Referral to Cardiac Rehabilitation and Outcomes for Patients With Takotsubo Cardiomyopathy.

PURPOSE: The aim of this study was to determine participation rates and outcomes for patients with Takotsubo cardiomyopathy (TC) in a cardiac rehabilitation (CR) program. METHODS: Patients at 2 academic medical centers with a discharge diagnosis of TC from January 2008 to March 2015 were retrospectively identified. Patients meeting the Mayo Clinic criteria for TC were cross-matched to the CR center affiliated with the hospitals to determine the referral rate and outcomes after completion of the program. RESULTS: In total, 380 unique patients were identified who survived the index hospitalization. Eighteen patients (5%) were referred to CR, 15 enrolled, and of those enrolled, 10 patients (67%) completed the program. Patients undergoing percutaneous coronary intervention of a nonculprit vessel at the time of diagnosis was the only predictor for referral to CR (11% vs 1%, P = .01). The 10 patients who completed CR attended 33 ± 6 (range, 20-36) sessions. Weight and body mass index reduction were 2.8 ± 3.5 lb and 0.6 ± 0.7 kg/m (P = .04, both), respectively. Post-CR exercise duration was 37 ± 4 min/session, which improved by 13 ± 6 min/session from baseline (P < .01). Two patients entered the phase III maintenance program. One-year cardiac readmission rates were comparable among patients who completed CR and those who were referred but did not attend or complete CR (0% vs 13%, P = .47). CONCLUSIONS: Referral for the TC population was low; however, enrollment and completion rates were adequate, with percutaneous coronary intervention in nonculprit vessel as the only predictor of CR referral. Limited data showed CR may help with weight reduction and improve exercise duration.

Takotsubo syndrome in a teen health centre.

BACKGROUND: Takotsubo syndrome is also referred to as stress cardiomyopathy and typically occurs in females aged 55 years and older. This demographic represents a significant part of the healthcare workforce and they have over recent decades experienced increasing levels of violence from patients and clients. AIMS: Our study describes a Takotsubo syndrome that occurred following an incident of physical and verbal aggression at work in a teen health centre. CASE REPORT: We report the case of a 56-year-old female community educator who suffered chest pain 48 h after suffering an aggressive incident at work. She had no history of cardiovascular disease. During hospitalization she was investigated with an electrocardiogram, echocardiography, coronary angiography, left ventriculography and a cardiac magnetic resonance imaging. Examinations confirmed the diagnosis of Takotsubo cardiomyopathy. This was deemed to be a work-related accident. With the help of her occupational physician, the patient was able to return to work with work adjustments. CONCLUSIONS: Increasing levels of violent behaviours towards staff in the health care sector underscores the need for measures in the workplace to help prevent precipitation of this syndrome in workers.

Takotsubo cardiomyopathy in the case of 72-year-old teacher after work-related psychological stress. Evolution of left ventricular longitudinal strain - Delayed but complete recovery in automated function imaging (AFI).

Takotsubo cardiomyopathy (TC) is related to a transient systolic dysfunction of left ventricle (LV), accompanied by clinical and electrocardiographic symptoms of myocardial ischemia in the absence of hemodynamically significant coronary artery disease. Takotsubo cardiomyopathy is usually provoked by a psychologically or/and physically stressful event which may be related to occupational activities. Although visually assessed evolution of LV function is well documented, the data concerning strain changes is sparse and various patterns of deformation abnormalities are suggested. We have described a 72-year-old woman with chest pain related to a lecture given at the meeting of the Senior University, fulfilling all the Mayo Clinic criteria of the TC. The longitudinal strain analysis with automated function imaging (AFI) documented severe impairment and stepwise recovery of regional and global LV contractility. The case described confirms that accurate diagnosis, treatment and documenting of functional improvement in takotsubo cardiomyopathy may enable the return to occupational activities even for elderly persons. Int J Occup Med Environ Health 2017;30(4):681-683.