scholarly journals Takotsubo Cardiomyopathy

2015 ◽  
Vol 10 (1) ◽  
pp. 25 ◽  
Author(s):  
Esha Sachdev ◽  
C Noel Bairey Merz ◽  
Puja K Mehta ◽  
◽  
◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Takotsubo Cardiomyopathy ◽  
Acute Stress ◽  
Plaque Rupture ◽  
Coronary Thrombosis ◽  
Coronary Microvascular Dysfunction ◽  
Coronary Syndrome ◽  
Menopausal Women ◽  
Post Menopausal

Takotsubo cardiomyopathy (TTC) is an acute, stress-induced cardiomyopathy with an increased prevalence in post-menopausal women. The syndrome is most frequently precipitated by an acute emotional or physical stressor and mimics acute myocardial infarction with symptoms, electrocardiogram (ECG) changes and cardiac troponin elevation that are indistinguishable from those caused by plaque rupture or coronary thrombosis. Diagnosis of TTC is made when coronary angiography reveals no obstructive coronary artery disease and the left ventricle demonstrates apical ballooning and basal hypercontractility. Other ventricular patterns have also been described. An abnormal myocardial response to the catecholamine surge from an emotional or a physical stressor is implicated in the pathophysiology, but the reasons for the high prevalence of TTC presentations in post-menopausal women are unknown. Several mechanisms including multi-vessel coronary vasospasm, endothelial and coronary microvascular dysfunction and direct catecholamine toxicity have been proposed. No specific guidelines for treatment of TTC have been established, but treatment is based on the American Heart Association/ American College of Cardiology guidelines for acute coronary syndrome/acute myocardial infarction and heart failure guidelines. In this review article, we discuss the characteristic clinical presentation of TTC and the commonly proposed mechanisms.

scholarly journals Takotsubo cardiomyopathy: case report

2017 ◽  
Vol 95 (7) ◽  
pp. 663-668
Author(s):  
Marina G. Matveeva ◽  
G. E. Gogin ◽  
M. N. Alekhin
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricle ◽  
Coronary Arteries ◽  
Takotsubo Cardiomyopathy ◽  
Left Ventricular ◽  
Classical Type ◽  
Coronary Microvascular Dysfunction ◽  
Apical Ballooning Syndrome ◽  
Coronary Syndrome

This article reports a clinical case of Takotsubo cardiomyopathy manifest clinically, biochemicaly, electrocardiographically, and echocardiographicalyas acute myocardial infarction. The diagnosis was based on finding intact coronary arteries and rapid positive dynamics of instrumental and laboratory data. Takotsubo cardiomyopathy (CMP) (stress-associated CMP, apical ballooning syndrome) is a rare reversible disease developing after acute emotional and physical stress. Its prevalence is estimated at 1-2% of all cases of acute myocardial infarction. It most commonly affects postmenopausal women. The clinical picture is similar to that of acute coronary syndrome with transient hypo- and akinesiaof apical and middle segments of the left ventricle (LV) in combination with hyperkinesia of its basal myocardial segment in the absence of stenosis or a spasm of coronary arteries. The precise pathophysiology of the disease is unknown; several hypotheses are proposed including enhancedsympathoadrenal activity, catecholamine multivesselepicardial coronary artery spasm, coronary microvascular dysfunction, catecholamine cardiotoxicity and catecholamine-mediated myocardial stunning. The Mayo Clinic diagnostic criteria are most widely used in clinical practice: transient hypokinesia, akinesia, or dyskinesia of left ventricular mid-segments with or without apical involvement; regional wall motion abnormalities extending beyond the region of blood supply of a single epicardialartery; a stressful event oftenbut not always present in the medical history in the absence of obstructive coronary disease or angiographic evidence of acute plaque rupture; new electrocardiographic abnormalities (either ST-segment elevation and/or T-wave inversion) or modest elevation in cardiac troponin 1 level; the absence of pheochromocytoma and myocarditis. Takotsubo cardiomyopathyhas been classified into 3 types based on the involvement of the left ventricle: classical type, reverse type and mid-ventricular type; lesions of right ventricle are also described. Specific treatment of the disease is unavailable, and the main purpose of therapy is normalization of LV systolic function. The prognosis of Takotsubo cardiomyopathyis favorable, complete clinical recovery is observed in 95,5% of the cases, the average time of recovery is between 2 and 3 weeks.

scholarly journals Acute Myocardial Infarction In Systemic Mastocytosis: Case Report With Literature Review Of The Role Of Inflammatory Process In Acute Coronary Syndrome

2020 ◽  
Vol 16 ◽  
Author(s):  
Ayman Battisha ◽  
Khalid Sawalha ◽  
Bader Madoukh ◽  
Omar Sheikh ◽  
Karim Doughem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Plasma Lipids ◽  
Plaque Rupture ◽  
Systemic Mastocytosis ◽  
Cardiac Risk ◽  
Control Group ◽  
Coronary Syndrome

: Systemic Mastocytosis (SM) is a disorder of excessive mast cell infiltration in multiple organ tissues. Atherosclerosis is a major risk factor for developing acute coronary syndrome [1]. In addition to lipid accumulation in the arterial wall, inflammation plays an important role in the pathogenesis of plaque rupture and activating the thrombosis cascade [2]. The Mast cells contribution to plaque destabilization has been well established in multiple animal and human studies [3]. In a recent study, SM has been proven to be associated with a higher incidence of acute coronary syndrome even with lower plasma lipids level [4]. The study showed that 20% of patients with SM had cardiovascular events compared to only 6% in the control group with adjustment to all cardiac risk factors. Here, we present a case of acute myocardial infarction in a patient with SM with limited risk factors other than age.

scholarly journals Pathophysiologic features of Takotsubo Cardiomyopathy: A review of the literature

2015 ◽  
Vol 3 (1-2) ◽  
pp. 39-48
Author(s):  
Ana Mercedes ◽  
Tiffany Caza ◽  
Chowdhury H Ahsan
Keyword(s):  
Myocardial Infarction ◽  
Takotsubo Cardiomyopathy ◽  
Disease Entity ◽  
Review Of The Literature ◽  
Imaging Studies ◽  
Clinical Criteria ◽  
Mri Angiography ◽  
Menopausal Women ◽  
Post Menopausal ◽  
Dominant Theory

Takotsubo cardiomyopathy is a newly recognized cause of chest pain mimicking a myocardial infarction in post-menopausal women. It is diagnosed based on clinical criteria established at the Mayo Clinic and imaging studies, including echocardiography, cardiac MRI, angiography, and left ventriculography. Several hypotheses have been postulated towards its etiology, with the dominant theory being cathecholamine toxicity to the myocardium in response to a stressful trigger. Pathologic investigations are limited, based mostly on autopsy findings, and represent inflammatory and fibrotic replacement of the myocardium. Here, we will address the current understanding of the disease entity of Takotsubo cardiomyopathy, its clinical mimics, and its pathophysiology. Ibrahim Cardiac Med J 2013; 3(1&2): 39-48

P3690Plasma levels of cardiac-specific micro-RNA mir-1 and mir-133a differ in patients with acute myocardial infarction and takotsubo cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Novosadov ◽  
T N Vlasik ◽  
M Y A Ruda ◽  
D V Pevsner ◽  
I N Rybalkin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Differential Diagnosis ◽  
Takotsubo Cardiomyopathy ◽  
Plasma Levels ◽  
Heart Attack ◽  
Mrna Levels ◽  
Coronary Syndrome ◽  
Technical Specifications ◽  
And Control

Abstract Background Takotsubo cardiomyopathy (TTC) is an acute, life-threatening condition which is typically induced by stress and manifested by chest pain and ECG changes. The TTC prevalence among patients (pts) with acute coronary syndrome is 1.7–2.2%. The mortality rate from TTC is up to 8%. TTC is clinically indistinguishable from acute myocardial infarction (AIM). Differential diagnosis of TTC and AIM remains an unresolved problem. Recent studies have shown the differences in profiles of plasma microRNAs inTTC and AIM. Purpose To evaluate the possibility of differentiating TTC and AIM using a PCR-based semi-quantitative analysis of mRNAs, the plasma levels of which had been shown to be increased in patients with AIM (miR-1, miR-208a, miR-133a, miR-499a) and TTC (miR-16, miR-26a). Methods Plasma from 38 pts was used: 13 pts with confirmed TTC (12 women, 1 man), 25 pts with AIM (9w, 16m). For 10 pts with AIM, blood was collected twice: at 6 and 24 hours after the heart attack. The control arm comprised 40 healthy people from the same age group (12w, 28m). Plasma was obtained using the Cell-Free DNA blood collection tubes. Nucleic acids were separated using a modified Boom method. A semi-quantitative assessment of the mRNA levels was performed using dCq method with stem-loop qRT-PCR. Normalization for spiked synthetic cel-miR-39 and endogenous miR-23a was performed. Control of hemolysis was performed by measuring the ratio of miR-451 (specific for RBCs) and miR-23a (absent from RBCs). The statistical significance of differences between mRNA levels was assessed using Mann–Whitney test. Results No significant differences in the levels of miR-16, miR-26a and miR-208a in TTC group and control group have been found. Pts with AIM significantly differed from pts with TTC (p=0.0038 and 0.0002, respectively) and control pts (p=3.1x10–9 and 2,66x10–10) with the increased levels of cardiac-specific miR-1 and miR-133a. As compared to plasma levels at 6 hours after the heart attack, at 24-hour point the levels of these mRNAs were markedly reduced in 9 of 10 pts (mean reduction was 22.3-fold for miR-133a and 7.5-fold for miR-1). The correlation between changes in the levels of these mRNAs was high (Spearman correlation coefficient=0.89). Significant differences in plasma levels of miR-133a between pts with AIM and TTC were maintained even if blood was collected after 24 hours (p=0.007). For miR-16 and miR-26a, no significant differences between pts with AIM and TTC were found. The results of analysis of these mRNAs are affected to a substantial degree by the residual hemolysis due to their high content in blood cells. Conclusions It was shown that measuring the plasma levels of mRNAs miR-1 and miR-133a allows to distinguish TTC from AIM by excluding the diagnosis of TTC. The differential diagnosis is possible only within several hours after acute clinical symptoms and requires proper normalization and full compliance with the technical specifications.

Proteomic profiling of acute coronary thrombosis reveals a local decrease in pigment epithelium-derived factor in acute myocardial infarction

2012 ◽  
Vol 123 (2) ◽  
pp. 111-119 ◽  
Author(s):  
Klaus Distelmaier ◽  
Christopher Adlbrecht ◽  
Johannes Jakowitsch ◽  
Oswald Wagner ◽  
Christopher Gerner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Plaque Rupture ◽  
Coronary Thrombosis ◽  
Pigment Epithelium ◽  
Coronary Plaque ◽  
Diabetic Patients ◽  
Label Free ◽  
Proteomic Profiling ◽  
Pigment Epithelium Derived Factor

Thrombotic occlusion of an epicardial coronary artery on the grounds of atherosclerotic plaque is considered the ultimate step in AMI (acute myocardial infarction). However, the precise pathophysiological mechanisms underlying acute coronary occlusion are not fully understood. We have analysed proteomic profiles of systemic plasma and plasma derived from the site of coronary plaque rupture of non-diabetic patients with STEMI (ST-segment elevation myocardial infarction). Label-free quantification of MS/MS (tandem MS) data revealed differential regulation of complement cascade components and a decrease in anti-thrombotic PEDF (pigment epithelium-derived factor) between CS (culprit site)-derived plasma and systemic plasma. PEDF, which is known to have a protective role in atherothrombosis, was relatively decreased at the CS, with a level of expression inverse to local MMP-9 (matrix metalloproteinase-9) activity. CS plasma displayed enhanced proteolytic activity towards PEDF. Proteomics of coronary thrombus aspirates indicate that PEDF processing is associated with coronary plaque rupture.

scholarly journals Clinical Characteristics and Outcomes of Takotsubo Cardiomyopathy

2016 ◽  
Vol 5 ◽  
Author(s):  
Jen Li Looi ◽  
Andrew J Kerr
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Stressful Event ◽  
Coronary Syndrome ◽  
Important Differential Diagnosis ◽  
Menopausal Women ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Post Menopausal

<p><span lang="EN-AU"><span style="font-family: Times New Roman; font-size: medium;">Takotsubo cardiomyopathy (TC) is a transient, reversible form of cardiomyopathy which predominantly affects post-menopausal women and is an important differential diagnosis of acute coronary syndrome. It is characterised by normal (or near-normal) coronary arteries, regional wall motion abnormalities that extend beyond a single coronary vascular bed, and often proceeded by a stressful event. The pathophysiologic mechanism is complex and remains to be elucidated. There is increasing awareness among physicians about TC and hence, more cases are being reported. The diagnosis of TC has important clinical implications in the management at presentation and afterward. In this review, we discuss the demographics, clinical features, prognosis and management of this cardiomyopathy.</span></span></p>

Myocardial Infarction with Nonobstructive Coronary Artery Disease—Definition, Etiopathogenesis, Diagnosis, and Management

2021 ◽  
Author(s):  
Patrick Baghdasaryan ◽  
Balaji Natarajan ◽  
Madlena Nalbandian ◽  
Padmini Varadarajan ◽  
Ramdas G. Pai
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Plaque Rupture ◽  
Coronary Microvascular Dysfunction ◽  
Rare Presentation ◽  
Diagnosis And Management ◽  
Coronary Syndrome ◽  
Disease Definition ◽  
Artery Disease

AbstractMyocardial infarction with nonobstructive coronary arteries (MINOCA) is a complex clinical syndrome that is characterized by evidence of acute myocardial infarction in the absence of significant epicardial coronary artery disease on angiography. The term “MINOCA” encompasses a group of heterogeneous diseases with varying underlying mechanisms and each with its own pathophysiology. Overlooked plaque rupture or erosion and coronary vasospasm are the most common causes of MINOCA and can be diagnosed by routine intracoronary imaging and vasoreactivity testing, respectively. Coronary microvascular dysfunction is a less recognized, albeit an important cause of morbidity in patients presenting with MINOCA. Although MINOCA is a rare presentation of acute coronary syndrome, it is not a benign disorder and can have adverse consequences if untreated. In this article, we aim to review the pathogenesis, clinical characteristics, and finally propose a systematic approach in the diagnosis and management of patients with MINOCA.

P816Mortality during weekend admission for takotsubo syndrome: a national cross sectional large scale study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Malanchini ◽  
F Lombardi
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Takotsubo Cardiomyopathy ◽  
Multivariate Logistic Regression Analysis ◽  
Early Reperfusion ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
The Impact

Abstract Background Higher mortality rates in patients admitted for an acute myocardial infarction during weekends has been recently confirmed. Differences in staffing and in lower rates of early reperfusion therapy are thought to affect outcomes of these patients particularly of those presenting with ST segment elevation. Patients affected by Takotsubo cardiomyopathy may present themselves mimicking those affected by heart attack and are frequently admitted with supposed diagnosis of acute coronary syndrome. No data is available about influence on mortality in relation to the time of admission among patients with Takotsubo cardiomyopathy. Rationale The aim of this study is to assess the effect on mortality due to admission during weekend among patients discharged with diagnosis of Takotsubo cardiomyopathy. Methods We retrieved administrative data about every admission to National Healthcare System hospitals in Italy between 2009 and 2017 with final diagnosis of Takotsubo cardiomyopathy according to ICD9-CM classification of diseases (code 429.83). Date of admission was used to determine the weekend (Saturday and Sunday) or weekdays exposure (Monday to Friday). The primary outcome was in-hospital mortality. Demographical characteristics of patients (age and sex) were included in a multivariate logistic regression analysis. We also analyzed the impact of weekend admission on time to coronary angiography and on length of hospital staying. Analyses were performed using Stata 13.0. Results A total of 10,861 Takotsubo admissions were identified. Mean age was 70.7 years and 91.7% were women. The in-hospital mortality was 2.21%. We found that there was no significant increase in the risk of death among patients admitted during weekends (OR 1.07; 95% CI 0.77–1.44). The variability explained by the model was of 4.2% (pseudo R-squared 0.042). Men have a higher risk of mortality as compared to women (OR 2.37, 95% C.I 1.69–3.33). Patients admitted during weekend tends to stay in hospital longer, but they do not seem to wait more days to get a coronary angiography. Conclusions At variance with patients with ST elevated acute myocardial infarction, subjects admitted during weekends for Takotsubo cardiomyopathy did not show an excess of in-hospital mortality in comparison to those admitted during week days.

Acute Coronary Syndrome

2019 ◽  
pp. 190-196
Author(s):  
Siva S. Ketha ◽  
Juan Carlos Leoni Moreno
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Plaque Rupture ◽  
Clinical Manifestations ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Atherosclerotic Plaque Rupture

Acute coronary syndrome (ACS) encompasses all clinical manifestations caused by active myocardial ischemia and includes 3 entities: unstable angina (UA), acute non–ST-segment elevation myocardial infarction (NSTEMI), and acute ST-segment elevation myocardial infarction (STEMI). Atherosclerotic plaque rupture is the most consistent pathophysiologic event in ACS. After plaque rupture, cardiac myocytes die as a consequence of continued occlusion, thereby causing acute myocardial infarction (MI). Prompt recognition of ACS is crucial because the greatest therapeutic effect is achieved if treatment is performed soon after presentation.

Sign in / Sign up

Export Citation Format

Share Document