scholarly journals Takotsubo Syndrome Associated with a New Onset Manic Episode: A case report

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110349
Author(s):  
Shin-Heng Shen ◽  
Hao-Tien Liu
Keyword(s):  
Psychiatric Disorders ◽  
Elderly Women ◽  
Manic Episode ◽  
Somatic Complaints ◽  
Therapeutic Interventions ◽  
Takotsubo Syndrome ◽  
Coronary Angiogram ◽  
Coronary Syndrome ◽  
St Elevation ◽  
New Onset

Takotsubo syndrome is a condition that mimics acute coronary syndrome. The exact pathogenesis of the condition is unclear but it tends to occur more frequently in elderly women and a large proportion of cases have acute, former, or chronic neurologic or psychiatric disorders. Here we describe a 55-year-old female patient, who was brought to the emergency department presenting with a new-onset manic episode characterized by grandiosity, distractibility, decreased need for sleep, and increased goal-directed behaviours. She experienced chest pain approximately two days later, and non-ST elevation myocardial infarction was observed. The emergent coronary angiogram showed patent coronary arteries, and a diagnosis of Takotsubo syndrome was made. We suggest clinical multidisciplinary vigilance for somatic complaints, especially cardiac ones, in people with psychiatric disorders in order to make timely therapeutic interventions.

scholarly journals Value of Cardiac Biomarkers in the Early Diagnosis of Takotsubo Syndrome

2020 ◽  
Vol 9 (9) ◽  
pp. 2985
Author(s):  
Charlotte Dagrenat ◽  
Jean Jacques Von Hunolstein ◽  
Kensuke Matsushita ◽  
Lucie Thebaud ◽  
Stéphane Greciano ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Troponin I ◽  
Early Stage ◽  
Cardiac Biomarkers ◽  
Takotsubo Syndrome ◽  
Gender History ◽  
Cardiac Biomarker ◽  
History Of ◽  
St Elevation ◽  
Bedside Diagnosis

Background: Bedside diagnosis between Takotsubo syndrome (TTS) and ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction remains challenging. We sought to determine a cardiac biomarker profile to enable their early distinction. Methods: 1100 patients (TTS n = 314, STEMI n = 452, NSTEMI n = 334) were enrolled in two centers. Baseline clinical and biological characteristics were compared between groups. Results: At admission, cut-off values of BNP (B-type natriuretic peptide)/TnI (Troponin I) ratio of 54 and 329 distinguished respectively STEMI from NSTEMI, and NSTEMI from TTS. Best differentiation was obtained by the use of BNP/TnI ratio at peak (cut-of values of 6 and 115 discriminated respectively STEMI from NSTEMI, and NSTEMI from TTS). We developed a score including five parameters (age, gender, history of psychiatric disorders, LVEF, and BNP/TnI ratio at admission) enabling good distinction between TTS and STEMI (77% specificity and 92% sensitivity, AUC 0.93). For the distinction between TTS and NSTEMI, a four variables score (gender, history of psychiatric disorders, LVEF, and BNP at admission) achieved a good diagnostic performance (89% sensitivity, 85% specificity, AUC 0.94). Conclusion: A distinctive cardiac biomarker profile enables at an early stage a differentiation between TTS and ACS. A four (NSTEMI) or five variables score (STEMI) permitted a better discrimination.

scholarly journals Complete Heart Block Complicating Takotsubo Syndrome: Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Michael J. McGee ◽  
William Yu ◽  
Joshua McCarthy ◽  
Malcolm Barlow ◽  
Rosemary Hackworthy
Keyword(s):  
Acute Coronary Syndrome ◽  
Case Report ◽  
Heart Block ◽  
Complete Heart Block ◽  
Final Diagnosis ◽  
Takotsubo Syndrome ◽  
Shortness Of Breath ◽  
Coronary Angiogram ◽  
Coronary Syndrome ◽  
Pacemaker Insertion

An 81-year-old woman presents with shortness of breath resulting in a diagnosis of picornavirus and complete heart block. Troponin was elevated and there was concern about acute coronary syndrome. The final diagnosis after echocardiogram and coronary angiogram was Takotsubo syndrome in addition to the heart block which required pacemaker insertion.

scholarly journals Isolated ST-Elevation Myocardial Infarction Involving Leads I and aVL: Angiographic and Electrocardiographic Correlations from a Tertiary Care Center

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Abhishek Singh ◽  
Sudhanshu Dwivedi ◽  
Akshyaya Pradhan ◽  
Varun S Narain ◽  
Rishi Sethi ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Tertiary Care ◽  
Coronary Angiogram ◽  
Coronary Syndrome ◽  
St Depression ◽  
St Segment ◽  
Infarct Related Artery ◽  
St Elevation

Background. Determining the infarct-related artery in STEMI during a coronary angiogram can be challenging due to the affliction of multiple vessels. Isolated STEMI involving only EKG leads I and aVL is infrequent. Localization of infarct-related artery based on EKG findings has not been previously done in this subset. Methods. All consecutive de novo acute coronary syndrome (ACS) patients admitted to coronary care unit with ST elevations involving only leads I and aVL were screened for enrollment. Patients with ST elevation in any additional lead and those who refused a coronary angiogram were excluded. Subsequently, a coronary angiogram was done as part of primary PCI or a pharmacoinvasive approach to identify the infract-related artery (IRA). IRA was defined by characteristics of lesion, flow of blood through stenosis, and presence of intracoronary thrombus. Coronary angiogram was interpreted by two independent observers blinded to the EKG findings. ST changes in inferior and precordial leads were analyzed to find ECG predictors of the culprit artery. Results. A total of 54 eligible patients of ACS were included in the study. The first major diagonal (D1) was the most frequent IRA in 35.2% followed by left circumflex-obtuse marginal (LCX-OM11) in 29.6%, left anterior descending (LAD) in 20.4%, and ramus intermedius (RI) in 14.8%. Out of total patients with ST depression in lead V2, the LCX-OM11 group was IRA in 50% cases while the RI, D1, and LAD groups accounted for 31.8%, 13.6%, and 4.5%, respectively ( p < 0.001 ). Similarly, LCX-OM1 was the most frequent IRA subjects with ST depressions in leads V1 and V3 (44.4%; p = 0.010 and 46.2%; p = 0.003 , resp.). On the contrary, in patients with ST depression in lead III, LAD and D1 were the most frequent IRA as compared to LCX-OM1 and RI though statistical significance was not attained ( p = 0.857 for lead III). ST-segment depression in lead V2 had a positive predictive value of 60% and a negative predictive value of 100% for LCX-OM1 as IRA. Similarly, ST-segment depression in lead V2 had a positive predictive value of 20% and a negative predictive value of 100% for the RI group. Conclusions. In patients presenting with isolated ST elevation in leads I and aVL, the most frequent IRA on angiogram was first diagonal. ST depressions in EKG leads V1–V3 were the most common predictor of LCX–OM1 while those in inferior leads indicated LAD-D1 as the IRA.

scholarly journals A Score to differentiate Takotsubo syndrome from non-ST-elevation myocardial nfarction in women at the bedside

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001197 ◽  
Author(s):  
Jen-Li Looi ◽  
Katrina Poppe ◽  
Mildred Lee ◽  
Jill Gilmore ◽  
Mark Webster ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Takotsubo Syndrome ◽  
Predictive Values ◽  
Derivation Cohort ◽  
Coronary Syndrome ◽  
T Wave ◽  
St Depression ◽  
Wave Inversion ◽  
Optimal Score ◽  
St Elevation

ObjectiveA score to distinguish Takotsubo syndrome (TS) from acute coronary syndrome would be useful to facilitate appropriate patient investigation and management. This study sought to derive and validate a simple score using demographic, clinical and ECG data to distinguish women with non-ST elevation myocardial infarction (NSTEMI) from NSTE-TS.MethodsThe derivation cohort consisted of women with NSTE-TS (n=100) and NSTEMI (n=100). Logistic regression was used to derive the score using ECG values available on the postacute ward round on day 1 post-hospital admission. The score was then temporally validated in subsequent consecutive patients with NSTE-TS (n=40) and NSTEMI (n=70).ResultsThe five variables in the score and their relative weights were: T-wave inversion in ≥6 leads (+3), recent stress (+2), diabetes (−1), prior cardiovascular disease (−2) and ST-depression in any lead (−3). When calculated using ECG values obtained at admission, discrimination between conditions was very good (area under the curve (AUC) 0.87 95% CI 0.83 to 0.92). The optimal score cut-point of ≥1 to predict NSTE-TS had 73% sensitivity and 90% specificity. When applied to the validation cohort at admission, AUC was 0.82 (95% CI 0.75 to 0.90) and positive and negative predictive values were 78% and 81%, respectively. On day 1 post-admission, AUC was 0.92 (95% CI 0.87 to 0.97), with positive and negative predictive values of 77% and 91%, respectively.ConclusionThis NSTE-TS score is easy to use and may prove useful in clinical practice to distinguish women with NSTE-TS from NSTEMI. Further validation in external cohorts is needed.

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