scholarly journals Takotsubo Syndrome: A Review of Presentation, Diagnosis and Management

2022 ◽  
Vol 16 ◽  
pp. 117954682110657
Author(s):  
Joseph Assad ◽  
Giuseppe Femia ◽  
Patrick Pender ◽  
Tamer Badie ◽  
Rohan Rajaratnam
Keyword(s):  
Myocardial Stunning ◽  
Ventricular Dysfunction ◽  
Clinical Presentation ◽  
Treatment Options ◽  
Left Ventricular ◽  
Current Evidence ◽  
Takotsubo Syndrome ◽  
Diagnostic Strategies ◽  
Coronary Syndrome ◽  
Post Menopausal

Takotsubo Syndrome (TTS) is a condition of transient left ventricular dysfunction that is typically triggered by emotional or physical stress. Since first described in Japan in 1990, it has increasingly been recognised in clinical practice, accounting for up to 2% of Acute Coronary Syndrome (ACS) presentations. In fact, the clinical presentation can be indistinguishable from a myocardial infarction. Although current evidence suggests a catecholamine induced myocardial stunning, the pathophysiological mechanisms remain unknown. Interestingly, it is more common in woman, particularly those who are post-menopausal. This review aims to summarise the current research and provide an overview of the diagnostic strategies and treatment options.

scholarly journals Takotsubo Cardiomyopathy Due to Combined Use of Phentermine and Lisdexamfetamine

2020 ◽  
Author(s):  
Tara Burleigh ◽  
Khandalavala Birgit
Keyword(s):  
Acute Coronary Syndrome ◽  
Case Report ◽  
Left Ventricular ◽  
Ventricular Wall ◽  
Takotsubo Syndrome ◽  
Coronary Syndrome ◽  
First Case ◽  
Combined Use ◽  
Menopausal Women ◽  
Post Menopausal

Objectives: This is the first case report of iatrogenic Takotsubo syndrome (TS) due to a combination of lisdexamfetamine and phentermine. Background: TS is characterized by transient acute ballooning of the left ventricular wall. Typically, it occurs in extremely stressed post-menopausal women, however a few iatrogenic causes have been described recently. Results: A 55-year old woman prescribed lisdexamfetamine and phentermine, presented with acute substernal chest pain. Acute coronary syndrome was excluded. The echocardiogram was diagnostic of TS, and she recovered spontaneously, with supportive care. Conclusion: Caution with the use of sympathomimetic medications in post-menopausal women appears warranted.

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.

Le syndrome de Takotusbo (STK)

2020 ◽  
Vol 29 (2) ◽  
pp. 65-74
Author(s):  
Christian Richard
Keyword(s):  
Left Ventricular Dysfunction ◽  
Initial Phase ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Prise En Charge ◽  
Single Coronary Artery ◽  
Takotsubo Syndrome ◽  
Severe Left Ventricular Dysfunction ◽  
Coronary Syndrome ◽  
Ventriculaire Gauche

Décrit initialement par des auteurs japonais dans les années 1990 le Syndrome de Takotsubo se présente comme un infarctus du myocarde associé à une dysfonction ventriculaire gauche sévère. La coronarographie est en général normale et la dysfonction ventriculaire gauche s’étend au-delà d’un territoire concerné par une seule artère coronaire. Les causes et la physiopathologie du Syndrome de Takotsubo restent à ce jour mal identifiées et comprises. En dépit de la survenue de complications cardio-vasculaires à la phase initiale chez les patients à risque élevé, le pronostic reste en général excellent même si les études les plus récemment publiées suggèrent la possibilité de séquelles et de récurrence. Les critères diagnostiques du Syndrome de Takotsubo ont été récemment publiés par la Société Européenne de Cardiologie afin d’éliminer l’existence d’un syndrome coronarien aigu et d’une myocardite. L’existence de Syndrome de Takotsubo primaire et secondaire a été rapportée et une stratification en risque modéré et élevé proposée. La prescription classique de beta bloquants tant en chronique qu’en aigu lorsqu’elle n’est pas contre indiquée est aujourd’hui remise en question au vu des résultats négatifs d’études prospectives récemment publiées. Des essais contrôlés randomisés et un suivi de cohorte précis sont nécessaires pour définir les modalités de la prise en charge thérapeutique et du suivi. Initially described by Japanese authors in the 1990s Takotsubo Syndrome presents as an acute myocardial infarction associated with severe left ventricular dysfunction. Coronary angiogram is generally within normal limits and left ventricular dysfunction extends beyond the territory concerned by a single coronary artery. The cause and pathogenesis of Takotsubo syndrome remain poorly understood. Despite the onset of complications at the initial phase in some high risk patients the prognosis is usually benign but the most recently published studies suggest the possibility of sequelae and recurrences. Diagnostic criteria for Takotsubo Syndrome have been recently published by the European Society of Cardiology in order to eliminate acute coronary syndrome and myocarditis. Primary and secondary Takotsubo Syndromes were reported and risk stratification was defined. The widely reported indication for beta blockers for the treatment of Takotsubo syndrome even at the initial phase of the disease was recently challenged by the negative results of prospective studies. Randomized controlled trials are needed to provide a stronger evidence base for decision-making.

scholarly journals Cardiovascular involvement in alpha-n-acetyl neuraminidase deficiency syndromes (sialidosis type I and II)

2021 ◽  
pp. 1-3
Author(s):  
Priyanka Prasanna ◽  
Chenni S. Sriram ◽  
Sarah H. Rodriguez ◽  
Utkarsh Kohli
Keyword(s):  
Autosomal Recessive ◽  
Ventricular Dysfunction ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Rare Condition ◽  
Autosomal Recessive Disorder ◽  
Left Ventricular ◽  
Type I ◽  
Neonatal Onset ◽  
Cardiovascular Involvement

Abstract Sialidosis, a rare autosomal recessive disorder, is caused by a deficiency of NEU1 encoded enzyme alpha-N-acetyl neuraminidase. We report a premature male with neonatal-onset type II sialidosis which was associated with left ventricular dysfunction. The clinical presentation and subsequent progression which culminated in his untimely death at 16 months of age are succinctly described. Early-onset cardiovascular involvement as noted in this patient is not well characterised. The case report is supplemented by a comprehensive review of the determinants, characteristics, and the clinical course of cardiovascular involvement in this rare condition.

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 A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia

2020 ◽  
Author(s):  
Akshar Jaglan ◽  
Tarek Ajam ◽  
Steven C Port ◽  
Tanvir Bajwa ◽  
A Jamil Tajik
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Treatment Options ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Artery Ectasia ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Patient Reported

Abstract Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.

scholarly journals Takotsubo syndrome after mitral valve surgery: a case report

2020 ◽  
Author(s):  
Ana Devesa ◽  
Rafael Hernández-Estefanía ◽  
José Tuñón ◽  
Álvaro Aceña
Keyword(s):  
Mitral Valve ◽  
Fatal Outcome ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Lv Function ◽  
Partial Recovery ◽  
Takotsubo Syndrome ◽  
Left Circumflex Artery ◽  
Coronary Syndrome

Abstract Background Takotsubo syndrome is a frequent entity; however, it has never been described after a mitral valve surgery. Case summary  We present the case of a 79-year-old woman, with background of atrial fibrillation and a left atrial appendage closure device, who was admitted for elective mitral valve replacement, because of asymptomatic severe primary mitral regurgitation. Biologic mitral valve was implanted without incidences, but in the postoperative, she developed cardiogenic shock. Electrocardiogram (ECG) showed inverted T waves in precordial leads and an echocardiography showed severe left ventricular (LV) dysfunction with mid to distal diffuse hypokinesis, and better contractility in basal segments. Troponin levels were mildly elevated. With the suspicion of a postoperative acute coronary syndrome, a coronary angiography was performed and showed no significant coronary lesions. The haemodynamic situation was compromised for the next 48 h, in which vasoactive support and intra-aortic balloon counterpulsation were implemented. After 48 h, the haemodynamic situation suddenly improved. The ECG was normalized, and a control echocardiogram showed partial recovery of the LV function with resolution of regional wall motion abnormalities. The patient could be discharged at 1 week. The clinical picture was interpreted as a stress cardiomyopathy after mitral valve surgery. Discussion  Takotsubo syndrome is a threatening condition; complications in acute phase could lead to a fatal outcome. Mitral valve surgery has to be considered as a trigger for this entity, after excluding coronary involvement, specially of left circumflex artery.

Elderly woman presenting with multivessel coronary artery disease and Takotsubo syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e242367
Author(s):  
Hari Vivekanantham ◽  
Martin Scoglio ◽  
Philipp Suter ◽  
Stephane Cook ◽  
Yann Roux ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Takotsubo Syndrome ◽  
Left Main ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Left Anterior Descending Artery ◽  
Artery Disease

Takotsubo syndrome is an acute and often reversible condition, with initial presentation mimicking acute coronary syndrome. Typically, patients present with left ventricular regional wall motion abnormalities, without a corresponding coronary artery obstruction on angiography. Coexistence of a coronary artery disease is possible and may render the distinction between the two entities particularly challenging. We report the case of a 94-year-old woman with chest pain after an emotional upset and acute myocardial injury. Transthoracic echocardiogram (TTE) revealed a severely reduced left ventricular ejection fraction (LVEF) with apical ballooning. Coronary angiogram showed significant stenosis of the distal left main coronary artery and of the mid-left anterior descending artery, as well as a 30%–50% stenosis of the mid-distal right coronary artery. Revascularisation was deferred and antiplatelet as well as heart failure therapy begun. A repeat TTE 6 days later revealed a quasi-normalised LVEF. Ultimately, percutaneous coronary revascularisation of the left main and left anterior descending artery was performed, with favourable outcome at 6-month follow-up.

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.

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