Extracorporeal cardiopulmonary resuscitation for Takotsubo cardiomyopathy triggered by coronary vasospasm complicated with gastrointestinal bleeding: A case report.

Takotsubo cardiomyopathy is typically triggered by excessive catecholamine release. Here, we present a case of Takotsubo cardiomyopathy following gastrointestinal bleeding. The patient experienced cardiac arrest, necessitating extracorporeal cardiopulmonary resuscitation. Coronary angiography revealed severe coronary vasospasm, and echocardiography showed left ventricular dysfunction with ballooning. The patient was transferred out of the emergency intensive care unit on the ninth day with improved consciousness.

Characteristics and outcomes of patients with cardiac conditions requiring emergency medical retrieval from the Great Barrier Reef, Australia.

INTRODUCTION: There is limited published data on the burden of cardiac disease among patients requiring emergency medical evacuation from the Great Barrier Reef, a popular tourist destination in Far North Queensland, Australia. The aim of this study was to examine the characteristics and outcomes of patients with cardiac conditions who were retrieved from the northern Great Barrier Reef to Cairns Hospital. METHODS: This observational study was a planned substudy of a broader analysis of medical retrievals from the Cairns/Cooktown section of the Great Barrier Reef. It included all patients retrieved to Cairns Hospital between July 2016 and January 2020 who were assigned a cardiac diagnosis during their hospital stay. Data were collected about electrocardiograph, cardiac troponin blood test and invasive coronary angiography results as well as final hospital diagnosis. RESULTS: During the study period, 120 patients were retrieved from the Great Barrier Reef to Cairns Hospital, of which 46 (38%) were subsequently diagnosed with a primary cardiac condition(s) or other disease process with clinically significant cardiac involvement. The most common diagnoses were type 2 myocardial infarction (20; 16.7% of all retrievals), primary cardiac arrhythmia (14; 12.5%) and acute coronary syndrome (5; 4.2%). An elevated troponin was recorded in 30% of all retrievals and in 78% of those with a cardiac diagnosis. A total of 14 (30.4%) of patients with a cardiac diagnosis died during their hospital admission. Invasive coronary angiography was performed in 18 cases, of which six patients had obstructive coronary artery disease. Four patients required percutaneous coronary intervention. CONCLUSION: A high proportion of patients retrieved to Cairns Hospital from the Great Barrier Reef were diagnosed with a primary cardiac condition. This data may assist tourism operators, retrieval organisations and health services to plan for, and respond to, cardiac events among visitors to the reef.

A review of the interplay between Takotsubo cardiomyopathy and adrenal insufficiency: Catecholamine surge and glucocorticoid deficiency.

BACKGROUND: Takotsubo Cardiomyopathy (TCM) is a transient heart condition often precipitated by stress and characterized by atypical ventricular ballooning. The interplay between TCM and Adrenal Insufficiency (AI), particularly the influence of catecholamine excess and glucocorticoid deficiency on TCM's pathogenesis in individuals with AI, warrants comprehensive exploration for a better understanding of TCM pathophysiology and establishment of potential therapeutic strategies. METHODS: We conducted an extensive literature search via PubMed and Google Scholar, targeting reports on AI, heart failure, and cardiomyopathy, supplemented by forward and backward citation tracing. We analyzed 46 cases from 45 reports, assessing the clinical presentation and outcomes in the context of AI categorization. RESULTS: In patients with AI, a glucocorticoid deficit appears to exacerbate the myocardial vulnerability to catecholamine toxicity, precipitating TCM. Most conditions were reversible; however, three pre-1990 cases resulted in irreversible outcomes. CONCLUSIONS: The investigation into the AI and TCM intersection highlights the pathogenic significance of catecholamines in the absence of glucocorticoids. The data consolidates the hypothesis that glucocorticoid scarcity exacerbates the cardiac susceptibility to catecholaminergic toxicity, potentially triggering TCM. The study affirms glucocorticoids' cardioprotective roles and elucidates how catecholamine surges contribute to TCM pathogenesis, suggesting strategic clinical management adjustments for AI patients to reduce TCM incidence.

Seizure and Takotsubo Cardiomyopathy Due to Proton Pump Inhibitor.

Proton Pump Inhibitor (PPI)-induced hypomagnesemia, first described in 2006, has gained increasing recognition in recent years as a potentially life-threatening adverse event. In comparison to histamine-2 receptor antagonists (H2RA), PPIs exhibit a higher frequency of electrolyte abnormalities, including hypomagnesemia, hypocalcemia, hypokalemia, and hyponatremia; hypomagnesemia is the most common. We report a case of an 80-year-old woman who presented with generalized weakness and diarrhea. She was found to have multiple electrolyte abnormalities that failed to resolve even after the resolution of diarrhea and resumption of feeding. However, her condition improved within one week of discontinuing PPI medication. Her hospital course was complicated by a seizure, attributed to alterations in ionic gradients across cellular membranes affecting neuronal discharge and facilitating epileptiform activities. Additionally, she experienced Takotsubo cardiomyopathy due to decreased myocardial contractility, both in the context of electrolyte imbalance induced by prolonged PPI use.

Clinical perspectives: Takotsubo cardiomyopathy.

Takotsubo syndrome is a condition characterised by temporary acute left ventricular dysfunction with regional wall abnormalities extending beyond a single coronary artery territory. Initially thought to be benign, this condition, which is challenging to distinguish from acute coronary syndrome, has substantial morbidity and mortality. The mechanism behind this condition remains elusive, but multiple theories have been proposed. Although beta blockers and angiotensin-converting enzyme inhibitors are used as treatments for left ventricular dysfunction, currently, there are no randomised controlled trials to support their use. In this paper, we review the latest evidence regarding aetiologies, pathophysiology, diagnostic criteria, prognosis, complications and management of Takotsubo syndrome.

Takotsubo syndrome in a Sardinian amyotrophic lateral sclerosis cohort.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is known to be associated with varying degrees of autonomic and cardiovascular dysfunction. Recent case reports showed that ALS may be linked to Takotsubo syndrome (TTS). We assessed the frequency of TTS in an incident ALS cohort from Sardinia, Italy, and investigated the relationship of TTS with ALS course. METHODS: We retrospectively examined a 10-year (2010-2019) incident cohort of ALS patients of Sardinian ancestry, reported TTS frequency and patients' clinical characteristics. Following, we checked for TTS among patients with ALS onset after 2019 and focused on the same features as for the incident cohort. RESULTS: Our incident cohort included 344 ALS patients and 5 of them (1.45%) developed TTS. All were female and their median onset age was 71.5 years (IQR 62.75-77). Two patients had spinal and three bulbar onset, though all patients had bulbar involvement and were at an advanced stage of disease (ALSFRS ≤ 25, King's ≥ 3) at TTS diagnosis. We identified a potential TTS trigger in three patients (hospitalization for PEG placement, pneumonia). Among patients who had ALS onset after 2019, we identified a further TTS case and described it. CONCLUSION: TTS is not a rare condition in ALS. Female sex, bulbar involvement, and later age of disease onset may be important risk factors for developing this cardiac condition and a physical or psychological trigger is often observed. Despite autonomic dysfunction in ALS has been already demonstrated, the precise physiopathological mechanism underlying TTS needs to be further clarified.

Successful administration of clazosentan in subarachnoid hemorrhage patient with severe heart failure.

Background: Clazosentan, an endothelin receptor antagonist, has been shown to prevent cerebral vasospasms following subarachnoid hemorrhage (SAH) effectively. However, clazosentan-induced pulmonary edema is a frequently reported adverse effect and a primary reason for discontinuing treatment. The presence of preexisting heart conditions predisposes patients to severe pulmonary edema; thus, the administration of clazosentan is generally contraindicated. Case Description: We report the successful administration of clazosentan in a 58-year-old female patient with SAH and severe heart failure (Takotsubo cardiomyopathy). The patient initially presented with a ruptured left internal carotid posterior communicating artery aneurysm, leading to SAH. She successfully underwent neck clipping, and postoperative treatment to prevent cerebral vasospasm, including clazosentan, was initiated. Following the emergency surgical intervention, she exhibited pulmonary edema and diffused left ventricular hypokinesis with an ejection fraction of 10-20%. Although drug-induced pulmonary edema emerged after the administration of clazosentan, tailored fluid management based on daily cardiac function and ventilator management in response to pulmonary edema enabled the completion of a 2-week clazosentan therapy regimen. This approach guaranteed the patient's stability throughout the treatment period. Neither cerebral vasospasm nor cardiopulmonary complications were observed. Conclusion: This case highlights the importance of a multidisciplinary approach in managing complex patients with severe cardiac comorbidities undergoing clazosentan therapy.

Investigating the effect of cancer medication in the development of Takotsubo cardiomyopathy.

Takotsubo cardiomyopathy (TCM) is a cardiac condition that is usually characterized by sudden heart failure (HF) or chest pain that resembles acute coronary syndrome (ACS). It is identified by severe systolic dysfunction of the left ventricle (LV) and can be caused by physical, medical, or emotional stress. The pathophysiological mechanisms leading to TCM have not yet been clearly determined. TCM is a complex condition to diagnose and may go undetected during cancer treatment due to the wide variety of cardiotoxic effects associated with antineoplastic therapies. Consequently, timely identification and effective treatment are critical to enhancing the prognosis. Nevertheless, TCM is a more prevalent condition in oncology than was previously believed; therefore, clinicians who treat cancer patients should consider it in their differential diagnosis. The purpose of this manuscript is to provide physicians with a summary of the available evidence regarding the ramifications of the association between TCM and cancer to aid in improving patient management.

Patent Foramen Ovale and Coronary Artery Spasm: A New Patent Foramen Ovale-associated Condition that May Explain the Mechanism of Vasospastic Angina.

Patent foramen ovale (PFO) may be an underlying factor in the pathogenesis of migraine, vasospastic angina, and Takotsubo cardiomyopathy. This article reviews the role that PFO may play in each of these clinical entities and discusses potential interventions. It also proposes a novel clinical syndrome wherein PFO may be the unifying link among migraine, coronary vasospasm, and Takotsubo cardiomyopathy in predisposed individuals.

Cushing's syndrome developing myasthenia gravis with takotsubo cardiomyopathy after adrenalectomy: a case report.

BACKGROUND: Several cases of autoimmune disease onset after treatment for Cushing's syndrome have been reported. CASE PRESENTATION: Herein, we report a case of myasthenia gravis crisis in a 51-year-old woman 2 months after adrenalectomy for adrenal Cushing's syndrome accompanied by takotsubo cardiomyopathy. The resolution of excessive endogenous cortisol after adrenalectomy may have triggered the onset of previously latent myasthenia gravis. CONCLUSIONS: Observing the similarities in symptoms between myasthenia gravis and adrenal crisis, which can sometimes be challenging to differentiate, is essential. Moreover, the presence of takotsubo cardiomyopathy as a non-motor manifestation of myasthenic crisis must be noted.

Repolarization Injury and Occurrence of Torsades de Pointes During Acute Takotsubo Syndrome.

Background: During takotsubo syndrome (TS), QTc prolongation is common, reflecting repolarization injury and providing the substrate for torsades de pointes (TdP). TdP has been reported sporadically in TS, yet QTc prolongation and TdP risk are often overlooked during management. Objectives: In TS patients, we sought to document TdP incidence, characteristics of patients with TdP, and association of QTc with postdischarge survival. Methods: Among consecutive TS patients at a single institution, we documented admission and discharge QTc, TdP incidence, and postdischarge 1-year mortality from 2006 to 2019. For perspective regarding TdP-TS risk, we characterized all published TdP cases from 2003 to 2022. Results: Of 259 patients, median age was 68 (range: 59-77) years; 92% were female. The QTc interval was prolonged (≥460 ms) on admission in 129 (49.8%) patients and at discharge in 140 (54%) patients. QTc was ≥500 ms either on admission or at discharge in 98 (37.8%) patients. In-hospital TdP incidence was 0.8%. Postdischarge mortality was associated with admission but not discharge, QTc: <460 ms (1.6%); 460-499 ms (12.6%); ≥500 ms (8.8%); P = 0.0056. Among 38 published TdP-TS cases, 80% of TdP events were within 48 hours of hospitalization, 90% of events occurred with QTc ≥500 ms, and 47.5% of events occurred with QTc ≥600 ms. Conditions associated with TdP risk were present in fewer than one-third of patients. Conclusions: During TS, QTc ≥500 ms was frequent. TdP incidence was low, with unpredictable occurrence and observed almost entirely with QTc ≥500 ms. A normal admission QTc was associated with >98% survival at 1-year postdischarge.

Severe stress cardiomyopathy following spinal corrective surgery for scoliosis complicated with pectus excavatum: a case report.

BACKGROUND: Stress cardiomyopathy (SCM) is an acute heart failure syndrome characterized by transient, usually reversible left ventricular systolic dysfunction with normal or enhanced basal compensatory wall motion abnormalities involving the left ventricular anterior septum and apex, resulting in a "ballooning" appearance. However, it has rarely been reported in patients undergoing spinal surgery. CASE PRESENTATION: We report a case of severe stress cardiomyopathy in a scoliosis patient with pectus excavatum who underwent spinal corrective surgery. During the wake-up period, circulatory collapse occurred. After multidisciplinary consultation, the patient was diagnosed with stress cardiomyopathy. At last, she had a good prognosis after a series of treatments including ECMO. CONCLUSION: Stress cardiomyopathy is a reversible but uncommon condition. It can cause death if it is not diagnosed in time. Consequently, this report should improve the awareness of orthopedists and anesthesiologists for timely identification and management. For patients with potential risk factors, timely preoperative intervention should be performed to reduce the occurrence of stress cardiomyopathy.

Cardiac Angiosarcoma in the Right Atrium Treated by Surgical Resection.

We present the case of a 49-year-old female of Caucasian European descent with chest tightness, fatigue, and palpitations, ultimately diagnosed with primary intracardiac angiosarcoma. Initial echocardiography revealed a significant mass within the right atrium, infiltrating the free wall. Surgical intervention included tumor excision and partial resection of the superior vena cava. Histopathological examination confirmed a high-grade angiosarcoma. Postoperative imaging identified a recurrent mass in the right atrium, suggestive of thrombus, alongside Takotsubo cardiomyopathy. Considering the elevated surgical risks and the presence of cardiomyopathy, management included anticoagulation therapy with Warfarin and adjuvant chemotherapy with Paclitaxel. Follow-up cardiac magnetic resonance imaging demonstrated a recurrent angiosarcoma with superimposed thrombus. This case presents the complex diagnostic and therapeutic landscape of angiosarcoma, highlighting the critical importance of early surgical intervention, advanced imaging techniques, and vigilant postoperative monitoring.

Cardiac Anomaly: Reverse Takotsubo Following Gallbladder Surgery.

Takotsubo cardiomyopathy is an acute but often reversible left ventricular dysfunction commonly triggered by emotional stress. There are multiple variants within the general condition; however, reverse Takotsubo cardiomyopathy is a rare variant of stress-induced cardiomyopathy affecting the basilar segment of the left ventricle. This commonly manifests in younger women with clinical presentations similar to acute coronary syndrome. Cases of postoperative reverse Takotsubo cardiomyopathy are limited in the current literature. Hence, we present an 81-year-old female with shortness of breath and chest pain with exertion following a recent laparoscopic cholecystectomy. Based on her symptoms during the presentation, troponin and beta-natriuretic peptide were obtained. Results demonstrated an elevation in both markers, raising concerns for possible acute coronary syndrome (ACS). The patient subsequently underwent a transthoracic echocardiogram (TTE), which demonstrated findings consistent with reverse Takotsubo cardiomyopathy (rTTC). Therefore, we present a unique case of an 81-year-old female presenting with rTTC following laparoscopic cholecystectomy.

Cardioversion-Induced Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or "broken heart syndrome," is a rare and reversible condition characterized by transient left ventricular dysfunction. It is typically triggered by acute emotional or physical stressors. Here, we present a unique case of TCM occurring in a 77-year-old woman following cardioversion for persistent and symptomatic atrial fibrillation. The patient underwent uncomplicated cardioversion with recent imaging showing intact global systolic function. She presented four days post-procedure for chest pain, shortness of breath, and peripheral edema. A repeat echocardiogram showed a marked decrease in cardiac function evidenced by an ejection fraction of 20-25%. The patient was readmitted and managed with IV diuretics. Symptoms resolved within three days and the patient showed improved cardiac function on imaging prior to discharge.

Takotsubo Cardiomyopathy Associated With Influenza A and a Ground-Level Fall.

Our case involves a 92-year-old female who presented to the emergency department due to a ground-level fall and difficulty breathing. She was found to have influenza A, elevated troponin, and decreased left ventricular ejection fraction. However, cardiac catheterization did not reveal any coronary artery stenosis, supporting a diagnosis of takotsubo cardiomyopathy (TC). The patient's ejection fraction was normal after nine months. This case highlights the importance of considering TC in elderly female patients who have reduced ejection fraction and elevated troponin in the setting of infection and a recent fall.

Incidence of Takotsubo cardiomyopathy in patients with acute coronary syndrome: a single center retrospective analysis.

BACKGROUND: Takotsubo cardiomyopathy (TTC) is an acute and usually reversible condition that often mimics the course of acute coronary syndrome (ACS), making it particularly challenging to differentiate, especially in the initial phases. In this study, we retrospectively analyzed the incidence, clinical course, examination results, and in-hospital mortality of TTC in patients with ACS hospitalized at our cardiology center from January 2018 to October 2023. RESULTS: During the study period, a total of 3835 selective coronary angiograms were urgently performed at our facility, with a diagnosis of TTC established in 52 (1.35%) patients, the majority of whom were females-48 (93%), with an average age of 64.2 ± 10.2 years. Stress-induced mechanisms were identified in 36 (69%) patients. The most common symptom was chest pain (86.5%). Electrocardiographic changes primarily included ST-segment elevations (61.6%) and depressions (14%). The average left ventricular ejection fraction was 45.1 ± 8.3 (33-57%), typically with an echocardiographic pattern of apical ballooning dysfunction followed by midventricular dyskinesia. In-hospital mortality was zero. CONCLUSIONS: TTC is a reversible condition with a low incidence of complications. Its occurrence in our patient cohort is lower compared to international registries. However, as demonstrated in this study, it is associated with significant in-hospital morbidity.

A Rare Case of Cephalosporin Anaphylaxis-Induced Reverse Takotsubo.

This case report details an unusual occurrence of reverse takotsubo induced by cefazolin anaphylaxis. While anaphylactic reactions typically manifest with hypotension and bronchospasm, the development of takotsubo is a rare outcome. The patient experienced an episode of cefazolin-induced anaphylaxis during elective shoulder surgery, subsequently developing reverse takotsubo cardiomyopathy (rTTC) during her hospitalization. Initial testing showed a reduced heart function, with an ejection fraction (EF) dropping to 32% from a previously normal EF exceeding 50%. However, a follow-up heart catheterization three weeks later revealed a return to normal heart function. The patient received appropriate management for heart failure. By emphasizing the nuanced features and symptoms, we aim to enhance the recognition and management of this condition. Sharing such cases contributes to the medical community's knowledge and facilitates the advancement of strategies for diagnosing and managing anaphylaxis-induced reverse takotsubo.