Different Clinical Features between Definite and Possible Takotsubo Syndrome in a Tertiary Referral Hospital

Cardiology ◽  
2021 ◽  
Author(s):  
Ju Hyeon Kim ◽  
Yeong Jin Jeong ◽  
Jino Park ◽  
Pil Hyung Lee ◽  
Jeong Yoon Jang ◽  
...  
Keyword(s):  
Imaging Study ◽  
Apical Ballooning ◽  
Tertiary Hospital ◽  
Takotsubo Syndrome ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
St Segment Elevation ◽  
St Segment ◽  
Clinical Profiles ◽  
Artery Disease

Background: Although imaging examination to exclude coronary artery disease (CAD) is an indispensable step for a definite diagnosis of Takotsubo syndrome (TTS), this step may be overlooked in a substantial proportion of patients with secondary TTS admitted to a tertiary hospital. However, the clinical profiles and outcomes of these patients with “possible TTS” have rarely been investigated. Methods: Among 420 consecutive TTS patients with characteristic transient ventricular ballooning on repeated echocardiography, 244 patients (58.1%) who underwent an imaging study for CAD were diagnosed with “definite TTS”, whereas the remaining 176 were designated with “possible TTS”. Results: Overall, hypoxia (67.6%) and dyspnea (55.5%) were predominant presentations. The possible group was characterized by higher prevalence of male gender (46.6% vs. 35.2%, p = 0.019), secondary TTS (97.2% vs. 86.5%, p <0.001), cancer (43.2% vs. 29.1%, p = 0.003), sepsis (46.0% vs. 32.0%, p = 0.003), and non-apical ballooning pattern (30.7% vs. 21.3%, p = 0.001) with less common ST-segment elevation on electrocardiogram (18.8% vs. 34.0%, p = 0.001). The possible group showed higher frequency of mechanical ventilation (56.2% vs. 40.2%, p = 0.001), pulmonary edema (72.2% vs. 61.5%, p = 0.023) and shock management (70.5% vs. 54.1%, p = 0.001) with similar in-hospital mortality (17.2% vs. 17.0%, p = 0.964). Conclusions: In real-world clinical practice, coronary evaluation for strict diagnosis of TTS is not frequently feasible. Addition of the possible group without coronary evaluation to the clinical spectrum of TTS would be helpful for fair estimation of clinical implication of TTS.

scholarly journals An Unusual Case of Takotsubo Syndrome With Hyperaldosteronism as the Potential Cause

2017 ◽  
Vol 103 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Yuanweixiang Ou ◽  
Zhengang Zhao ◽  
Jiayyu Tsauo ◽  
Licheng Jiang ◽  
Yong Yang ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Unusual Case ◽  
Apical Ballooning ◽  
Major Contributor ◽  
Case Description ◽  
Takotsubo Syndrome ◽  
Related Factors ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Context Catecholamine-related factors are the most popular explanation for the occurrence of Takotsubo syndrome. An aldosterone-related mechanism, however, has not been proposed. Case Description A 45-year-old male patient presenting with ST-segment elevation myocardial infarction was diagnosed with primary aldosteronism, severe hypokalemia, and Takotsubo syndrome. After excluding the known conditions of apical ballooning and the factors of vasospasm, primary aldosteronism is considered as the major contributor to the development of Takotsubo syndrome. The potential mechanisms are discussed. Conclusions The case suggests a possible hyperaldosteronism-induced and vasoconstriction-mediated mechanism in the development of Takotsubo syndrome.

Should Percutaneous Coronary intervention be the Standard Treatment Strategy for Significant Coronary Artery Disease in all Octogenarians?.

2020 ◽  
Vol 16 ◽  
Author(s):  
George Kassimis ◽  
Grigoris V. Karamasis ◽  
Athanasios Katsikis ◽  
Joanna Abramik ◽  
Nestoras Kontogiannis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Symptom Relief ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Coronary artery disease (CAD) remains the leading cause of cardiovascular death in octogenarians. This group of patients represents nearly a fifth of all patients treated with percutaneous coronary intervention (PCI) in real-world practice. Octogenarians have multiple risk factors for CAD and often greater myocardial ischemia than younger counterparts, with a potential of an increased benefit from myocardial revascularization. Despite this, octogenarians are routinely under-treated and belittled in clinical trials. Age does make a difference to PCI outcomes in older people, but it is never the sole arbiter of any clinical decision, whether in relation to the heart or any other aspect of health. The decision when to perform revascularization in elderly patients and especially in octogenarians is complex and should consider the patient on an individual basis, with clarification of the goals of the therapy and the relative risks and benefits of performing the procedure. In ST-segment elevation myocardial infarction (MI), there is no upper age limit regarding urgent reperfusion and primary PCI must be the standard of care. In non-ST-segment elevation acute coronary syndromes, a strict conservative strategy must be avoided; whereas the use of a routine invasive strategy may reduce the occurrence of MI and need for revascularization at follow-up, with no established benefit in terms of mortality. In stable CAD patients, invasive therapy on top of the optimal medical therapy seems better in symptom relief and quality of life. This review summarizes the available data on percutaneous revascularization in the elderly patients and particularly in octogenarians, including practical considerations on PCI risk secondary to ageing physiology. We also analyse technical difficulties met when considering PCI in this cohort and the ongoing need for further studies to ameliorate risk stratification and eventually outcomes in these challenging patients.

scholarly journals Focal ST-segment elevation without coronary occlusion: myocardial infarction with no obstructive coronary atherosclerosis associated with COVID-19—a case report

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Casey Meizinger ◽  
Bruce Klugherz
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Respiratory Failure ◽  
Coronary Atherosclerosis ◽  
Myocardial Injury ◽  
Cardiovascular Complications ◽  
St Segment Elevation ◽  
St Segment ◽  
Hypoxic Respiratory Failure ◽  
Artery Disease

Abstract Background While it is understood that coronavirus disease 2019 (COVID-19) is primarily complicated by respiratory failure, more data are emerging on the cardiovascular complications of this disease. A subset of COVID-19 patients present with ST-elevations on electrocardiogram (ECG) yet normal coronary angiography, a presentation that can fit criteria for myocardial infarction with no obstructive coronary atherosclerosis (MINOCA). There is little known about non-coronary myocardial injury observed in patients with COVID-19, and we present a case that should encourage further conversation and study of this clinical challenge. Case summary An 86-year-old man presented to our institution with acute hypoxic respiratory failure and an ECG showing anteroseptal ST-segment elevation concerning for myocardial infarction. Mechanic ventilation was initiated prior to presentation, and emergent transthoracic echocardiography reported an ejection fraction of 50–55%, with no significant regional wall motion abnormalities. Next, emergent coronary angiography was performed, and no significant coronary artery disease was detected. The patient tested positive for COVID-19. Despite supportive management in the intensive care unit, the patient passed away. Discussion We present a case of COVID-19 that is likely associated with MINOCA. It is crucial to understand that in COVID-19 patients with signs of myocardial infarction, not all myocardial injury is due to obstructive coronary artery disease. In the case of COVID-19 pathophysiology, it is important to consider the cardiovascular effects of hypoxic respiratory failure, potential myocarditis, and significant systemic inflammation. Continued surveillance and research on the cardiovascular complications of COVID-19 is essential to further elucidate management and prognosis.

scholarly journals Cardiac Rupture—The Most Serious Complication of Takotsubo Syndrome: A Series of Five Cases and a Systematic Review

2021 ◽  
Vol 10 (5) ◽  
pp. 1066
Author(s):  
Małgorzata Zalewska-Adamiec ◽  
Hanna Bachórzewska-Gajewska ◽  
Sławomir Dobrzycki
Keyword(s):  
Female Gender ◽  
Left Ventricular ◽  
Cardiac Rupture ◽  
Control Group ◽  
Mechanical Complication ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
Risk Of Death ◽  
St Segment

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).

Electrocardiographic characteristics and associated outcomes in patients with Takotsubo syndrome. Insights from the RETAKO registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Martin-Demiguel ◽  
I Nunez-Gil ◽  
A Perez-Castellanos ◽  
O Vedia ◽  
A Uribarri ◽  
...  
Keyword(s):  
Heart Rate ◽  
Primary Endpoint ◽  
Qt Interval ◽  
Protective Factor ◽  
Independent Predictor ◽  
Prognostic Significance ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Corrected Qt Interval ◽  
St Segment

Abstract Background Our aim was to describe the prevalence and prognostic significance of electrocardiographic features in patients with Takotsubo syndrome (TTS). Methods Our data come from the Spanish Multicenter REgistry of TAKOtsubo syndrome (RETAKO). All patients with complete electrocardiogram were included. Results 246 patients were studied, mean age was 71.3±11.5 and 215 (87.4%) were women. ST-segment elevation was seen in 143 patients (59.1%) and was present in ≥2 wall leads in 97 (39.8%). Exclusive elevation in inferior leads was infrequent (5 - 2.0%). After 48 hours, 198 patients (88.0%) developed negative T-waves in a median of 8 leads with a mean amplitude of 0.7±0.5 mV. Mean corrected QT interval was 520±72 ms and it was independently associated with the primary endpoint of all-cause death and nonfatal cardiovascular events (p=0.002) and all-cause death (p=0.008). A higher heart rate at admission was also an independent predictor of the primary endpoint (p=0.001) and of developing acute pulmonary edema (p=0.04). ST-segment elevation with reciprocal depression was an independent predictor of all-cause death (p=0.04). Absence of ST-segment deviation was a protective factor (p=0.005) for the primary endpoint. Arrhythmias were independently associated with cardiogenic shock (p&lt;0.001). Conclusion Prolonged corrected QT interval, arrhythmia, heart rate at admission and broader repolarization alterations are associated with a poor outcome in TTS. Typical ECG at admission and after 48h. Funding Acknowledgement Type of funding source: None

scholarly journals Infarct-related chronic total coronary occlusion and the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors

2021 ◽  
Author(s):  
M. van der Graaf ◽  
L. S. D. Jewbali ◽  
J. S. Lemkes ◽  
E. M. Spoormans ◽  
M. van der Ent ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Coronary Occlusion ◽  
Independent Factor ◽  
St Segment Elevation ◽  
St Segment ◽  
Artery Disease ◽  
Chronic Total Coronary Occlusion ◽  
Hospital Cardiac Arrest

Abstract Introduction Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. Methods We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. Results A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2–35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. Conclusion In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event.

Credibility of Risk scores in predicting coronary artery disease severity in non-ST segment elevation acute coronary syndrome patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Elhusseini
Keyword(s):  
Clinical History ◽  
Risk Scores ◽  
Syntax Score ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Early Risk ◽  
Timi Score ◽  
St Segment ◽  
Artery Disease ◽  
Grace Score

Abstract Objectives We aimed to assess the value of Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores (RSs) for predicting coronary artery disease (CAD) severity and prognosis in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Background Patients with NSTE-ACS are at varying risks of death and recurrent cardiac events, early risk stratification plays a central role, different scores are now available based on initial clinical history, ECG, and laboratory tests that enable early risk stratification on admission. Methods A prospective study was conducted including 100 patients (age, 45–68 years) with NSTE-ACS who were admitted at our hospital from January 2018 to January 2019. The two RSs (TIMI& GRACE) were calculated from the initial clinical history, electrocardiogram, and laboratory values collected and recorded on admission. All patients were subjected to conventional coronary angiography during admission, Patients were divided into two groups: 1) patients with syntax score ≤32 (test group, 80 patients) and 2) patients with syntax score &gt;32 (comparative group, 20 patients). Median follow-up duration was 6 (4–9) days. Results Regarding correlation between coronary angiographic severity based on syntax score and the clinical profile based on the two RSs (TIMI&GRACE) in NSTE-ACS patients, statistically significant correlation were found between GRACE score and syntax score (r=0.789; P=0.001) with GRACE score accuracy: 94% and negative predictive value (NPV): 98.7%, whereas no statistically significant correlation were found between TIMI score and syntax score (r=0.087; P=0.388) with TIMI score accuracy: 32% and NPV: 73.1%. Conclusions In conclusion the GRACE score provides a quick and reliable prediction of CAD severity in NSTE-ACS patients, It allows accurate risk estimation, categorizes patients and consequently can help in making accurate therapeutic decisions either with the use of invasive strategies in high risk selected patients or the use of conservative strategies in low risk patients in presence of limited resources. Funding Acknowledgement Type of funding source: None

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