Differential diagnostics of takotsubo syndrome and acute myocardial infarction against the background of a new COVID-19 coronavirus infection

Background. Takotsubo syndrome is a reversible heart failure syndrome which often presents with symptoms and ECG changes that mimic an acute myocardial infarction. Obstructive coronary artery disease has traditionally been seen as exclusion criteria for the diagnosis of takotsubo; however, recent reports have called this into question and suggest that the two conditions may coexist. Case Summary. We describe a case of an 83-year-old male presenting with chest pain consistent with acute myocardial infarction. The ECG demonstrated anterior ST elevation with bedside echocardiography showing apical wall motion abnormalities. Cardiac catheterisation found an occluded OM2 branch of the left circumflex artery with ventriculography confirming apical ballooning consistent with takotsubo and not in the vascular territory supplied by the occluded epicardial vessel. Repeat echocardiogram 6 weeks later confirmed resolution of the apical wall motion abnormalities consistent with a diagnosis of takotsubo. Discussion. This case demonstrates the finding of takotsubo syndrome in a male patient with acute myocardial infarction. Traditionally, this would preclude a diagnosis of takotsubo; however, following previous reports of takotsubo in association with coronary artery dissection and acute myocardial infarction in female patients, new diagnostic criteria have been proposed which allow the diagnosis of takotsubo in the presence of obstructive coronary artery disease. This case adds to the growing body of literature that suggests takotsubo can coexist with acute myocardial infarction; however, it remains to be elucidated if it is a consequence or cause of myocardial infarction.

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Complications of Acute Myocardial Infarction or Takotsubo Cardiomyopathy: from Intravascular Thrombus Formation to Disseminated Intravascular Coagulation

International Cardiovascular Forum Journal ◽

10.17987/icfj.v13i0.535 ◽

2018 ◽

Vol 13 ◽

Author(s):

Stefan Peters ◽

Bettina Götting

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Takotsubo Cardiomyopathy ◽

Disseminated Intravascular Coagulation ◽

Thrombus Formation ◽

Takotsubo Syndrome ◽

Intravascular Coagulation

Two cases of suggested takotsubo syndrome and severe complications have been described. It has been discussed whether these two cases are complications of acute myocardial infarction or suggested takotsubo syndrome.

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Acute myocardial damage in new coronavirus infection (COVID-19)

Уральский медицинский журнал ◽

10.52420/2071-5943-2021-20-5-98-104 ◽

2021 ◽

Vol 20 (5) ◽

pp. 98-104

Author(s):

N. V. Izmozherova ◽

A. A. Popov ◽

A. I. Tsvetkov ◽

M. A. Shambatov ◽

I. P. Antropova ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Medical Care ◽

Myocardial Injury ◽

Troponin I ◽

Myocardial Damage ◽

True Incidence ◽

Wide Range ◽

Acute Myocardial Injury ◽

Coronavirus Infection

Introduction. Acute respiratory distress syndrome (ARDS) and cardiovascular events, acute myocardial injury being the most frequent of the latter, are among the leading causes of death in COVID-19 patients. The lack of consensus on acute myocardial injury pathogenesis mechanisms, the patients management, treatment an rehabilitation logistics, the anticoagulant treatment in identified SARS-CoV-2 or suspected COVID-19 patients setting indicates the need to assess, analyze and summarize the available data on the issue.Materials and methods. Scientific publications search was carried out in PubMed, Google Scholar databases for the period from December 2019 to September 2021.Results and Discussion. Cardiospecific troponin I increase beyond reference limits is reported to occur in at least every tenth patient with identified SARS-CoV-2, the elevated troponin detection rate increasing among persons with moderate to severe course of the infection. The mechanisms of acute myocardial injury in patients with COVID-19 are poorly understood. By September 2021, there are several pathogenesis theories. A high frequency viral myocarditis direct cardiomyocytes damage is explained by the high SARS-CoV-2 affinity to ACE2 expressed in the myocardium. The cytokine storm related myocardial damage is reported a multiple organ failure consequence. Coagulopathy may also trigger myocardial microvessels damage. Up to every third death of SARS-CoV-2 infected persons is related to the acute myocardial injury. At the same time, due to the high incidence of the acute myocardial injury, it is rather difficult to assess the true incidence of acute myocardial infarction in patients with COVID-19. In the pandemic setting, the waiting time for medical care increases, the population, trying to reduce social contacts, is less likely to seek medical help. In this regard, in order to provide effective medical care to patients with acute myocardial infarction, it is necessary to develop algorithms for providing care adapted to the current epidemiological situation.Conclusion. The treatment of patients with probable development of acute myocardial damage against the background of new coronavirus infection should be performed in accordance with the current clinical guidelines. Anticoagulant therapy should be administered in a prophylactic dose under control of hemostasis parameters and a wide range of biochemical parameters.

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Chromogranin-A serum levels in patients with takotsubo syndrome and ST elevation acute myocardial infarction

International Journal of Cardiology ◽

10.1016/j.ijcard.2020.07.040 ◽

2020 ◽

Vol 320 ◽

pp. 12-17

Author(s):

Nicola Tarantino ◽

Francesco Santoro ◽

Luigi Di Biase ◽

Vito Di Terlizzi ◽

Enrica Vitale ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chromogranin A ◽

Serum Levels ◽

Takotsubo Syndrome ◽

St Elevation ◽

Elevation Acute Myocardial Infarction

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Serum Metabolomic Analysis Suggests Impairment of Myocardial Energy Production in Takotsubo Syndrome

Metabolites ◽

10.3390/metabo11070439 ◽

2021 ◽

Vol 11 (7) ◽

pp. 439

Author(s):

Iván J. Nuñez-Gil ◽

Mireia Andrés ◽

Begoña Benito ◽

Esther Bernardo ◽

Oscar Vedia ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Pattern Recognition ◽

Acute Phase ◽

Energy Production ◽

Pulse Sequence ◽

Krebs Cycle ◽

Production Capacity ◽

Takotsubo Syndrome ◽

Serum Samples

Introduction: Takotsubo syndrome is a complex entity that, although it usually has a good prognosis, can be life threatening. While recent advances have improved the knowledge of takotsubo syndrome, many aspects of its etiology still remain uncertain. Metabolomics, a hypothesis generating approach, could provide novel pathophysiology information about this disease. Methods and Results: Serum samples were obtained from takotsubo (n = 19) and acute myocardial infarction patients (n = 8) at the cath lab and, in the case of takotsubo, again once the patient had recovered, 3 months after the main event. 1H NMR spectra of the serum were acquired at 9.4T using a CPMG pulse sequence (32 ms effective delay). Supervised and unsupervised pattern recognition approaches where applied to the data. Pattern recognition was able to differentiate between takotsubo and acute myocardial infarction during the acute phase with 95% accuracy. Myocardial infarction patients showed an increase in lipid signals, a known risk factor for the disease while takotsubo patients showed a relative increase in acetate that could suggest a reduced turnover of the Krebs cycle. When comparing acute and recovered phases, we could detect an increase in alanine and creatine once patients recovered. Conclusions: Our results demonstrate that takotsubo syndrome is metabolically different than AMI, showing limited myocardial energy production capacity during the acute phase. We achieved high classification success against AMI; however, this study should be considered as a proof of concept regarding clinical application of metabolic profiling in takotsubo cardiomyopathy.

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Diagnóstico diferencial da Síndrome de Takotsubo e Infarto Agudo do Miocárdio: uma revisão narrativa / Differential diagnosis of Takotsubo syndrome and Acute Myocardial Infarction: a narrative review

Brazilian Journal of Health Review ◽

10.34119/bjhrv4n2-021 ◽

2021 ◽

Vol 4 (2) ◽

pp. 4223-4235

Author(s):

Igor Martins Costa ◽

Pedro Duarte Moreira Andrade ◽

Raíssa Teixeira Pinto ◽

Rafaela Neves de Assis ◽

Rafael Rolli Haddad ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Differential Diagnosis ◽

Narrative Review ◽

Takotsubo Syndrome

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Сlinical case of occurrence of myocardial infarction type 2 as a complication of new coronavirus infection

EMERGENCY MEDICAL CARE ◽

10.24884/2072-6716-2021-22-3-65-70 ◽

2021 ◽

Vol 22 (3) ◽

pp. 65-70

Author(s):

D. V. Oblavatckii ◽

S. A. Boldueva ◽

S. V. Alekseeva ◽

A. A. Sushkova ◽

R. R. Mikhailov ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Cardiovascular Events ◽

Clinical Case ◽

Distress Syndrome ◽

Coronavirus Infection

As known, a new coronavirus infection that causes acute respiratory distress syndrome can proceed in severe forms and lead to various complications, including acute cardiovascular events. This article describes a clinical case of the occurrence of acute myocardial infarction in a patient with a confirmed diagnosis of coronavirus infection. A peculiarity of this observation is the pathogenesis of the development of myocardial infarction, which is not directly related to atherothrombosis and differs from the classic type 1 myocardial infarction.

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