scholarly journals Takotsubo syndrome and pheochromocytoma: an insidious combination

2021 ◽  
Author(s):  
Stefano Maffè ◽  
Pierfranco Dellavesa ◽  
Paola Paffoni ◽  
Luca Bergamasco ◽  
Marisa Arrondini ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Systolic Function ◽  
Abdominal Mass ◽  
Clinical Status ◽  
Vena Cava ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Abdomen Ct ◽  
Retrosternal Pain

Pheochromocytoma is a rare adrenal tumor characterized by the secretion of catecholamines and vasoactive peptides. It can cause a catecholaminergic storm and lead to acute coronary syndromes. We present the case of a 53-year-old man, without any medical history, who arrived to the hospital following a spinal trauma due a fall. He presents back and retrosternal pain, with a clinical status of acute pulmonary edema, sinus tachycardia with left bundle branch block, left ventricular apical ballooning with depressed systolic function. Blood tests show a very important increase of Troponin and transaminases. A contrast chest-abdomen CT highlighted a right adrenal solid mass, with a diameter of 78mm, partial capsular laceration, compression of the inferior vena cava and the hepatic parenchyma. The clinical condition of the patient rapidly worsens from a respiratory and hemodynamic point of view, with cardiogenic shock, anuria and sepsis, refractory to all the medical treatments, until the patient died. The autopsy confirmed that the abdominal mass was a pheochromocytoma, broken after the trauma suffered. The resulting catecholaminergic storm caused a myocardial ischemia with Takotsubo syndrome, with cardiogenic shock. This unfortunate case confirms the pheochromocytoma as important risk factor for the onset of Takotsubo syndrome, and the how dramatic and severe a catecholaminergic storm can be.

scholarly journals Dynamic Left Intraventricular Obstruction Phenotype in Takotsubo Syndrome

2021 ◽  
Vol 10 (15) ◽  
pp. 3235
Author(s):  
Davide Di Vece ◽  
Angelo Silverio ◽  
Michele Bellino ◽  
Gennaro Galasso ◽  
Carmine Vecchione ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Systolic Function ◽  
Hemodynamic Instability ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Benign Condition ◽  
Coronary Syndrome ◽  
Lv Dysfunction ◽  
Appropriate Therapy ◽  
Selection Of

Takotsubo syndrome (TTS) is characterized by acute, generally transient left ventricular (LV) dysfunction. Although TTS has been long regarded as a benign condition, recent evidence showed that rate of acute complications and in-hospital mortality is comparable to that of patients with acute coronary syndrome. In particular, the prevalence of cardiogenic shock ranges between 6% and 20%. In this setting, detection of mechanisms leading to cardiogenic shock can be challenging. Besides a severely impaired systolic function, onset of LV outflow tract obstruction (LVOTO) together with mitral regurgitation related to systolic anterior motion of mitral valve leaflets can lead to hemodynamic instability. Early identification of LVOTO with echocardiography is crucial and has important implications on selection of the appropriate therapy. Application of short-acting b1-selective betablockers and prudent administration of fluids might help to resolve LVOTO. Conversely, inotrope agents may increase basal hypercontractility and worsen the intraventricular pressure gradient. To date, outcomes and management of patients with TTS complicated by LVOTO as yet has not been comprehensively investigated.

scholarly journals Syndrome of Reversible Cardiogenic Shock and Left Ventricular Ballooning in Obstructive Hypertrophic Cardiomyopathy

2021 ◽  
Author(s):  
Mark V. Sherrid ◽  
Daniel G. Swistel ◽  
Iacopo Olivotto ◽  
Maurizio Pieroni ◽  
Omar Wever‐Pinzon ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Systolic Function ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Outflow Obstruction ◽  
Refractory Shock ◽  
Alcohol Ablation

Background Cardiogenic shock from most causes has unfavorable prognosis. Hypertrophic cardiomyopathy (HCM) can uncommonly present with apical ballooning and shock in association with sudden development of severe and unrelenting left ventricular (LV) outflow obstruction. Typical HCM phenotypic features of mild septal thickening, outflow gradients, and distinctive mitral abnormalities differentiate these patients from others with Takotsubo syndrome, who have normal mitral valves and no outflow obstruction. Methods and Results We analyzed 8 patients from our 4 HCM centers with obstructive HCM and abrupt presentation of cardiogenic shock with LV ballooning, and 6 cases reported in literature. Of 14 patients, 10 (71%) were women, aged 66±9 years, presenting with acute symptoms: LV ballooning; depressed ejection fraction (25±5%); refractory systemic hypotension; marked LV outflow tract obstruction (peak gradient, 94±28 mm Hg); and elevated troponin, but absence of atherosclerotic coronary disease. Shock was managed with intravenous administration of phenylephrine (n=6), norepinephrine (n=6), β‐blocker (n=7), and vasopressin (n=1). Mechanical circulatory support was required in 8, including intra‐aortic balloon pump (n=4), venoarterial extracorporeal membrane oxygenation (n=3), and Impella and Tandem Heart in 1 each. In refractory shock, urgent relief of obstruction by myectomy was performed in 5, and alcohol ablation in 1. All patients survived their critical illness, with full recovery of systolic function. Conclusions When cardiogenic shock and LV ballooning occur in obstructive HCM, they are marked by distinctive anatomic and physiologic features. Relief of obstruction with targeted pharmacotherapy, mechanical circulatory support, and myectomy, when necessary for refractory shock, may lead to survival and normalization of systolic function.

scholarly journals Dynamic left ventricular outflow tract obstruction in Takotsubo cardiomyopathy resulting in cardiogenic shock

2021 ◽  
Vol 14 (3) ◽  
pp. e240010
Author(s):  
Paulina M Conradi ◽  
Ramon B van Loon ◽  
M Louis Handoko
Keyword(s):  
Mitral Valve ◽  
Cardiogenic Shock ◽  
Left Ventricular Outflow Tract ◽  
Apical Ballooning ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Systolic Anterior Motion ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow

We report a case of a 73-year-old female patient, who was admitted to the coronary care unit due to chest pain, malaise and near syncope. During physical examination, the patient was hypotensive and there were signs of left-sided heart failure and a loud systolic murmur. Echocardiogram showed apical ballooning with dynamic left ventricular outflow tract obstruction, based on systolic anterior motion of the mitral valve with important mitral valve regurgitation. In the acute setting, the cardiogenic shock was treated cautiously with fluid resuscitation and intravenous metoprolol, resulting in direct stabilisation of her haemodynamic condition. As a codiagnosis, there was a significant stenosis of left anterior descending artery, which was treated successfully by percutaneous coronary intervention with drug eluting stents. During follow-up, left ventricular function normalised, and the left ventricular outflow tract obstruction, systolic anterior motion of mitral valve and related mitral regurgitation all resolved.

scholarly journals A life-threatening reverse Takotsubo syndrome in a young breastfeeding woman: a case report

2021 ◽  
Author(s):  
Carla Marques Pires ◽  
Sérgia Rocha ◽  
Nuno Salomé ◽  
Pedro Azevedo
Keyword(s):  
Cardiogenic Shock ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Presumptive Diagnosis ◽  
Lv Dysfunction ◽  
St Segment ◽  
Life Threatening ◽  
Triggering Factor ◽  
Β Blocker

Abstract Background Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction and is usually triggered by emotional, physical or combined stress. This syndrome has been increasingly recognized, although it remains a challenging and often misdiagnosed disorder. Case Summary A 36-year-old breastfeeding woman was admitted with sudden dyspnoea and oppressive chest pain. On admission she was lethargic, hypotensive and tachycardic. The electrocardiogram showed rapid atrial fibrillation and diffuse ST-segment depression. The transthoracic echocardiogram (TTE) revealed severe LV systolic dysfunction, with midventricular and basal akinesis, compensatory apical hyperkinesia and without intraventricular gradient. Emergent coronary angiogram showed normal coronary arteries. A presumptive diagnosis of reverse TTS with cardiogenic shock was made. The patient was transferred to the Intensive Care Unit after intubation and inotropic and vasopressor support was initiated. During hospitalization, rapid clinical improvement was observed. In three days, the patient was weaned from hemodynamic support and extubated. Furthermore, β-blocker and angiotensin receptor blocker were initiated and tolerated. Cabergoline was also administered to inhibit lactation. The presumptive diagnosis was further strengthened by cardiac magnetic resonance and all triggering factors were excluded. At hospital discharge she was asymptomatic and the follow-up TTE was normal, which confirmed the diagnosis of reverse TTS. DISCUSSION We present a case of a young woman, eight months after delivery, which developed a life-threatening reverse TTS without triggering factor identified. Reverse TTS is a rare variant of TTS with different clinical features and is more likely to be complicated by pulmonary edema and cardiogenic shock.

scholarly journals Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases

2020 ◽  
Vol 2 (11) ◽  
pp. 2102-2108 ◽  
Author(s):  
Sandeep Singh ◽  
Rupak Desai ◽  
Zainab Gandhi ◽  
Hee Kong Fong ◽  
Shriya Doreswamy ◽  
...  
Keyword(s):  
Case Reports ◽  
Hypertensive Crisis ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Complications ◽  
Time Interval ◽  
Takotsubo Syndrome ◽  
Ventricular Ejection Fraction ◽  
Successful Recovery

AbstractTakotsubo syndrome (TTS) is caused by catecholamine surge, which is also observed in COVID-19 disease due to the cytokine storm. We performed a systematic literature search using PubMed/Medline, SCOPUS, Web of Science, and Google Scholar databases to identify COVID-19-associated TTS case reports and evaluated patient-level demographics, clinical attributes, and outcomes. There are 12 cases reported of TTS associated with COVID-19 infection with mean age of 70.8 ± 15.2 years (range 43–87 years) with elderly (66.6% > 60 years) female (66.6%) majority. The time interval from the first symptom to TTS was 8.3 ± 3.6 days (range 3–14 days). Out of 12 cases, 7 reported apical ballooning, 4 reported basal segment hypo/akinesia, and 1 reported median TTS. Out of 12 cases, during hospitalization, data on left ventricular ejection fraction (LVEF) was reported in only 9 of the cases. The mean LVEF was 40.6 ± 9.9% (male, 46.7 ± 5.7%, and female, 37.7 ± 10.6%). Troponin was measured in all 12 cases and was elevated in 11 (91.6%) without stenosis on coronary angiography except one. Out of 11 cases, 6 developed cardiac complications with 1 case each of cardiac tamponade, heart failure, myocarditis, hypertensive crisis, and cardiogenic shock in 2. Five patients required intubation, 1 patient required continuous positive airway pressure, and 1 patient required venovenous extracorporeal membrane oxygenation. The outcome was reported in terms of recovery in 11 (91.6%) out of 12 cases, and a successful recovery was noted in 10 (90.9%) cases. COVID-19-related TTS has a higher prevalence in older women. Despite a lower prevalence of cardiac comorbidities in COVID-19 patients, direct myocardial injury, inflammation, and stress may contribute to TTS with a high complication rate.

scholarly journals Inverted takotsubo syndrome complicated with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation in a patient with bilateral pheochromocytoma: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 1-5
Author(s):  
Bebiana Manuela Monteiro Faria ◽  
João Português ◽  
Roberto Roncon-Albuquerque Jr ◽  
Rodrigo Pimentel
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Lv Function ◽  
Takotsubo Syndrome ◽  
Membrane Oxygenation ◽  
Lv Dysfunction

Abstract Background Takotsubo syndrome (TS) is characterized by a transient left ventricular (LV) dysfunction and rarely presents with cardiogenic shock (CS). Inverted TS (ITS) is a rare entity associated with the presence of a pheochromocytoma. Case summary We present a case of a young woman was admitted to the emergency department due to intense headache, chest discomfort, palpitations, and breathlessness. An ITS secondary to a pheochromocytoma crisis presenting with CS was diagnosed. The patient was managed with veno-arterial extracorporeal membrane oxygenation, until recovery of LV function. On the 35th day of hospitalization, open bilateral adrenalectomy was performed. Discussion Takotsubo syndrome patients presenting with CS are challenging and clinicians should be aware of underlying causes. Specific triggers such as pheochromocytoma should systematically be considered particularly if ITS was presented. Extracorporeal life support devices could provide temporary mechanical circulatory support in patients with TS on refractory CS and help to manage complex cases with TS due to pheochromocytoma.

scholarly journals The electrocardiographic ‘triangular QRS-ST-T waveform’ pattern: a marker of severe haemodynamic compromise in Takotsubo syndrome—a case report

2020 ◽  
Vol 4 (3) ◽  
pp. 1-6
Author(s):  
Tuukka Joki ◽  
Kjell Nikus ◽  
Jari Laukkanen
Keyword(s):  
Systolic Dysfunction ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Lv Function ◽  
Takotsubo Syndrome ◽  
St Elevation ◽  
Electrocardiogram Ecg ◽  
Waveform Pattern ◽  
Lambda Wave

Abstract Background Takotsubo cardiomyopathy is characterized by transient regional systolic dysfunction of the left ventricle, mimicking myocardial infarction. Although systolic left ventricular (LV) function normalizes in most cases, the outcome is not always favourable. Recently, a rare electrocardiogram (ECG) finding, lambda wave ST elevation or ‘triangular QRS-ST-T waveform’, was suggested as a possible marker of poor outcome in Takotsubo patients Case summary After a brief episode of chest pain and shortness of breath, a 67-year-old woman developed cardiogenic shock. Her resting ECG showed widespread ST elevations, which soon evolved into a pattern of triangular QRS-ST-T waveforms in the inferior leads and V3–V6. Emergent coronary angiography was normal. The ejection fraction was 20% with apical ballooning and an LV thrombus. At 1-month follow-up, the patient was asymptomatic and the ECG showed only T-wave inversions. Discussion The triangular QRS-ST-T waveform ECG pattern has recently been introduced as a high-risk marker in the Takotsubo syndrome.

scholarly journals Giant Cell Myocarditis: Not Always a Presentation of Cardiogenic Shock

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Rose Tompkins ◽  
William J. Cole ◽  
Barry P. Rosenzweig ◽  
Leon Axel ◽  
Sripal Bangalore ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Giant Cell ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Rapid Decline ◽  
Giant Cell Myocarditis ◽  
Hemodynamic Compromise ◽  
Hemodynamic Deterioration

Giant cell myocarditis is a rare and often fatal disease. The most obvious presentation often described in the literature is one of rapid hemodynamic deterioration due to cardiogenic shock necessitating urgent consideration of mechanical circulatory support and heart transplantation. We present the case of a 60-year-old man whose initial presentation was consistent with myopericarditis but who went on to develop a rapid decline in left ventricular systolic function without overt hemodynamic compromise or dramatic symptomatology. Giant cell myocarditis was confirmed via endomyocardial biopsy. Combined immunosuppression with corticosteroids and calcineurin inhibitor resulted in resolution of symptoms and sustained recovery of left ventricular function one year later. Our case highlights that giant cell myocarditis does not always present with cardiogenic shock and should be considered in the evaluation of new onset cardiomyopathy of uncertain etiology as a timely diagnosis has distinct clinical implications on management and prognosis.

Haemodynamic insights into the effects of ischaemia and cycle length on tissue Doppler-derived mitral annulus diastolic velocities

2004 ◽  
Vol 106 (2) ◽  
pp. 147-154 ◽  
Author(s):  
Sherif F. NAGUEH ◽  
Liyun RAO ◽  
Julia SOTO ◽  
Katherine J. MIDDLETON ◽  
Dirar S. KHOURY
Keyword(s):  
Cycle Length ◽  
Systolic Function ◽  
Vena Cava ◽  
Coronary Artery Occlusion ◽  
Mitral Annulus ◽  
Tissue Doppler ◽  
Artery Occlusion ◽  
Left Ventricular ◽  
Heart Catheterization ◽  
Cycle Lengths

In the present study, we performed simultaneous epicardial echocardiography and left heart catheterization on ten adult dogs to investigate the effects of ischaemia and tachycardia on the mitral annulus early (Ea) and late (Aa) diastolic velocities and the haemodynamic mechanisms involved. Left atrial pressure and left ventricular (LV) volumes and pressures were measured with 5 French Millar catheters. In each dog, inferior vena cava occlusion was used to alter preload and circumflex coronary artery occlusion was applied to induce ischaemia at two different cycle lengths: 450 and 550 ms. At both cycle lengths, ischaemia resulted in a reduction in LV relaxation, LV global and ipsilateral systolic function, transmitral pressure gradient (TMG), Ea and Aa (P<0.05). The shorter cycle length was associated with a shorter tau (time constant of LV relaxation), reduced TMG and reduced septal and lateral Ea (P<0.05 for all variables). Both septal and lateral Aa were significantly increased (P<0.05). Ischaemia influences Ea through changes in LV relaxation, global and regional systolic function and TMG. An increase in heart rate reduces Ea, but increases Aa.

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