Abstract 1072: Myocardial and Microvascular Stunning in Apical Ballooning Syndrome

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Alberto R De Caterina ◽  
Angelo Porfidia ◽  
Simona Giubilato ◽  
Francesca Marzo ◽  
Maurizio Pieroni ◽  
...  
Keyword(s):  
Perfusion Defect ◽  
Myocardial Dysfunction ◽  
Contrast Echocardiography ◽  
Apical Ballooning ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Apical Ballooning Syndrome ◽  
Early Results ◽  
Score Index

Apical Ballooning Syndrome (ABS) is characterized by chest pain, ST segment elevation at ECG, normal coronary arteries and transient left ventricular (LV) apical a-dyskinesia that typically recovers within a few weeks. Limited and conflicting data about microvascular flow pattern in ABS exist so far. Eight consecutive patients (all women, 72±14 years) presenting with ABS were evaluated by Myocardial Contrast Echocardiography (MCE) at rest, during adenosine test and at 1 month follow-up. Myocardial dysfunction was assessed by Wall Motion Score Index (WMSI) and endocardial length of contractile dysfunction defect (CDD), while myocardial perfusion by Contrast Score Index (CSI) and endocardial length of perfusion defect (PD). MCE study was performed during the infusion of contrast medium (Sonovue, Bracco) at rest and at peak of 90 seconds-infusion of adenosine (140 μg/Kg/min) to elicit coronary microvascular response. LV perfusion defect was present in apical dysfunctional myocardium in all patients. Compared to resting condition, during adenosine WMSI decreased from 1.90±0.29 to 1.72±0.32 (p<.01) and CDD from 40.3±15.5% to 33.2±15.3% of LV endocardial length (p<.001). Similarly, during adenosine test, CSI decreased from 1.55±0.21 to 1.36±0.16, (p<.01) and PD from 23.8±8.6% to 18.6±6.5% of LV endocardial length (p<.05). At follow-up, both myocardial and microvascular dysfunction reverted to normal. Our early results indicate that ABS is characterized by a condition of regional myocardial and microvascular dysfunction partially reversible during adenosine infusion and entirely reversible at 1-month follow-up. These observations suggest that myocardial stunning associated with microvascular stunning could represent a common pathophysiologic pattern in ABS.

Favourable mid-term clinical and echocardiographical follow-up of patients with transient left ventricular apical ballooning

2008 ◽  
Vol 7 ◽  
pp. 35-35
Author(s):  
I TATJERHERNANZ ◽  
J GONZALEZCOSTELLO ◽  
A TORRENSOSES ◽  
J MARISTANYDAUNERT ◽  
A ARIZASOLE ◽  
...  
Keyword(s):  
Apical Ballooning ◽  
Left Ventricular

scholarly journals Rare recurrence of apical ballooning (takotsubo) syndrome in an elderly man

2018 ◽  
pp. bcr-2017-222451
Author(s):  
Rosalyn Adigun ◽  
Samantha Morley ◽  
Abhiram Prasad
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Obstructive Coronary Artery Disease ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Major Surgery ◽  
Apical Ballooning Syndrome ◽  
Elderly Male

Apical ballooning syndrome (ABS) is an under recognised clinical entity characterised by acute reversible left ventricular systolic dysfunction that mimics acute myocardial infarction in the absence of obstructive coronary artery disease; typically occurring in the setting of profound stress.1 ABS disproportionately affects older women and recurrences are infrequent. We, hereby, describe a rare phenomenon of recurrent ABS in an elderly male patient, 10 years apart, presenting with the same left ventricular morphological appearance following non-cardiac surgeries. The case illustrates the importance of considering ABS in the differential diagnosis of perioperative acute myocardial infarction in older men undergoing major surgery.

Out-of-hospital cardiac arrest caused by transient left ventricular apical ballooning syndrome

2008 ◽  
Vol 128 (1) ◽  
pp. e31-e33 ◽  
Author(s):  
Riccardo Raddino ◽  
Claudio Pedrinazzi ◽  
Gregoriana Zanini ◽  
Debora Robba ◽  
Cinzia Portera ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Apical Ballooning Syndrome ◽  
Hospital Cardiac Arrest

scholarly journals Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis

2016 ◽  
Vol 43 (2) ◽  
pp. 152-155 ◽  
Author(s):  
Keval Patel ◽  
George T. Griffing ◽  
Paul J. Hauptman ◽  
Joshua M. Stolker
Keyword(s):  
Left Ventricular Function ◽  
Ventricular Function ◽  
Takotsubo Cardiomyopathy ◽  
Obstructive Coronary Artery Disease ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Apical Ballooning Syndrome ◽  
Wall Motion Abnormalities ◽  
Artery Disease

Takotsubo cardiomyopathy, or transient left ventricular apical ballooning syndrome, is characterized by acute left ventricular dysfunction caused by transient wall-motion abnormalities of the left ventricular apex and mid ventricle in the absence of obstructive coronary artery disease. Recurrent episodes are rare but have been reported, and several cases of takotsubo cardiomyopathy have been described in the presence of hyperthyroidism. We report the case of a 55-year-old woman who had recurrent takotsubo cardiomyopathy, documented by repeat coronary angiography and evaluations of left ventricular function, in the presence of recurrent hyperthyroidism related to Graves disease. After both episodes, the patient's left ventricular function returned to normal when her thyroid function normalized. These findings suggest a possible role of thyroid-hormone excess in the pathophysiology of some patients who have takotsubo cardiomyopathy.

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.

Is everything clear about Tako-Tsubo syndrome?

Folia Medica ◽  
2011 ◽  
Vol 53 (2) ◽  
pp. 5-35 ◽  
Author(s):  
Ivo S. Petrov ◽  
Mariya P. Tokmakova ◽  
Daniel N. Marchov ◽  
Kostadin N. Kichukov
Keyword(s):  
Left Ventricle ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Clinical Manifestations ◽  
Apical Ballooning ◽  
Microvascular Dysfunction ◽  
Good Prognosis ◽  
Acute Onset ◽  
Left Ventricular ◽  
Catecholamine Excess

Abstract Introduction: Tako-tsubo syndrome is a novel cardio-vascular disease affecting predominantly postmenopausal women exposed to unexpected strong emotional or physical stress, in the absence of significant coronary heart disease. It is characterized by acute onset of severe chest pain and/or acute left ventricular failure, ECG-changes, typical left ventricular angiographic findings, good prognosis and positive resolution of the morphological and clinical manifestations. First described in 1990 in Japan by Sato, Tako-tsubo cardiomyopathy is characterized by transient contractile abnormalities of the left ventricle, causing typical left ventricular apical ballooning at end-systole with concomitant compensatory basal hyperkinesia. There are also atypical forms, presenting with left ventricular systolic dysfunction which affects the mid-portions of the left ventricle. The etiology of the disease still remains unclear. Many theories have been put forward about the potential underlying pathophysiological mechanisms that may trigger this syndrome among which are the theory of catecholamine excess, the theory of multivessel coronary vasospasm, the ischemic theory, and the theory of microvascular dysfunction and dynamic left ventricular gradient induced by elevated circulating catecholamine levels. Adequate management of Tako-tsubo syndrome demands immediate preparation for coronary angiography. Once the diagnosis is made, treatment is primarily symptomatic and includes monitoring for complications. Patients with Tako-tsubo syndrome most frequently develop acute LV failure, pulmonary edema, rhythm and conductive disturbances and apical thrombosis. Treatment is symptomatic and includes administration of diuretics, vasodilators and mechanical support of circulation with intra-aortic balloon counterpulsation.

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