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 ‘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 An Unusual Case of Paraquat-Induced Rhabdomyolysis and Hepatic Injury Presenting With Takotsubo Cardiomyopathy

2021 ◽  
Vol 9 ◽  
pp. 232470962110394
Author(s):  
Sara Jaka ◽  
Theingi Tiffany Win ◽  
Fowrooz Joolhar ◽  
Arash Heidari ◽  
Leila Moosavi
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Hepatic Injury ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Lower Extremity Weakness ◽  
Diagnostic Uncertainty ◽  
Coronary Syndrome ◽  
Field Worker ◽  
Missed Diagnosis

Takotsubo cardiomyopathy (TCM) is a syndrome of reversible left ventricular systolic dysfunction that, at presentation, can be easily conflated with acute coronary syndrome. TCM has a clinical preponderance for older, postmenopausal females. We report on a patient’s case who presented with complaints of upper and lower extremity weakness with evidence of rhabdomyolysis and hepatic injury. Her occupation as a field worker exposed her to a toxic chemical known as paraquat, which has been banned by multiple countries across the world; a chemical we presume culminated in both. The subsequent clinical cascade and resulting acute physiological illness and emotional distress primed her to develop TCM. However, she neither endorsed chest pain nor dyspnea. Her subtle clinical presentation could have led to a missed diagnosis as she was also not in a fluid overloaded state consistent with the depressed left ventricular function discovered on transthoracic echo. The diagnostic uncertainty until coronary angiography is obtained, and its association with severe and acute emotional and physical stress prompts to a greater reliance on patient history to identify occupational and toxic exposures that can contribute to its development.

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.

scholarly journals A Case of Reverse Takotsubo Cardiomyopathy Incited by a Spinal Subdural Hematoma

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Kyle Sanchez ◽  
Steven Glener ◽  
Nathan E. Esplin ◽  
Okorie N. Okorie ◽  
Amay Parikh
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Subdural Hematoma ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Apical Ballooning ◽  
Cord Compression ◽  
Left Ventricular ◽  
Cardiac Enzymes ◽  
Spinal Subdural Hematoma ◽  
Apparently Healthy

Takotsubo cardiomyopathy is a rare syndrome of transient, reversible left ventricular systolic dysfunction. It mimics myocardial infarction clinically and includes elevated cardiac enzymes, but echocardiography reveals apical ballooning and basal hyperkinesis. Infrequently, midventricular or even reverse Takotsubo patterns have been described, involving ballooning of the basal heart without the characteristic ‘Takotsubo’ appearance. There are cases in the literature that support a connection between reverse Takotsubo cardiomyopathy (r-TTC) and neurological insults as inciting factors. We report a case of r-TTC in an otherwise healthy 23-year-old man presenting with back pain, urinary retention, bradycardia, and hypertension. Troponin levels and brain natriuretic peptide (BNP) were elevated, and echocardiogram revealed an ejection fraction (EF) of less than 20%. In addition, MRI demonstrated a spinal subdural hematoma from T1-S1 with no cord compression. Repeated echocardiogram demonstrated an EF of 20-25% with a reverse Takotsubo pattern of cardiomyopathy. With supportive care, his clinical picture improved with normalization of cardiac enzyme and BNP values. This case represents a r-TTC presenting as heart failure in a young, apparently healthy male likely incited by a spinal subdural hematoma. To our knowledge, it is the first of its kind reported.

scholarly journals Comparative Value of Simple Inflammatory Markers in the Prediction of Left Ventricular Systolic Dysfunction in Postacute Coronary Syndrome Patients

2009 ◽  
Vol 2009 ◽  
pp. 1-7 ◽  
Author(s):  
Panagiotis Aggelopoulos ◽  
Christina Chrysohoou ◽  
Christos Pitsavos ◽  
Lambros Papadimitriou ◽  
Catherine Liontou ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
Wbc Count ◽  
Serum Crp

Objectives. We sought to assess the comparative value of inflammatory markers on the occurrence of left ventricular systolic dysfunction (LVSD) after an acute coronary syndrome (ACS).Methods. During 2006–2008, 760 patients with an ACS were enrolled. C-reactive protein (CRP) and white blood cell (WBC) count were measured during the first 12 hours of hospital admission.Results. CRP levels and WBC count were significantly higher in those who developed LVSD compared to those who did not. The analysis revealed that a 10 mg/dL increase of CRP levels and a 1000/L increase in WBC are associated with a 6% and a 7% increase in the likelihood of developing LVSD, respectively. Furthermore, WBC count at entry and CRP have almost the same predictive value for development of LVSD after an ACS ( versus ).Conclusions. Serum CRP levels and WBC count at entry are almost equally powerful independent predictors of LVSD, after an ACS.

scholarly journals A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ronny Cohen ◽  
Alla Lysenko ◽  
Thierry Mallet ◽  
Brooks Mirrer ◽  
Michael Gale ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Young Patient ◽  
Left Ventricular Systolic Dysfunction ◽  
Acute Myocarditis ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Low Grade ◽  
Drug Induced ◽  
Severe Left Ventricular Dysfunction ◽  
Coronary Syndrome

We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB). An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine) versus acute coronary syndrome. He was managed conservatively and transferred to another facility for endomyocardial biopsy confirming myocarditis. This case is an example of one of the most typical presentations of suspected drug-induced acute myocarditis and will hopefully prompt the reader to think of this underdiagnosed entity in the right clinical setting.

scholarly journals Combined neurogenic pulmonary edema and atypical takotsubo cardiomyopathy in a patient with ischaemic stroke: a unique case report

2021 ◽  
Author(s):  
Letizia Riva ◽  
Gianni Casella ◽  
Luigi Simonetti ◽  
Andrea Zini
Keyword(s):  
Ischaemic Stroke ◽  
Takotsubo Cardiomyopathy ◽  
Neurological Disorders ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Invasive Mechanical Ventilation ◽  
Left Ventricular ◽  
Neurogenic Pulmonary Edema ◽  
Ventricular Systolic Dysfunction ◽  
Nervous Stimulation

Abstract Background Neurogenic pulmonary oedema (NPE) and Takotsubo cardiomyopathy are rare complications of ischaemic stroke. They are considered to be due to an excess catecholamine release after sympathetic nervous stimulation following stroke onset. Among the different types of Takotsubo cardiomyopathy, apical ballooning is recognized as the typical form, but 3 atypical patterns have been described (midventricular, basal and focal) which are more commonly observed in patients with neurological disorders. Case summary A 78-year-old woman was treated with intravenous alteplase and underwent mechanical thrombectomy for ischaemic stroke. During the procedure, her respiratory condition quickly worsened requiring invasive mechanical ventilation because of a wide and persistent reduction of the inspiratory oxygen fraction/arterial partial oxygen pressure ratio (FiO2/PaO2). Transthoracic echocardiography revealed moderate left ventricular systolic dysfunction with akinesis of the septal-apical and inferior-apical segments. Coronary angiography excluded obstructive lesions and/or evidence of acute plaque rupture. Ventriculography confirmed akinesis/dyskinesis of the inferior segment of the left ventricular apex associated with normal kinesis of the remaining segments. Chest X-ray revealed an infiltrative shadow on both lungs. After 24 hours from NPE onset, her respiratory function improved and she was finally discharged on day 7 without neurological defects. Left ventricular systolic dysfunction was reversible and ejection fraction normalized in 3 months. Discussion It is a very rare case of simultaneous NPE and Takotsubo cardiomyopathy following ischaemic stroke. Moreover, it is unique in that it is the first observation of NPE associated with an atypical pattern of Takotsubo cardiomyopathy, which is more frequent in patients with neurological disorders. A rapid recognition and treatment are essential for patient survival.

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.

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