Life-threatening Takotsubo Cardiomyopathy

2011 ◽  
Vol 9 (2) ◽  
pp. 119 ◽  
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.

scholarly journals CORELATION OF GLOBAL LONGITUDINAL STRAIN (GLS) – LEFT VENTRICLE AND SOLUBLE SUPRESSION OF TUMORGENICITY 2 (sST2) IN ACUTE HEART FAILURE WITH SYSTOLIC DYSFUNCTION

2019 ◽  
Vol 39 (4) ◽  
Author(s):  
Herlina Yulidia ◽  
Muhammad Aminuddin ◽  
Budi S Pikir
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Acute Heart Failure ◽  
Longitudinal Strain ◽  
Significant Positive Correlation ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Soluble St2 ◽  
Positive Correlation

Background  :  Assessment of  left  ventricular  function  in  patients with   acute heart failure is important for prognostication, determination of treatment plan, for decisions related to  expensive device therapies and for assessing response  to treatment. Echocardiography is the "gold standard" of assessing left ventricular function, and in establishing a diagnosis of heart failure. Left ventricular Global Longitudinal Strain (GLS) assessed through Speckle Tracking Echocardiography (STE) is currently considered sensitive in assessing left ventricular motion, by analyzing multidimensional myocardial deformation . s ST2 used to be correlated with stretch miocard and inhibid ligand of IL-33 wich also inhibit the cardioprotectve effect. Objective : To prove the positive correlation between GLS-left ventricle with soluble ST2. Methods  :  This  is  a  correlational  study  with  cosecutive   sampling   technique. Thirty subjects participate in this reseach and each subject underwent echocardiography and  GLS-left  ventricle  and  soluble ST2 blood examination. The correlation between GLS-left ventricle and soluble ST2  were  evaluated using Spearman correlation test. Results : There is a strong, significant, positive correlation between the GLS-left ventricle with soluble ST2 (r = 0.99 and p =  0.0001). Conclusion : There is a  strong,  significant,  positive  correlation  between  the  GLS- left ventricle with soluble ST2. Keywords :  acute  heart  failure,   systolic   dysfunction,   global  longitudinal  strain, soluble ST2.

scholarly journals Computational modeling of Takotsubo cardiomyopathy: effect of spatially varying β-adrenergic stimulation in the rat left ventricle

2014 ◽  
Vol 307 (10) ◽  
pp. H1487-H1496 ◽  
Author(s):  
Sander Land ◽  
Steven A. Niederer ◽  
William E. Louch ◽  
Åsmund T. Røe ◽  
Jan Magnus Aronsen ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Takotsubo Cardiomyopathy ◽  
Troponin I ◽  
Contractile Function ◽  
Single Cells ◽  
Apical Ballooning ◽  
Calcium Sensitivity ◽  
Takotsubo Syndrome ◽  
Adrenergic Stimulation ◽  
Inotropic Effects

In Takotsubo cardiomyopathy, the left ventricle shows apical ballooning combined with basal hypercontractility. Both clinical observations in humans and recent experimental work on isolated rat ventricular myocytes suggest the dominant mechanisms of this syndrome are related to acute catecholamine overload. However, relating observed differences in single cells to the capacity of such alterations to result in the extreme changes in ventricular shape seen in Takotsubo syndrome is difficult. By using a computational model of the rat left ventricle, we investigate which mechanisms can give rise to the typical shape of the ventricle observed in this syndrome. Three potential dominant mechanisms related to effects of β-adrenergic stimulation were considered: apical-basal variation of calcium transients due to differences in L-type and sarco(endo)plasmic reticulum Ca2+-ATPase activation, apical-basal variation of calcium sensitivity due to differences in troponin I phosphorylation, and apical-basal variation in maximal active tension due to, e.g., the negative inotropic effects of p38 MAPK. Furthermore, we investigated the interaction of these spatial variations in the presence of a failing Frank-Starling mechanism. We conclude that a large portion of the apex needs to be affected by severe changes in calcium regulation or contractile function to result in apical ballooning, and smooth linear variation from apex to base is unlikely to result in the typical ventricular shape observed in this syndrome. A failing Frank-Starling mechanism significantly increases apical ballooning at end systole and may be an important additional factor underpinning Takotsubo syndrome.

scholarly journals Takotsubo Cardiomyopathy in Dextrocardia with Situs Inversus

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
A. Ganes ◽  
L. Segan
Keyword(s):  
Coronary Artery ◽  
Takotsubo Cardiomyopathy ◽  
Situs Inversus ◽  
Systolic Dysfunction ◽  
Apical Ballooning ◽  
Contralateral Side ◽  
Left Ventricular ◽  
Psychological Stressors ◽  
Ventricular Response ◽  
St Elevation

Takotsubo cardiomyopathy (TTC) is an acute reversible form of left ventricular (LV) systolic dysfunction extending beyond a coronary artery vascular territory usually due to physical or psychological stressors. Dextrocardia with situs inversus is a rare embryologic anomaly whereby the heart and aorta are mirrored on the contralateral side. We describe a case of a 93-year-old female with dextrocardia who presented with chest pain, atrial fibrillation with rapid ventricular response, and transient inferior ST elevation. Coronary angiography demonstrated an eccentric mid right coronary artery (RCA) lesion and apical ballooning consistent with concurrent takotsubo cardiomyopathy (TTC). To our knowledge, this is the first reported case of this dual pathology in a patient with dextrocardia, highlighting the procedural and diagnostic complexity in the setting of a rare anatomicvariant.

Is everything clear about Tako-Tsubo syndrome?

Folia Medica ◽  
2011 ◽  
Vol 53 (2) ◽  
pp. 5-35 ◽  
Author(s):  
Ivo S. Petrov ◽  
Mariya P. Tokmakova ◽  
Daniel N. Marchov ◽  
Kostadin N. Kichukov
Keyword(s):  
Left Ventricle ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Clinical Manifestations ◽  
Apical Ballooning ◽  
Microvascular Dysfunction ◽  
Good Prognosis ◽  
Acute Onset ◽  
Left Ventricular ◽  
Catecholamine Excess

Abstract Introduction: Tako-tsubo syndrome is a novel cardio-vascular disease affecting predominantly postmenopausal women exposed to unexpected strong emotional or physical stress, in the absence of significant coronary heart disease. It is characterized by acute onset of severe chest pain and/or acute left ventricular failure, ECG-changes, typical left ventricular angiographic findings, good prognosis and positive resolution of the morphological and clinical manifestations. First described in 1990 in Japan by Sato, Tako-tsubo cardiomyopathy is characterized by transient contractile abnormalities of the left ventricle, causing typical left ventricular apical ballooning at end-systole with concomitant compensatory basal hyperkinesia. There are also atypical forms, presenting with left ventricular systolic dysfunction which affects the mid-portions of the left ventricle. The etiology of the disease still remains unclear. Many theories have been put forward about the potential underlying pathophysiological mechanisms that may trigger this syndrome among which are the theory of catecholamine excess, the theory of multivessel coronary vasospasm, the ischemic theory, and the theory of microvascular dysfunction and dynamic left ventricular gradient induced by elevated circulating catecholamine levels. Adequate management of Tako-tsubo syndrome demands immediate preparation for coronary angiography. Once the diagnosis is made, treatment is primarily symptomatic and includes monitoring for complications. Patients with Tako-tsubo syndrome most frequently develop acute LV failure, pulmonary edema, rhythm and conductive disturbances and apical thrombosis. Treatment is symptomatic and includes administration of diuretics, vasodilators and mechanical support of circulation with intra-aortic balloon counterpulsation.

P778Valsartan reduces level of soluble ST2 and left ventricle remodeling in patients with dual chamber pacemaker

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Radzik ◽  
K T Pigon ◽  
G B Banasik ◽  
A T Tomasik ◽  
W J Jachec ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Systolic Dysfunction ◽  
Protective Role ◽  
Alternative Mechanism ◽  
Dual Chamber ◽  
Double Blind ◽  
Dual Chamber Pacemaker ◽  
Soluble St2 ◽  
Left Ventricle Remodeling

Abstract Introduction Permanent right ventricle pacing leads to left ventricle remodeling, its systolic dysfunction and symptomatic heart failure in the long run. Valsartan is well known for its preventive anti-remodeling function in the post infarction heart remodeling. Objectives To assess the effect of valsartan on left ventricle remodeling in patients with second and third degree atrioventricular block with first-time implantation of dual chamber pacemaker. Methods This was a randomized, double-blind, placebo controlled single center study. One hundred eligible patients were assigned in a 1:1:1 fashion to receive placebo, valsartan 80mg or 160mg once daily, respectively. Echocardiographic assessment of left ventricle geometry, its systolic and diastolic function was performed at baseline and at twelve months. One patient from placebo group suffered stroke. We present the baseline date for 100 enrolled patients and follow-up data for 88 patients who have completed the study. Data in valsartan arms are pooled in one group. Concentration of soluble ST2 was measured in duplicates with Aspect Reader (Critical Diagnostics). Results Results are presented in table. Data are presented as mean and standard deviation. Table 1 Placebo (n=28) Valsartan (n=60) ANOVA Baseline 12 mths Baseline 12 mths sST2, ng/mL 36.0±16.0 39.4±15.3 35.1±15.2 19.9±6.5 0.01 LVEF, % 60±8 55±9 60±8 58±8 0.01 LVEDD, mm 48±5 50±4 48±6 49±5 NS LVESD, mm 29±4 32±5 29±5 31±4 NS LVEDV, mL 79±12 84±13 80±12 81±13 NS LVESV, mL 32±5 38±7 31±5 34±6 0.01 E/A 0.94±0.12 0.92±0.13 0.94±0.15 0.95±0.15 NS DecT, ms 211±38 226±43 223±45 218±37 0.01 IVRT, ms 98±14 108±17 101±17 99±18 0.01 Conclusion Valsartan has protective effect of left ventricle remodeling and function. It may be useful in prevention of pacing induced heart failure. Decrease in soluble ST2 concentration may help explain the alternative mechanism for protective role of valsartan. (NCT01805804)

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.

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