Takotsubo Cardiomyopathy: A Challenging Diagnosis for Emergency Service Clinicians!

Abstract. Background: Outreach psychiatric emergency services play an important role in all stages of a suicidal crisis; however, empirical assessment data are scarce. This study describes characteristics of patients assessed by these services and involved in suicidal crises. Method: During a 5-year period, detailed information from psychiatric emergency service assessments was recorded; 14,705 assessments were included. Characteristics of patients with/without suicidal behavior and with/without suicide attempts were compared. Outcomes were adjusted for clustering of features within individual patients. Results: Suicidal behavior was assessed in 32.2% of patients, of whom 9.2% attempted suicide. Suicidal behavior was most commonly associated with depression or adjustment disorder and these patients were referred to the service by a general practitioner or a general hospital, whereas those who attempted suicide were less likely to be referred by a general practitioner. Those who attempted suicide were more likely to be female and have had a referral by a general hospital. Self-poisoning by medication was the most common method of attempting suicide. Limitations: Bias could be due to missed or incomplete assessments. Primary diagnoses were based on clinical observation at the time of the assessment or on the primary diagnosis previously recorded. In addition, suicidal behavior or attempted suicide might have been underestimated. Conclusions: Suicidal behavior is commonplace in assessments by psychiatric emergency services. Suicidal patients with/without a suicide attempt differed with respect to demographic features, primary diagnoses, and referring entities, but not with respect to treatment policy. About 40% of the suicidal patients with/without an attempt were admitted following assessment.

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Suicidal Behavior in Four Ethnic Groups in The Hague, 2002–2004

Crisis ◽

10.1027/0227-5910.30.2.63 ◽

2009 ◽

Vol 30 (2) ◽

pp. 63-67 ◽

Cited By ~ 22

Author(s):

Irene Burger ◽

Albert M. van Hemert ◽

Willem J. Schudel ◽

Barend J.C. Middelkoop

Keyword(s):

Suicide Attempt ◽

Ethnic Groups ◽

Suicidal Behavior ◽

Emergency Service ◽

Attempted Suicide ◽

Public Health Problem ◽

Specific Rate ◽

Completed Suicide ◽

The Hague ◽

Psychiatric Department

Background: Suicidal behavior is a severe public health problem. Aims: To determine the rates of attempted and completed suicide among ethnic groups in The Hague, The Netherlands (2002–2004). Methods: By analyzing data on attempted and completed suicide (from the psychiatric department of general medical hospitals; the psychiatric emergency service and the municipal coroners). Results: Turkish and Surinamese females aged 15–24 years were at highest risk for attempted suicide (age-specific rate 545 / 100,000 and 421 / 100,000 person-years, respectively). Both rates were significantly higher than in the same age group of Dutch females (246 / 100,000 person-years). Turkish (2%) and Surinamese (7%) had lower repeat suicide-attempt rates than did Dutch (16%) females aged 15–24. Significantly lower suicide-attempt rates were found for Surinamese than for Dutch females aged 35–54 years. Differences were not explained by socioeconomic living conditions. The ratio fatal/nonfatal events was 4.5 times higher in males than in females and varied across age, gender, and ethnicity strata. Completed suicide was rare among migrant females. No completed suicides were observed in the Turkish and Surinamese females aged 15–24 years. Conclusions: The study demonstrates a high risk of attempted suicide and a low risk of completed suicide among young Turkish and Surinamese females.

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Diagnostic Yield of CT Brain Studies in the Emergency Service of a Tertiary Care Center: A Retrospective Audit of 130 Patients

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0032-1316222 ◽

2012 ◽

Vol 73 (S 03) ◽

Author(s):

D. Cronin ◽

D. Philbin ◽

C. Kaliaperumal ◽

I. O'Sullivan ◽

C. Marks

Keyword(s):

Emergency Service ◽

Diagnostic Yield ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Retrospective Audit ◽

Ct Brain

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Takotsubo cardiomyopathy and major depressive disorder

Nervenheilkunde ◽

10.1055/s-0038-1675699 ◽

2018 ◽

Vol 37 (11) ◽

pp. 803-807

Author(s):

B. J. Connemann ◽

T. Dahme ◽

T. Tesfay ◽

M. Gahr ◽

M. Elsayed

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Takotsubo Cardiomyopathy ◽

Apical Ballooning ◽

Major Depressive ◽

Linksventrikuläre Dysfunktion ◽

Klinische Relevanz ◽

Diagnostik Und Therapie

Zusammenfassung Gegenstand und Ziel: Das Tako-Tsubo-Syndrom (TTS) ähnelt klinisch einem akuten Myokardinfarkt und ist häufig mit emotionalem oder physischem Stress assoziiert. Patienten mit TTS stellen sich daher häufig zuerst in einer psychiatrischen Klinik vor; dies kann die adäquate Diagnostik und Therapie verzögern, insbesondere wenn der Psychiater nicht mit TTS vertraut ist. Material und Methoden: Ein klinischer Fall eines TTS wird vorgestellt und diskutiert und das Krankheitsbild des TTS vorgestellt. Ergebnisse: Eine 43-jährige Patientin stellte sich notfallmäßig in unserer psychiatrischen Ambulanz vor. Unmittelbar vor der Vorstellung war es am Arbeitsplatz zu erheblicher Schikane der Patientin gekommen (Mobbing). Zum Vorstellungszeitpunkt beklagte die Patientin akute linksthorakale Schmerzen sowie seit einigen Wochen bestehend gedrückte Stimmung, verminderten Antrieb, Anhedonie, generalisierte Ängste und Schlafprobleme. Das Elektrokardiogramm (EKG) war unauffällig, das Serumtroponin jedoch deutlich erhöht. Die Patientin wurde daraufhin in die Abteilung für Kardiologie verlegt. Herzkatheter und Kardio-MRT zeigten eine apikale Ballonbildung (apical ballooning) und linksventrikuläre Dysfunktion, passend zu TTS. Schlussfolgerungen und klinische Relevanz: Bei Patienten mit akuter Psychopathologie und kardialen und/oder thorakalen Symptomen sollten ein EKG und eine Bestimmung des Serumtroponins durchgeführt werden.

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Takotsubo Cardiomyopathy: A rare cause of postpneumonectomy pulmonary edema

10.1055/s-0039-1694206 ◽

2019 ◽

Author(s):

M Hassan ◽

S Schmid ◽

B Siepe ◽

B Haager ◽

B Passlick

Keyword(s):

Pulmonary Edema ◽

Takotsubo Cardiomyopathy

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Efektivitas Layanan Darurat Jakarta Siaga 112 dalam Penanganan Kebakaran oleh UPT. Pusat Data & Informasi Kebencanaan BPBD Provinsi DKI Jakarta

Jurnal Good Governance ◽

10.32834/gg.v16i1.157 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Musa Musa

Keyword(s):

Emergency Service ◽

Fire Management ◽

Emergency Services ◽

The Public ◽

Information Center ◽

Disaster Data ◽

In Fire ◽

Document Review

This research was conducted to determine the Effectiveness of Jakarta Siaga 112 Emergency Services in Fire Management by UPT. Disaster Data & Information Center of BPBD DKI Jakarta Province by paying attention to aspects contained in the Effectiveness of the Jakarta Siaga Emergency Service Program 112. The research method was carried out with a case study method with data collection techniques using interview methods and document review. Interviews were conducted on 10 (ten) key informants, document review focused on documents related to the Jakarta Emergency Alert Service 112 Effectiveness research in Fire Management. The results showed that the Effectiveness of Jakarta Siaga 112 Emergency Services in Fire Management by UPT. The Center for Disaster Data & Information BPBD DKI Jakarta Province Its effectiveness is still low, due to the Implementation of Emergency Services Jakarta Standby 112 in Fire Management implemented by UPT. Disaster Data & Information Center of BPBD DKI Jakarta Province in terms of the Target Group Understanding of the Program, the Achievement of the Program Objectives aspects, and the Program Follow-up aspects. It is recommended to continue to disseminate this Emergency Service to the public, it is necessary to increase the firm commitment of the Head of 8 SKPD related to fire management so that all units play a role in accordance with the Standard Operating Procedures (SOPs) for Fire Management and the evaluation and follow-up of program services that are held periodically 3 once a month.Keywords: Effectiveness, Emergency Services, Fire Handling

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Life-threatening Takotsubo Cardiomyopathy

The American Heart Hospital Journal ◽

10.15420/ahhj.2011.9.2.119 ◽

2011 ◽

Vol 9 (2) ◽

pp. 119 ◽

Cited By ~ 4

Author(s):

Karen Mrejen-Shakin ◽

Ricardo Lopez ◽

Mohandas M Shenoy ◽

◽

...

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Acute Heart Failure ◽

Takotsubo Cardiomyopathy ◽

Stress Test ◽

Systolic Dysfunction ◽

Apical Ballooning ◽

Assisted Ventilation ◽

Two Dimensional ◽

Life Threatening

Objective:To report a case of seizure-induced takotsubo cardiomyopathy with rare etiology and rarer complications.Methods:A 50-year-old woman had multiple epileptic seizures and later developed acute heart failure complicated by ventricular fibrillation and shock. A two-dimensional echocardiogram revealed apical ballooning of the left ventricle resembling a takotsubo (a Japanese fisherman's pot used to trap octopi). The apex was also hypokinetic.Results:The hemodynamic abnormalities normalized with defibrillation, assisted ventilation, inotropic support, and pressor agents. More importantly, the apical ballooning deformity and systolic dysfunction reversed. The echocardiogram normalized three months later. A nuclear treadmill stress test was negative for ischemia.Conclusions:Apical ballooning of the left ventricle and hypokinesis are typical echocardiographic features in takotsubo cardiomyopathy, a stress-induced heart disease. It may follow severe emotional, physical, and neurologic stressors, in our rare case, grand mal seizures (0.2 % of all takotsubo disease patients). Also rare are life-threatening complications. Based on these observations, in a case with severe stress followed by acute heart failure, takotsubo cardiomyopathy should be a major diagnostic consideration. The dramatic initial triggering event, in our case an epileptic seizure, should not mask the possibility of coexisting takotsubo cardiomyopathy. Awareness of this disease, anticipation of complications, and two-dimensional echocardiography will help channel the management in the right direction.

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