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.

Left ventricular catecholamines during acute myocardial infarction in the dog

1987 ◽  
Vol 65 (2) ◽  
pp. 172-178 ◽  
Author(s):  
W. Reuben Kaufman ◽  
Bodh I. Jugdutt
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricle ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Normal Myocardium ◽  
Radioenzymatic Assay ◽  
Coronary Ligation ◽  
Anesthetized Dogs ◽  
Norepinephrine Depletion

To determine whether changes in left ventricular catecholamine content occur during the first 30 to 90 min of acute myocardial infarction, myocardial catecholamine (radioenzymatic assay) over the interval was studied in the dog. In nine pentobarbital-anesthetized opened-chest dogs without coronary ligation, myocardial catecholamine at 2.5 h after pentobarbital (i) consisted mainly of norephinephrine (87% total catecholamine), (ii) showed a base to apex gradient in norephinephrine (1.44 ± 0.10 vs. 1.03 ± 0.10 μg/g, p < 0.05) and dopamine (0.20 ± 0.03 vs. 0.12 ± 0.02 μg/g, p < 0.05) but not epinephrine (0.017 vs. 0.016 μg/g), and (iii) showed no difference in norepinephrine, dopamine, or epinephrine across basal, mid, and apical left ventricular transverse planes spanning the vascular territories of the two coronary arteries. In 18 pentobarbital-anesthetized dogs with coronary ligation, (i) norepinephrine, measured in 14 regions across the mid left ventricle after 90 min ischemia in four dogs, was less in the ischemic center of the occluded bed than normal myocardium (1.01 ± 0.04 vs. 1.29 ± 0.04 μg/g, p < 0.05), and (ii) norepinephrine was unchanged in normal myocardium of 14 dogs at 30, 60, 90 min, and 48 h but decreased in ischemic myocardium by 31% at 60 min (0.89 ± 0.10 vs. 1.29 ± 0.08 μg/g, p < 0.025) and 79% at 48 h (0.27 ± 0.04 vs. 1.26 ± 0.08 μg/g, p < 0.001). Thus, norepinephrine depletion from ischemic but not normal myocardium is detectable by 60 min during acute myocardial infarction.

scholarly journals Dynamics of electrocardiographic changes, brain-natriuretic peptide and cortisol levels in a patient with stress (takotsubo) cardiomyopathy: A case report

2013 ◽  
Vol 70 (5) ◽  
pp. 511-515 ◽  
Author(s):  
Ivica Djuric ◽  
Slobodan Obradovic ◽  
Branko Gligic
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Left Ventricle ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Takotsubo Cardiomyopathy ◽  
Left Ventricular ◽  
Stressful Event ◽  
Coronary Syndrome ◽  
Electrocardiographic Changes

Introduction. Takotsubo cardiomyopathy is a transient acute heart failure syndrome caused by stress that provokes left ventricular mid-apical akinesis and mimics acute coronary syndrome. Case report. A 66-year-old woman had chest pain and dispnoea a few hours before hospitalization. A sudden emotional stressful event preceded the symptoms. Electrocardiographic abnormalities - precordial ST elevation and modest increase of cardiac troponin mimiced acute myocardial infarction. However, echocardiographic examination showed apical ballooning with markedly diminished left ventricle ejection fraction and the obstruction in the outflow tract of the left ventricle. Coronary angiography at admission showed no coronary stenosis and slower blood flow through the left anterior descending artery. According to anamnesis, echocardiography and coronarography finding we established the diagnosis of stress cardiomyopathy - takotsubo cardiomyopathy. We described in details the slow but dynamic electrocardiographic changes, levels of brain natriuretic peptide, cortisol and echocardiography evolution of disease during a 4-month follow-up till the full recovery. Conclusion. Stress (takotsubo) cardiomyopathy - became an important differential diagnosis of acute anterior myocardial infarction and it should be reconsidered every time when emotionally stressed patients with transient-apical akinesis or dyskinesis of the LV are present.

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 Rare recurrence of apical ballooning (takotsubo) syndrome in an elderly man

2018 ◽  
pp. bcr-2017-222451
Author(s):  
Rosalyn Adigun ◽  
Samantha Morley ◽  
Abhiram Prasad
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Obstructive Coronary Artery Disease ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Major Surgery ◽  
Apical Ballooning Syndrome ◽  
Elderly Male

Apical ballooning syndrome (ABS) is an under recognised clinical entity characterised by acute reversible left ventricular systolic dysfunction that mimics acute myocardial infarction in the absence of obstructive coronary artery disease; typically occurring in the setting of profound stress.1 ABS disproportionately affects older women and recurrences are infrequent. We, hereby, describe a rare phenomenon of recurrent ABS in an elderly male patient, 10 years apart, presenting with the same left ventricular morphological appearance following non-cardiac surgeries. The case illustrates the importance of considering ABS in the differential diagnosis of perioperative acute myocardial infarction in older men undergoing major surgery.

scholarly journals Surgical treatment of left ventricular wall rupture, regarded as a consequence of Takotsubo cardiomyopathy

2017 ◽  
Vol 5 ◽  
pp. 2050313X1668921 ◽  
Author(s):  
Taalaibek Kudaiberdiev ◽  
Irina Akhmedova ◽  
Gulzada Imanalieva ◽  
Ildar Abdildaev ◽  
Kilichbek Jooshev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Emotional Stress ◽  
Coronary Arteries ◽  
Takotsubo Cardiomyopathy ◽  
Laboratory Tests ◽  
Left Ventricular ◽  
Left Ventricular Aneurysm ◽  
Lv Function ◽  
Inferior Myocardial Infarction

Objective: We present the case of possible reverse type of TCM in a female patient presented with progressive left ventricular dysfunction and its rupture in pericardium. Methods: The detailed history, physical examination, laboratory tests, electrocardiography, serial echocardiography, coronary angiography with left ventriculography were performed to diagnose possible Takotsubo cardiomyopathy in 63-year old woman admitted to our center with complaints of dyspnea, lightheadedness, weakness and signs of hypotension and history of inferior myocardial infarction, acute left ventricular aneurysm, and effusive pericarditis and pleuritis, developed after emotional stress 5 months ago. Results: Clinical evaluation revealed unremarkable laboratory tests, normal troponin values, signs of old inferior myocardial infarction on electrocardiogram, and left ventricular (LV) dilatation and dysfunction, akinesia of LV infero-lateral wall with thinning and its rupture and blood shunting in pericardium. Her coronary angiography revealed normal coronary arteries. The diagnosis of pheochromocytoma was excluded. The patient underwent surgery under cardiopulmonary bypass with removal of LV pseudoaneurysm. The patient was discharged from hospital with improvement in NYHA class and LV function. Conclusion: Thus, in female postmenopausal patients presenting with acute myocardial infarction signs complicated by pericarditis, intact coronary arteries and LV dysfunction with emotional stress as triggering factor, reverse type of TCM should be considered and proper management applied to prevent development of life-threatening complications like LV rupture.

scholarly journals P181 An uncommon mechanism of severe mitral regurgitation due to infective endocarditis mimicking acute myocardial infarction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Collevecchio ◽  
G Simeti ◽  
M Previtero ◽  
S Iliceto ◽  
D Muraru ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Infective Endocarditis ◽  
Mitral Regurgitation ◽  
Coronary Arteries ◽  
Papillary Muscle ◽  
Distal Part ◽  
Troponin I ◽  
Blood Cultures ◽  
Coronary Syndrome

Abstract A 53-year-old man, smoker, with diabetes mellitus, presented to the Emergency Department because of intense chest and abdominal pain, accompanied by dyspnea and high fever (39.5 °C) in the previous 4 days. Physical examination revealed an apical holosystolic murmur, with no signs of peripheral or pulmonary edema. An ECG showed sinus rhythm (90 bpm), complete right bundle branch block and minimal ST elevation in the inferior leads. A transthoracic echocardiography showed a mild reduction in left ventricle ejection fraction (EF 44%) due to akinesia of the infero-lateral wall, and mild mitral regurgitation (MR) due to mitral valve prolapse. An abdominal ultrasound ruled out signs of acute cholecystitis. Blood cultures were collected, and an empirical antibiotic therapy was started. Urgent blood exam showed high Troponin I (72000 ng/L) and high C-reactive protein (290 mg/L). An acute coronary syndrome was suspected based on clinical, ECG and echocardiography exam, and the patient underwent coronary angiography (Figure 1, Panel A) that showed no significant coronary stenosis, except for two small filling defects in the very distal part of both the left anterior descendent and the circumflex coronary arteries suspected for coronary emboli. The patient was then admitted in the coronary care unit, but after just a few hours his clinical and hemodynamic condition deteriorated. A transesophageal echocardiography was performed to rule out mechanical complications related to the acute myocardial infarction and revealed severe MR (Panel D), elongated, hyperechogenic and dysfunctioning antero-lateral papillary muscle (ALPM) with an abnormal mobility suggestive for myocardial abscess, and a mobile mass attached on the aortic valve suggestive for vegetation (Panel B and C). Due to the worsening hemodynamic status, the patient underwent urgent cardiac surgery. Histological analysis confirmed the presence of an abscess of the ALPM due to Staphylococcus Aureus. The patient died after a week because of cerebral hemorrhage. Autopsy reported multiple lungs, renal and cerebral embolic septic infarctions. Learning points coronary artery embolization and papillary muscle abscess are very rare and often fatal consequences of infective endocarditis (IE). High (otherwise unexplained) fever and signs of embolism are minor Duke modified criteria for IE that should lead the physician to look for major criteria, such as positive blood cultures or echocardiography suggestive for IE. Emboli seen in the very distal part of the coronary arteries might have caused the ALPM abscess. Abstract P181 Figure

Depression in Acute Coronary Syndrome

2003 ◽  
Vol 93 (3_suppl) ◽  
pp. 1105-1108 ◽  
Author(s):  
Damir Kozmar ◽  
Katija Čatipović-Veselica ◽  
Andrea Galić ◽  
Jasna Habek
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Ventricular Fibrillation ◽  
Good Prognosis ◽  
Left Ventricular ◽  
Control Group ◽  
Coronary Syndrome ◽  
Mean Differences ◽  
And Control

This study examined the prevalence of depression based on scores of 200 patients with acute coronary syndrome on the Emotion Profile Index of Plutchik and its relationship with the type of acute coronary syndrome and the severity of ischemic heart disease. Patients with acute coronary syndrome scored higher on depression than the control group. There was no difference in scores on Depression by type of acute coronary syndrome and no significant mean differences on Depression for patients with and without left ventricular failure. Patients with acute myocardial infarction and ventricular fibrillation scored lower on Depression than other patients with acute myocardial infarction and control group. This study supports the view that patients with acute myocardial infarction and ventricular fibrillation and lower scores on Depression have good prognosis during hospitalization and maybe for the long term.

scholarly journals Elevated Plasma IL-37, IL-18, and IL-18BP Concentrations in Patients with Acute Coronary Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Qingwei Ji ◽  
Qiutang Zeng ◽  
Ying Huang ◽  
Ying Shi ◽  
Yingzhong Lin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Angina Pectoris ◽  
Unstable Angina ◽  
Left Ventricular ◽  
Unstable Angina Pectoris ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome

Objective.More recently, evidence showed that the novel anti-inflammatory cytokine interleukin- (IL-) 37 was expressed in the foam-like cells of atherosclerotic coronary and carotid artery plaques, suggesting that IL-37 is involved in atherosclerosis-related diseases. However, the plasma levels of IL-37 in patients with acute coronary syndrome (ACS, including unstable angina pectoris and acute myocardial infarction) have yet to be investigated.Methods.Plasma IL-37, IL-18, and IL-18BP levels were measured in 50 patients with stable angina pectoris (SAP), 75 patients with unstable angina pectoris (UAP), 67 patients with acute myocardial infarction (AMI), and 65 control patients.Results.The plasma IL-37, IL-18, and IL-18BP levels were significantly increased in ACS patients compared to SAP and control patients. A correlation analysis showed that the plasma biomarker levels were positively correlated with each other and with the levels of C-reactive protein (CRP),N-terminal probrain natriuretic peptide (NT-proBNP), and left ventricular end-diastolic dimension (LVEDD) but negatively correlated with left ventricular ejection fraction (LVEF). Furthermore, the plasma IL-37, IL-18, and IL-18BP had no correlation with the severity of the coronary artery stenosis.Conclusions.The results indicate that the plasma IL-37 levels are associated with the onset of ACS.

scholarly journals The Influence of the Duration of Acute Coronary Syndrome on the Outcomes of Endovascular Treatment

2021 ◽  
pp. 43-48
Author(s):  
Sergii V. Salo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Efficiency ◽  
Clinical Course ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Systolic Pulmonary Artery Pressure ◽  
Infarct Zone ◽  
Coronary Syndrome

Multicenter studies have proven the high effectiveness of percutaneous coronary intervention (PCI) in terms of restoring patency of the infarct-related artery (IRA) and improving the prognosis in acute myocardial infarction (AMI). The mechanism of improvement of clinical result after PCI procedure appears to be multifactorial. The aim. To investigate the effect of IRA stenting on the clinical course, prognosis and contractility of the heart in patients with different duration of acute myocardial infarction and its influence on the short-term and long-term effects after intervention. The main determinant for the favorable clinical course and improvement of the prognosis is early (within the first hours of the disease) restoration of antegrade blood flow by IRA stenting. Thus, it is possible to signifi-cantly improve the blood supply to the peri-infarct zone and limit the area of necrosis and maintain heart rate. Materials and methods. The analyzed group included 684 patients with AMI who were endovascularly treated at the Department of Emergency Endovascular Heart Surgery of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from January 1, 2017 to January 1, 2021. Coronary artery stenting was performed in all the patients. STEMI occurred in 495 (72.4%) patients, and non-STEMI in 189 (27.6%) patients. The mean age of the subjects was 61.8 ± 12.1 years. There were 289 women (42.3%) and 395 men (57.7%). Distribu-tion of the patients depending on the initial Killip class was as follows: 13 (1.9%) had class I, 199 (29.1%) had class II, and 472 (69.0%) had class III myocardial infarction. Atrial fibrillation occurred in 72 (10.5%) patients. Echocardiographic parameters were as follows: left ventricular (LV) end-systolic index 54.1 ± 12.8 ml/m2, LV ejection fraction 0.53 ± 0.05, left atrial diameter 39.5 ± 3.8 mm, systolic pulmonary artery pressure 44.8 ± 7.8 mmHg. In this study, clinical condition and functional capacity of the heart muscle in patients with AMI depending on the condition of the stent segment and the timing of endovascular procedures after the onset of the disease were first inves-tigated in the long term. Conclusions. High efficiency and safety of PCI have been proven, which makes it possible to recommend this pro-cedure for wide application. It has been proven that PCI using matrix and modular stents, as well as statins can reduce the frequency of in-stent stenosis and improve the clinical course of the disease in the long term. It has been proven that stenting in patients with AMI is most effective in the earliest stages of the disease with preservation of LV contractility with possibly complete myocardial revascularization, which contributes to the preservation of viable myocardium in the peri-infarct zone, improvement of myocardial contractility and prevention of myocardium remodeling.

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