scholarly journals Takotsubo cardiomyopathy in amiodarone-induced hyperthyroidism

2017 ◽  
Vol 2017 ◽  
Author(s):  
Ismael Capel ◽  
Elisabet Tasa-Vinyals ◽  
Albert Cano-Palomares ◽  
Irene Bergés-Raso ◽  
Lara Albert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Takotsubo Cardiomyopathy ◽  
Thyroid Dysfunction ◽  
Case Reports ◽  
Left Ventricular ◽  
List Type ◽  
Emotional Trauma ◽  
Class Iii ◽  
Heart Insufficiency ◽  
Class Iii Antiarrhythmic Agent

Summary Takotsubo cardiomyopathy (TC) is an atypical, severe but reversible form of acute heart insufficiency. It typically presents with left ventricular failure, transient apical and mid-segments hypokinesis, absence of significant coronary stenosis and new electrographic abnormalities and/or elevation in serum cardiac enzymes. Although TC (‘broken heart syndrome’) has classically been associated with emotional trauma, evidence suggests that other precipitants might exist, including iatrogenic and thyroid-mediated forms. Thyroid disease is a relatively common comorbidity in TC patients. We report a case of TC in a postmenopausal female with no history of emotional trauma or other potential precipitant factors who was diagnosed with amiodarone-induced hyperthyroidism during her hospital stay. Though some case reports of thyroid-related TC exist, we are not aware of any other reported case of TC precipitated by amiodarone-induced hyperthyroidism. Learning points: TC is a relatively new, rare, transient, severe, but reversible cardiovascular condition that is characterized by an acute left ventricular cardiac failure, which can clinically, analytically and electrocardiographically mimic an acute myocardial infarction. Many precipitant factors have been described in TC, being the most classical and emotional trauma. However, thyroid dysfunction is also a significant condition frequently found in patients with TC. A hypercatecholaminergic state leading to cardiomyocyte damage has been established as the main fact of TC physiopathology. Hyperthyroidism induces an upregulation of β-adrenergic receptors. Both hyperthyroidism and hypothyroidism have been related with TC development. Most reported cases of TC involving thyroid dysfunction correspond to hyperthyroidism due to Graves–Basedow disease, but there are also descriptions with severe hypothyroidism, radioiodine treatment or thyroid surgery. Amiodarone is a class III antiarrhythmic agent widely used, and it is a well-known cause of thyroid dysfunction, which can present either with hypothyroidism or hyperthyroidism, as approximately 40 percent of the amiodarone molecule is composed of iodine. In this case, a type II amiodarone-induced hyperthyroidism was the precipitant factor of a TC in a patient with a pre-existing atrial fibrillation. Given the high prevalence of atrial fibrillation and the wide use of amiodarone, the risk of this iatrogenic effect should be taken into account.

Effects of a novel class III antiarrhythmic agent, CPUY11018, on rat atrial fibrillation

2010 ◽  
Vol 71 (5) ◽  
pp. 303-312 ◽  
Author(s):  
Xiang Guo ◽  
Chun-Lin Chen ◽  
Qian Yang ◽  
Yue-Miao Yin ◽  
Qi-Dong You ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antiarrhythmic Agent ◽  
Class Iii ◽  
Class Iii Antiarrhythmic Agent

scholarly journals Incidence and Characterization of Concealed Cardiac Amyloidosis Among Unselected Elderly Patients Undergoing Post-mortem Examination

2021 ◽  
Vol 8 ◽  
Author(s):  
Aldostefano Porcari ◽  
Rossana Bussani ◽  
Marco Merlo ◽  
Guerino Giuseppe Varrà ◽  
Linda Pagura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Amyloidosis ◽  
Left Ventricular ◽  
Functional Class ◽  
Red Flags ◽  
Class Iii ◽  
History Of ◽  
Ca 50 ◽  
Diffuse Distribution

Background: The prevalence of cardiac amyloidosis (CA) is unknown.Aims and Methods: We sought to (a) determine the prevalence of CA in unselected patients ≥75 years undergoing autopsy, (b) characterize cardiological profiles of CA and non-CA patients by providing clinical-histological correlations, and (c) compare their cardiological profiles. After dedicated staining, the localization (interstitial or vascular) and the distribution (non-diffuse or diffuse) of amyloid deposition were analyzed. Cardiological data at last evaluation were retrospectively assessed for the presence of CA red-flags.Results: CA (50% light chains, 50% transthyretin) was found in 43% (n = 24/56) of the autopsied hearts. Atria were involved in 96% of cases. Amyloid localized both at the perivascular and interstitial levels (95.5 and 85%, respectively) with a slightly predominant non-diffuse distribution (58% of cases). Compared to the other patients, CA patients had a more frequent history of heart failure (HF) (79 vs. 47%, p = 0.014), advanced NYHA functional class (III-IV 25 vs. 6%, p = 0.047), atrial fibrillation (68 vs. 36%, p = 0.019), discrepancy between QRS voltage and left ventricular (LV) thickness (70 vs. 12%, p < 0.001), thicker LV walls (15 vs. 11 mm, p < 0.001), enlarged left atrium (49 vs. 42 mm, p = 0.019) and restrictive filling pattern (56 vs. 19%, p = 0.020). The presence of right ventricular amyloidosis seemed to identify hearts with a higher amyloid burden. Among the CA patients, >30% had ≥3 echocardiographic red-flags of disease.Conclusion: CA can be found in 43% of autopsied hearts from patients ≥75 years old, especially in patients with HF, LV hypertrophy and atrial fibrillation.

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.

Clinical Outcomes after Mitral Valve Repair with the Physio II Annuloplasty Ring

2021 ◽  
Author(s):  
Thilo Noack ◽  
Franz Sieg ◽  
Mateo Marin Cuartas ◽  
Ricardo Spampinato ◽  
David Holzhey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Clinical Outcomes ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Annuloplasty Ring ◽  
Ventricular Ejection Fraction

Abstract Background Mitral valve (MV) repair with annuloplasty is the standard of care in patients with primary degenerative mitral regurgitation (DMR). Newer generations of annuloplasty rings have been developed with the goals of closer reproduction of native annular geometry and easier implantation. This study investigates the short-term and 5-year clinical outcomes of MV repair with the Carpentier-Edwards (CE) Physio II annuloplasty ring. Methods This is an observational study including a total of 486 patients who underwent MV repair for DMR using the CE Physio II annuloplasty ring between 2011 and 2016. Results Mean age was 54.8 ± 12.1 years, 364 patients (74.9%) were males, and 84 patients (17.3%) presented with atrial fibrillation. Mean left ventricular ejection fraction was 62.3 ± 7.3%. Mean logistic EuroSCORE was 2.7 ± 2.4%. New York Heart Association functional class III–IV symptoms were present in 134 (27.6%) patients preoperatively. Isolated MV repair was performed via a right-sided mini-thoracotomy in 479 patients (98.6%). Concomitant procedures included ablation for atrial fibrillation in 83 patients (17.1%) and closure of atrial septum defect in 88 patients (18.1%). Median size of implanted annuloplasty rings was 34 mm (interquartile range: 34–38 mm). Mean cardiopulmonary bypass time was 116 ± 34 minutes and mean cross-clamp time was 74 ± 25 minutes. Thirty-day mortality was 0.4%. The Kaplan–Meier 4-year survival was 98.5%. Freedom from MV reoperation was 96.2 and 94.0% at 1 and 4 years. Conclusion MV repair with the CE Physio II annuloplasty ring is associated with excellent midterm clinical outcome.

A Quarter of a Century Later: What is Dofetilide’s Clinical Role Today?

2018 ◽  
Vol 24 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Deborah L. Wolbrette ◽  
Sarah Hussain ◽  
Ilir Maraj ◽  
Gerald V. Naccarelli
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Real World ◽  
Antiarrhythmic Agent ◽  
Good Choice ◽  
Drug Trials ◽  
Efficacy And Safety ◽  
Class Iii ◽  
Clinical Role ◽  
Class Iii Antiarrhythmic Agent

Dofetilide is a class III antiarrhythmic agent approved by the Food and Drug Administration for the conversion of atrial fibrillation and atrial flutter and maintenance of sinus rhythm in symptomatic patients with persistent arrhythmia. Drug trials showed neutral mortality in post–myocardial infarction patients and those with heart failure. This is a review of postmarket data, including real-world efficacy and safety in a variety of populations. Dofetilide has been used off-label with success in patients with paroxysmal atrial fibrillation and atrial flutter, as well as atrial tachycardia and ventricular tachycardia. The real-world acute conversion rate of atrial fibrillation and atrial flutter is higher than that reported in clinical trials. Dofetilide has an acceptable safety profile when initiated (or reloaded) under hospital monitoring and dosed according to creatinine clearance. Dofetilide is well tolerated and a good choice for patients with acceptable renal function and a normal QT interval, especially if atrioventricular nodal blockade needs to be avoided.

scholarly journals Prognostic impact of atrial fibrillation in patients with hypertrophic cardiomyopathy in a community-based Japanese cohort: results from Kochi RYOMA study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kubo ◽  
K Sugiura ◽  
Y Ochi ◽  
A Takahashi ◽  
Y Baba ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Adverse Events ◽  
Left Ventricular ◽  
Disease Stage ◽  
Prognostic Impact ◽  
Class Iii ◽  
Community Based ◽  
New Onset

Abstract Background The prognostic impact of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM) is not fully elucidated. Purpose The aim of this study was to examine the prevalence and prognostic impact of AF in a prospectively assembled community-based HCM patient cohort in an aged Japanese community. Methods In 2004, we established a cardiomyopathy registration network in Kochi Prefecture, Japan, consisting of 9 hospitals, and finally 293 patients with HCM were followed. Results The ages at registration and at diagnosis were 63±14 and 56±16 years, respectively, and 197 patients (67%) were men. 86 patients (29%) showed AF. During follow-up period of 6.1±3.2 years, 44 patients died. In those patients, HCM-related deaths occurred in 23 patients with an annual mortality rate of 1.3%. Regarding HCM-related adverse events including HCM-related deaths, appropriate ICD discharge, heart failure admission and hospitalization for embolic events, a total of 77 cardiovascular events in 70 patients occurred. Multivariate analysis revealed that presence of AF, left ventricular (LV) outflow obstruction, NYHA functional class III, and lower LV fractional shortening at registration were significant predictors of these adverse events. During the follow-up period, additional 31 patients (11%) developed new-onset AF. Importantly, the incidence of HCM-related adverse events was significantly higher in patients with new AF observed from its onset compared with those with AF at registration (log-rank p=0.029) (Figure 1). Conclusions In an unselected HCM registry in an aged Japanese community, presence of AF, particularly new-onset AF, was associated with unfavorable clinical outcomes. AF is not just a marker of the disease stage but an important trigger of HCM-related adverse events. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Takotsubo Cardiomyopathy as a Sequela of Elective Direct-Current Cardioversion for Atrial Fibrillation

2014 ◽  
Vol 41 (2) ◽  
pp. 184-187 ◽  
Author(s):  
Jonathan S. Siegfried ◽  
Satjit Bhusri ◽  
Nils Guttenplan ◽  
Neil L. Coplan
Keyword(s):  
Atrial Fibrillation ◽  
Cardiogenic Shock ◽  
Direct Current ◽  
Takotsubo Cardiomyopathy ◽  
Obstructive Coronary Artery Disease ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Clinical Appearance ◽  
Direct Current Cardioversion ◽  
Catecholamine Excess

In takotsubo cardiomyopathy, the clinical appearance is that of an acute myocardial infarction in the absence of obstructive coronary artery disease, with apical ballooning of the left ventricle. The condition is usually precipitated by a stressful physical or psychological experience. The mechanism is unknown but is thought to be related to catecholamine excess. We present the case of a 67-year-old woman who experienced cardiogenic shock caused by takotsubo cardiomyopathy, immediately after undergoing elective direct-current cardio-version for atrial fibrillation. After a course complicated by left ventricular failure, cardiogenic shock, and ventricular tachycardia, she made a complete clinical and echocardiographic recovery. In addition to this case, we discuss the possible direct effect of cardioversion in takotsubo cardiomyopathy.

Sign in / Sign up

Export Citation Format

Share Document