Recurrent takotsubo syndrome: case report and literature review

Introduction: Takotsubo syndrome is a cardiomyopathy that can lead to severe myocardial involvement. It is characterized by the presence of signs and symptoms suggestive of ventricular dysfunction associated with an adrenergic discharge during a stressful event. This case report presents a literature review, as well as a comparison with other similar cases. Case presentation. A 56-year-old female with a previous episode of Takotsubo was admitted to the emergency department due to symptoms of acute coronary syndrome and a history of Takotsubo syndrome. Her electrocardiogram showed T-wave inversion in leads V1-V4 and a raise in troponins. Percutaneous coronary angiography revealed no coronary lesions, and an echocardiogram revealed segmental alterations compatible with Takotsubo syndrome, requiring medical therapy with beta-blockers and angiotensin-converting enzyme (ACE) inhibitors, with subsequent improvement in ventricular function. Conclusions. Recurrence in Takotsubo cardiomyopathy is a rare complication that should be suspected. The risk factors associated with recurrence are not known. Although therapy with ACE inhibitors and beta-blockers seems to have an impact on the recovery of ventricular function in patients with this condition, further studies are necessary to establish the best pharmacological treatment.

Introducción. La miocardiopatía de Takotsubo (MT) es una afección cardiaca que puede generar compromiso miocárdico severo y se caracteriza por la presencia de signos y síntomas sugestivos de disfunción ventricular que se asocian a una descarga adrenérgica durante un evento estresor. En este reporte de caso se realizó una revisión de la literatura y se hizo una comparación con otros casos similares al presentado. Presentación del caso. Mujer de 56 años, quien asistió al servicio de urgencias por síntomas sugestivos de un síndrome coronario agudo. A la paciente, que tenía antecedente de MT, se le realizó un electrocardiograma que mostró inversión de la onda T en las derivaciones V1-V4 y elevación de troponinas, una angiografía coronaria que evidenció arterias epicárdicas sin lesiones y un ecocardiograma que reveló alteraciones segmentarias compatibles con MT, por lo que se estableció manejo con betabloqueadores e inhibidores de la enzima convertidora de angiotensina (IECA), con lo cual se logró mejoría de la función ventricular. Conclusiones. La MT es una afección poco frecuente de la cual no se conocen los factores de riesgo asociados a su recurrencia. Aunque la terapia con IECA y betabloqueadores parece tener un impacto en la recuperación de la función ventricular en pacientes con esta condición, se requieren estudios adicionales para establecer el mejor manejo farmacológico.

Diagnosis and treatment of Takotsubo syndrome after liver transplantation and literature review / 器官移植

Objective To summarize the experience of diagnosis and treatment of Takotsubo syndrome (TTS) after liver transplantation. Methods Clinical data of one TTS patient after liver transplantation was retrospectively analyzed. Clinical features, diagnosis and treatment strategies were summarized, and literature review was conducted. Results A 43-year-old female patient successfully underwent split liver transplantation due to primary biliary cirrhosis for 8 years. At postoperative 3 d, the patient developed anxiety, irritation, dyspnea, disorientation, hypotension, N-terminal pro-brain natriuretic peptide (NT-proBNP) of > 35 000 pg/mL, creatine kinase isoenzyme (CK-MB) of 5.9 U/L and troponin I (TnI) of 1.78 μg/L. Electrocardiogram indicated the signs of sinus rhythm. Echocardiography indicated diffuse weakening of the left ventricular wall motion and spherical dilatation of the apex, accompanied with moderate and severe regurgitation of the mitral valve and tricuspid valve. The left ventricular ejection fraction (LVEF) declined to 23%, whereas no abnormal segmental motion of ventricular wall or corresponding electrocardiogram changes were observed. The possibility of acute coronary syndrome was excluded. The InterTAK diagnostic score was 73. The diagnosis of TTS after liver transplantation was considered. Metoprolol, coenzyme Q10, recombinant human brain natriuretic peptide, deacetyl lanatoside and lorazepam were given. Echocardiography at postoperative 10 d showed that the left ventricular function was significantly improved and the LVEF recovered to 50%. The patient was discharged 40 d after liver transplantation. The liver function was recovered well. During postoperative follow-up, she was given with metoprolol till the submission date, and no recurrence was reported. Conclusions TTS after liver transplantation is rare in clinical practice. It is difficult to make the diagnosis. The condition of TTS is severe and clinical prognosis is poor. Prompt diagnosis and interventions should be implemented.

Características clínicas, demográficas y epidemiológicas de una cohorte de pacientes con síndrome de Takotsubo entre 2011 y 2016 en Medellín, Colombia / Clinical, demographic and epidemiological characteristics of a cohort of patients with Takotsubo's syndrome from 2011 to 2016 in Medellin, Colombia

Resumen Introducción: El síndrome de Takotsubo es una disfunción ventricular aguda de carácter temporal, usualmente reversible, secundaria a eventos estresantes que comprometen el eje cerebro-corazón. Objetivo: describir las características clínicas, epidemiológicas y desenlaces de una cohorte de pacientes con síndrome de Takotsubo en Medellín-Colombia. Materiales y métodos: Estudio observacional, descriptivo, ambispectivo, realizado en una cohorte de pacientes. Se revisaron las historias clínicas de pacientes que ingresaron al servicio de urgencias de una institución de tercer nivel de complejidad de la ciudad de Medellín entre enero de 2011 y diciembre de 2016 con diagnóstico de síndrome de Takotsubo. Se diseñó un cuestionario para recolectar variables demográficas, clínicas, de laboratorio e imagenológicas. Se obtuvieron medidas de frecuencia y análisis estadístico con el programa SPSS versión 21. Resultados: El 66,7% de los pacientes fueron mujeres, la mortalidad fue del 11,1% y la recurrencia del 5,6%. La mayoría de los casos tuvieron un desencadenante conocido (94,5%), siendo la infección el más frecuente (44,4%). El 77,8% de los pacientes presentó disnea al ingreso y el 27,8% requirió uso de algún vasopresor. El promedio de la fracción de eyección del ventrículo izquierdo inicial fue del 34.17+7.8 con evidencia de mejoría en el control, promedio luego del control= 54,81+10.2. Discusión y conclusiones: El síndrome de Takotsubo es una condición infrecuente, las mujeres son la población más afectada y la mayoría de los casos obedece a un factor desencadenante. La mortalidad reportada está dentro de lo esperado y se evidenció un buen pronóstico a mediano plazo. MÉD.UIS. 2020;34(1):27-33.

Abstract Introduction: Takotsubo syndrome is an acute, usually reversible, temporal ventricular dysfunction secondary to stressful events that compromise the brain-heart axis. The study's objective is to describe the clinical, epidemiological characteristics and outcomes of a cohort of patients with Takotsubo syndrome in Medellin-Colombia. Methods: Observational, descriptive, ambispective study performed in a cohort of patients. We reviewed the medical records of patients who entered the emergency department of a third-level complex institution of Medellin between January 2011 and December 2016 with Takotsubo syndrome diagnosis. A questionnaire was designed to collect demographic, clinical, laboratory, and imaging variables. Frequency measures and statistical analyses were obtained with the SPSS version 21 program. Results: 66.7% of the patients were women, mortality was 11.1%, and recurrence was 5.6%. The majority of the cases had a known trigger (94.5%), being the infection the most frequent (44.4%), 77.8% of the patients presented dyspnea on admission, and 27.8% required the use of vasopressor. The mean baseline left ventricular ejection fraction was 34.17 + 7.8 with evidence of improvement in control, average after control = 54.81 + 10.2. Discussion and conclusions: Takotsubo syndrome is an uncommon condition. Women are the most affected population and most cases are due to a secondary cause. The reported mortality is within expectations, and a good medium-term cardiac prognosis was evidenced. MÉD.UIS. 2020;34(1):27-33.

Takotsubo. The great imitator of acute myocardial infarction / Takotsubo. El gran simulador del infarto agudo del miocardio

Abstract Takotsubo myocardiopathy, known as broken-heart syndrome due to its relationship with stressful situations, is characterized by causing symptoms which are suggestive of myocardial infarction, in the context of temporary left ventricular systolic dysfunction, with no angiographic evidence of ob structive coronary artery disease. It is much more common in older adults, predominantly in women. It is diagnosed by clinical, echocardiographic and angiographic findings. Treatment is eminently medical, generally associated with spontaneous and progressive recovery of the left ventricular systolic function. However, when the clinical presentation simulates an acute myocardial infarction in a setting where angiography is not available, there must be a clear therapeutic decision, without underestimating that a confirmed diagnosis, depending on the patient's ventricular function and/or comorbidities, may trigger cardiogenic shock and be fatal. A case of Takotsubo myocardiopathy is described, along with its management and follow-up. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/aamc.2019.1314).

Resumen La miocardiopatía de Takotsubo, conocida como síndrome del corazón roto por su relación con situaciones de estrés; se caracteriza por ocasionar síntomas sugestivos de infarto de miocardio en contexto de una disfunción sistólica temporal del ventrículo izquierdo sin demostración angiográfica de enfermedad arterial coronaria obstructiva. Es mucho más común en adultos mayores predominantemente mujeres. El diagnóstico se hace mediante hallazgos clínicos, ecocardiográficos y angiográficos. El tratamiento es eminentemente médico, generalmente relacionado con la recuperación espontánea y progresiva de la función sistólica del ventrículo izquierdo; sin embargo, el escenario de su presentación clínica que simula un infarto agudo de miocardio en un ambiente sin la disponibilidad de angiografía requiere tener claro decisión terapéutica sin desestimar que confirmado el diagnostico de acuerdo al compromiso de la función ventricular y/o comorbilidades del paciente puede desencadenar shock cardiogénico y ser fatal. Se describe un caso de miocardiopatía de Takotsubo su manejo y seguimiento. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/aamc.2019.1314).

Broken Heart Syndrome– An Intra Operative Complication.

We report a case of Broken heart Syndrome in a 56 year old Postmenopausal women suffered while undergoing simple biopsy procedures for vocal cord polyp that lead to physical, mental and financial burden both for the patient and doctors. The diagnosis of this case is made by a team of cardiologists based on clinical and echocardiographic findings.

Gastrointestinal Pain Suspected a Stressor Leading to the Onset of Takotsubo Cardiomyopathy: A Case Report.

Aims: To investigate a case of the mid-ventricular variant of Takotsubo cardiomyopathy (TTC), stress-induced cardiomyopathy, and evaluate if gastrointestinal pain may also contribute to this cardiomyopathy. Presentation of Case: A 73-year-old female was admitted for severe abdominal pain, found to have positive cardiac biomarkers and ischemic ECG changes and was diagnosed with mid-ventricular TTC after non-invasive and invasive investigation. Discussion: There are many variants of TTC that was found in a literature review. We demonstrated a unique variant of TTC that occurred of a significant emotional stressor with acute abdominal pain. Conclusion: Not much detail is known about the variants TTC. Investigators must continue to study TTC so that physicians can more effectively diagnose, treat, and manage patients who present the condition. We suspect that gastrointestinal illness was the physical stressor that contributed to the onset of our patients TTC in a setting of ongoing emotional distress and should be on the differential as an eitology.