.

Atypical Takotsubo Cardiomyopathy with Hypokinetic Left Mid-ventricle and Apical Wall Sparing: A Case Report and Literature Review

2020 ◽  
Vol 16 (3) ◽  
pp. 241-246
Author(s):  
Dipesh Ludhwani ◽  
Belaal Sheikh ◽  
Vasu K Patel ◽  
Khushali Jhaveri ◽  
Mohammad Kizilbash ◽  
...  
Keyword(s):  
Case Report ◽  
Takotsubo Cardiomyopathy ◽  
Systolic Dysfunction ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome ◽  
Normal Left Ventricular ◽  
Artery Disease

Background: Takotsubo Cardiomyopathy (TTC) is an uncommon cause of acute reversible ventricular systolic dysfunction in the absence of obstructive Coronary Artery Disease (CAD). Typically manifesting as apical wall ballooning, TTC can rarely present atypically with apical wall sparing. Case report: A 62-year-old female presented with complaints of chest pain and features mimicking acute coronary syndrome. Coronary angiogram revealed no obstructive CAD and left ventriculogram showed reduced ejection fraction, normal left ventricular apex and hypokinetic mid-ventricles consistent with atypical TTC. The patient was discharged home on heart failure medications and a follow-up transthoracic echocardiogram demonstrated improved left ventricular function with no wall motion abnormality. Conclusion: This case report provides an insight into the diagnosis and management of TTC in the absence of pathognomic features.

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