scholarly journals Case report: Takotsubo cardiomyopathy in a patient with Alzheimer’s disease

2021 ◽  
Author(s):  
Isadora Vieira de Melo ◽  
Eduardo Guimarães Lacerda ◽  
Gustavo de Freitas Mendonça Gontijo ◽  
Hugo Haran Souza Andrade ◽  
Marlon Séles de Paula ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Case Report ◽  
Emotional Stress ◽  
Takotsubo Cardiomyopathy ◽  
Left Ventricular ◽  
Lv Function ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Multiple Drugs

Context: The Takotsubo cardiomyopathy (TTC) is an acute cardiac dysfunction, clinically similar to myocardial ischemia, more common in postmenopausal women and related to emotional stress. Case report: A 71-year-old female patient, with Alzheimer’s disease (AD), sought emergency care after severe chest pain. Electrocardiogram showed ST segment elevation in the anteroseptal wall. Physical exam: HR=108bpm, PA=126x78mmHg, SaO2=6%. Complementary exams showed a mild lesion in the middle third of the anterior descending artery, moderate impairment of left ventricular (LV) function by apical aneurysm without thrombi, mitral prolapse with mild reflux and an ejection fraction of 37%, suspecting of TTC. Conclusions: TTC is defined as a transient, usually reversible and segmental LV dysfunction, configuring a differential diagnosis of acute coronary syndrome. An overactivation of the sympathetic autonomic nervous system can cause catecholamine toxicity to the heart. Although several studies show a lower emotional response capacity in patients with cognitive impairment, more recent studies suggest that this emotional responsiveness is not so affected by dementia. Therefore, patients with AD may be susceptible to developing TTC, both because of the multiple drugs that they are exposed, increasing catecholamine levels, and because of the disease itself, that represents a stressful context. Thus, TTC is often associated with emotional stress and should not be overlooked in patients with AD.

scholarly journals Takotsubo Cardiomyopathy: An Unusual Case Report in a Patient Affected with Alzheimer’s Disease

2019 ◽  
pp. 1-3
Author(s):  
Pietro Gareri
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Case Report ◽  
Left Ventricular ◽  
Female Ratio ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Male Female Ratio ◽  
One Year

We describe a case report regarding an elderly woman affected with Alzheimer’s disease (AD), presenting to the ER for chest pain, and showing ST-segment elevation on electrocardiography, and elevated cardiac enzyme levels. She was hospitalized and after a number of laboratory and instrumental exams she was diagnosed Tako-tsubo syndrome. One year after the event she is feeling fine, electrocardiogram is normal, and no symptoms of cardiac heart failure are present. Tako-tsubo syndrome is a stress-induced cardiomyopathy that involves left ventricular apical akinesis and mimics acute coronary syndrome. It was first described in Japan in 1991, it is rare (1:36.000) with 1:3 male/female ratio and survival is usually 96%. The novelty of this case-report is due to its rarity and to the onset of the disease in an elderly patient affected with AD.

Atypical Takotsubo Cardiomyopathy with Hypokinetic Left Mid-ventricle and Apical Wall Sparing: A Case Report and Literature Review

2020 ◽  
Vol 16 (3) ◽  
pp. 241-246
Author(s):  
Dipesh Ludhwani ◽  
Belaal Sheikh ◽  
Vasu K Patel ◽  
Khushali Jhaveri ◽  
Mohammad Kizilbash ◽  
...  
Keyword(s):  
Case Report ◽  
Takotsubo Cardiomyopathy ◽  
Systolic Dysfunction ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome ◽  
Normal Left Ventricular ◽  
Artery Disease

Background: Takotsubo Cardiomyopathy (TTC) is an uncommon cause of acute reversible ventricular systolic dysfunction in the absence of obstructive Coronary Artery Disease (CAD). Typically manifesting as apical wall ballooning, TTC can rarely present atypically with apical wall sparing. Case report: A 62-year-old female presented with complaints of chest pain and features mimicking acute coronary syndrome. Coronary angiogram revealed no obstructive CAD and left ventriculogram showed reduced ejection fraction, normal left ventricular apex and hypokinetic mid-ventricles consistent with atypical TTC. The patient was discharged home on heart failure medications and a follow-up transthoracic echocardiogram demonstrated improved left ventricular function with no wall motion abnormality. Conclusion: This case report provides an insight into the diagnosis and management of TTC in the absence of pathognomic features.

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.

Takotsubo cardiomyopathy associated with adrenal insufficiency in the context of long-term steroid use mimicking acute coronary syndrome

2021 ◽  
Vol 14 (1) ◽  
pp. e234983
Author(s):  
Timothy Bagnall ◽  
Ying Ran Tow ◽  
Nicholas Bunce ◽  
Zoe Astroulakis
Keyword(s):  
Acute Coronary Syndrome ◽  
Adrenal Insufficiency ◽  
Takotsubo Cardiomyopathy ◽  
Left Ventricular ◽  
Lv Function ◽  
Rapid Improvement ◽  
Steroid Use ◽  
Coronary Syndrome ◽  
First Case

Takotsubo cardiomyopathy (TCMP) is an important, though under-recognised, syndrome which mimics acute coronary syndrome (ACS) presenting with similar clinical, biochemical and ECG features. A 68-year-old man was referred as ACS for emergency coronary angiography; however, a history of lethargy, weight loss and electrolyte abnormalities prompted further investigations. Angiography was postponed, adrenal insufficiency confirmed and steroid replacement commenced. Echocardiography demonstrated reduced left ventricular (LV) function (45%) with regional wall motion abnormalities, although angiography confirmed unobstructed arteries. Steroid replacement induced a rapid improvement in symptoms and LV function. Few cases of TCMP associated with adrenal insufficiency have been reported. This appears to be the first case describing TCMP precipitated by new-onset secondary adrenal insufficiency following long-term steroid use in a male patient, and highlights the importance of considering TCMP in patients presenting with suspected ACS. Here, prompt recognition and treatment of a serious underlying disorder prevented a potentially life-threatening Addisonian crisis.

Management of airway obstruction with nebulised adrenaline resulting in takotsubo cardiomyopathy: case report

2016 ◽  
Vol 130 (9) ◽  
pp. 883-886 ◽  
Author(s):  
F Keshtkar ◽  
O T Dale ◽  
W O Bennett ◽  
C E Hall
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
Takotsubo Cardiomyopathy ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Coronary Syndrome ◽  
Wave Inversion ◽  
Acute Airway Obstruction ◽  
Artery Disease ◽  
High Index Of Suspicion

AbstractBackground:Takotsubo cardiomyopathy has been associated with the use of catecholamines; however, its development after the use of nebulised adrenaline for the management of acute airway obstruction has not previously been described.Case report:A 66-year-old man with squamous cell carcinoma of the larynx, with tumour–node–metastasis staging of T3N2cM0, confirmed by biopsy and computed tomography, presented to the emergency department with acute airway obstruction. He was treated twice with nebulised adrenaline and intravenous dexamethasone. After a period of 24 hours, cardiac rhythm changes were noted on telemetry. A 12-lead electrocardiogram showed widespread T-wave inversion and QT prolongation suggestive of an acute coronary syndrome. Coronary angiography demonstrated no coronary artery disease, but left ventricular angiography showed marked apical ballooning and apical wall akinesia consistent with a diagnosis of takotsubo cardiomyopathy.Conclusion:Takotsubo cardiomyopathy can mimic true ischaemic heart disease and the diagnosis requires a high index of suspicion in patients managed with nebulised adrenaline.

scholarly journals Electrocardiographic Findings in Takotsubo Cardiomyopathy: ECG Evolution and Its Difference from the ECG of Acute Coronary Syndrome

2014 ◽  
Vol 8 ◽  
pp. CMC.S14086 ◽  
Author(s):  
June Namgung
Keyword(s):  
Acute Coronary Syndrome ◽  
Takotsubo Cardiomyopathy ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Qtc Interval ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Wave Inversion ◽  
St Segment

Background Electrocardiogram (ECG) manifestations of takotsubo cardiomyopathy (TC) produce ST-segment elevation or T-wave inversion, mimicking acute coronary syndrome (ACS). We describe the ECG manifestation of TC, including ECG evolution, and its different points from ACS. Methods We studied 37 consecutive patients (age 67 ± 15 years, range 23-89, M:F = 12:25) from March 2004 to November 2012 with a diagnosis of TC who were proven to have apical ballooning on echocardiography or left ventricular angiography and normal coronary artery. We analyzed their standard 12-lead ECGs, including rate, PR interval, QRS duration, corrected QT (QTc) interval, ECG evolutions, and arrhythmia events. Results Two common ECG findings in TC were ST-segment elevation (n = 13, 35%) and T inversion (n = 24, 65%), mostly in the precordial leads. After ST-segment resolution, in a few days (3.5 days), diffuse and often deep T-wave inversion developed. Eight patients (22%) had transient Q-waves lasting a few days in precordial leads. No reciprocal ST-segment depression was noted. T-wave inversion continued for several months. QT prolongation (>440 milliseconds) was observed in 37 patients (97%). There were no significant life-threatening arrhythmias except atrial fibrillation (n = 6, 16%). Conclusion There are distinct differences between the ECGs of TC and ACS. These differences will help to differentiate TC from ACS.

Takotsubo Cardiomyopathy in an Elderly Patient With Severe Alzheimer's Disease: A Case Report

2012 ◽  
Vol 13 (3) ◽  
pp. 207-209 ◽  
Author(s):  
Anna Paola Cerri ◽  
Fabiola Teruzzi ◽  
Marianna Gregorio ◽  
Giuseppe Bellelli ◽  
Giorgio Annoni
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Elderly Patient ◽  
Case Report ◽  
Takotsubo Cardiomyopathy

Postoperative takotsubo cardiomyopathy: an illustration of the electrocardiographic features that raise suspicion for takotsubo

2013 ◽  
Vol 7 (3) ◽  
pp. 230-235 ◽  
Author(s):  
Hesham R Omar ◽  
James Fairbairn ◽  
Hany D Abdelmalak ◽  
Maja Delibasic ◽  
Enrico M Camporesi
Keyword(s):  
Myocardial Infarction ◽  
Takotsubo Cardiomyopathy ◽  
Systolic Function ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
St Segment Elevation ◽  
Clinical Disorder ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Takotsubo cardiomyopathy is an increasingly recognized clinical disorder mimicking acute coronary syndrome. It is usually preceded by physical or emotional stress and recovery of the left ventricular systolic function occurs in most cases within 1–4 weeks. Takotsubo cardiomypathy can masquerade as ST-segment elevation myocardial infarction when chest pain, ST-segment elevation, and high cardiac biomarkers coexist. ST-segment elevation is encountered in approximately half of the cases of takotsubo cardiomyopathy and its pattern is indistinguishable at times from ST-segment elevation myocardial infarction. However, several electrocardiographic criteria have been shown to characterize takotsubo cardiomyopathy. Awareness of these electrocardiographic features has several diagnostic and therapeutic implications. Nevertheless, these electrocardiographic criteria alone cannot reliably differentiate between both entities, and the diagnosis of takotsubo cardiomyopathy is only established after coronary angiography confirms the absence of occlusive coronary artery disease and the characteristic apical ballooning is evident on left ventriculogram (in the case of the apical form). Herein, we present a case of postoperative takotsubo cardiomyopathy and discuss the various electrocardiographic features that raise suspicion for this transient cardiac syndrome.

scholarly journals Myocardial Infarction or Takotsubo Cardiomyopathy? A Case Report of a Rare Clinical Dilemma in the Setting of Atrial Myxoma

2021 ◽  
Author(s):  
Balasubramaniyan Amirtha Ganesh ◽  
Sasinthar Rangasamy ◽  
Arumugam Aashish ◽  
Selvaraj Karthikeyan
Keyword(s):  
Myocardial Infarction ◽  
Takotsubo Cardiomyopathy ◽  
Acute Chest Pain ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Atrial Myxoma ◽  
Lv Function ◽  
St Segment Elevation ◽  
Coronary Embolization ◽  
Clinical Dilemma

Abstract Background Acute myocardial infarction (AMI) secondary to coronary embolization is one of the rare complications of atrial myxoma. Takotsubo cardiomyopathy (TCM), a close mimic of AMI, is extremely rare in the setting of atrial myxoma. We report a patient with atrial myxoma presenting with features leading to a clinical dilemma between these two entities. Case summary  A 60-year-old woman presented with acute chest pain with ST segment elevation. Echocardiogram revealed left ventricular (LV) apical ballooning which is typical of TCM, coexisting with a fragile left atrial mass. Emergency coronary angiogram showed a hazy lesion in the circumflex ostium and an intermediate lesion in ramus without any obstruction. Surgical excision of the tumor was done due to features of recurrent coronary embolism. The histopathology examination confirmed it as a myxoma. Regional wall motion abnormalities reversed within a month and LV function normalized. Cardiac magnetic resonance (CMR) imaging at follow-up suggested myocardial infarction. Discussion TCM can occur very rarely in the setting of atrial myxoma. In a patient with atrial myxoma presenting with features of TCM, differentiating it from coronary embolization is important.

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