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1.
J Med Case Rep ; 15(1): 485, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34579764

RESUMO

BACKGROUND: Severe venlafaxine intoxication may cause arrhythmias, cardiac failure, and even cardiac arrest. CASE PRESENTATION: A 48-year-old caucasian male with an extensive psychiatric history ingested a high dose of venlafaxine causing a serum venlafaxine concentration of 12.6 mg/L 24 hours after ingestion. Seven hours post-ingestion, he experienced tonic-clonic seizures, and 8 hours later, takotsubo cardiomyopathy was recognized followed by cardiac arrest. The patient was resuscitated with prolonged cardiopulmonary resuscitation including ongoing automatic external compressions during helicopter transportation to a tertiary hospital for extracorporeal membrane oxygenation treatment. Despite a cardiopulmonary resuscitation duration of 2 hours, 36 hours of extracorporeal membrane oxygenation, and a total of 30 days of intensive care, the patient made a full recovery. CONCLUSION: In cases of intoxication-induced cardiac arrests among otherwise young and healthy patients, prolonged cardiopulmonary resuscitation and extracorporeal circulation can be a life-saving bridge to recovery.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Cardiomiopatia de Takotsubo , Parada Cardíaca/induzido quimicamente , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Cardiomiopatia de Takotsubo/induzido quimicamente , Cardiomiopatia de Takotsubo/terapia , Resultado do Tratamento , Cloridrato de Venlafaxina
2.
Neurol India ; 69(4): 944-949, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507417

RESUMO

Background: Neurogenic stress cardiomyopathy (NSC), also known as stress-induced cardiomyopathy (SIC), is a significant complication of aneurysmal subarachnoid hemorrhage and an important contributor to morbidity mortality. Objective: This prospective observational study assessed whether the high sensitive troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NTproBNP) helps in the prediction of NSC after SAH. Methods: The consecutive patients with aSAH without any cardiac history were included prospectively over 12 months. Neurological assessment for the grade of SAH (Hunt & Hess and WFNS grade), electrocardiogram, and echocardiography done at admission. The serial measurements of serum hsTnT and NTproBNP for consecutive 7 days done. The NSC is defined as transient hypokinesia of the ventricular wall on echocardiography. Results: The study included 69 patients, and 7 (10.1%) were diagnosed with NSC. The NSC had a positive correlation with Hunt and Hess grade (P = 0.010), and the serum levels of hsTnT and NTproBNP were higher in patients with NSC in comparison to without NSC over all 7 days. The peak levels of hsTnT and NTproBNP were significantly higher in patients with cardiomyopathy (P = 0.000 and 0.032, respectively). The best cut-off level of peak hsTnT was 0.032 pg/dl to predict cardiomyopathy with sensitivity and specificity of 100% and 80%, respectively, and NTproBNP was 430.6 ng/dL with sensitivity and specificity of 86% and 73%, respectively. Conclusion: The peak levels of hsTnT and NTproBNP with abnormal ECG and echocardiography at admission help identify NSC in the early phase of aSAH.


Assuntos
Hemorragia Subaracnóidea , Cardiomiopatia de Takotsubo , Biomarcadores , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Hemorragia Subaracnóidea/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia , Troponina T
3.
Int J Mol Sci ; 22(18)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34576040

RESUMO

Takotsubo syndrome (TTS), recognized as stress's cardiomyopathy, or as left ventricular apical balloon syndrome in recent years, is a rare pathology, described for the first time by Japanese researchers in 1990. TTS is characterized by an interindividual heterogeneity in onset and progression, and by strong predominance in postmenopausal women. The clear causes of these TTS features are uncertain, given the limited understanding of this intriguing syndrome until now. However, the increasing frequency of TTS cases in recent years, and particularly correlated to the SARS-CoV-2 pandemic, leads us to the imperative necessity both of a complete knowledge of TTS pathophysiology for identifying biomarkers facilitating its management, and of targets for specific and effective treatments. The suspect of a genetic basis in TTS pathogenesis has been evidenced. Accordingly, familial forms of TTS have been described. However, a systematic and comprehensive characterization of the genetic or epigenetic factors significantly associated with TTS is lacking. Thus, we here conducted a systematic review of the literature before June 2021, to contribute to the identification of potential genetic and epigenetic factors associated with TTS. Interesting data were evidenced, but few in number and with diverse limitations. Consequently, we concluded that further work is needed to address the gaps discussed, and clear evidence may arrive by using multi-omics investigations.


Assuntos
COVID-19/complicações , Epigênese Genética/imunologia , Heterogeneidade Genética , Predisposição Genética para Doença , Cardiomiopatia de Takotsubo/genética , Biomarcadores/análise , COVID-19/imunologia , COVID-19/virologia , Variações do Número de Cópias de DNA/imunologia , Loci Gênicos/imunologia , Ventrículos do Coração/imunologia , Ventrículos do Coração/patologia , Humanos , Anamnese , Polimorfismo de Nucleotídeo Único/imunologia , SARS-CoV-2/imunologia , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/imunologia , Cardiomiopatia de Takotsubo/patologia
4.
J Med Case Rep ; 15(1): 451, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34481520

RESUMO

BACKGROUND: Takotsubo cardiomyopathy is a syndrome characterized by acute left ventricular wall motion abnormalities leading to left ventricular systolic dysfunction. It remains an important differential diagnosis for acute coronary syndrome. CASE PRESENTATIONS: Here we describe three cases of Takotsubo cardiomyopathy occurring in three Caucasian female trauma patients (aged 79, 81, and 82 years old) and the impact on their clinical course. CONCLUSIONS: For patients requiring surgical management, delays in the diagnosis of Takotsubo cardiomyopathy may lead to postponement of urgent operative management. This delay in surgery likely impacts on length of hospital stay, leading to an increasing morbidity and mortality.


Assuntos
Síndrome Coronariana Aguda , Cardiomiopatia de Takotsubo , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Cardiomiopatia de Takotsubo/diagnóstico
7.
Curr Opin Cardiol ; 36(5): 589-596, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397465

RESUMO

PURPOSE OF REVIEW: Myocardial infarction with nonobstructive coronary artery disease (MINOCA) (≥ 50% stenosis) accounts for 5-8% of acute coronary syndrome (ACS) presentations. The demographic characteristics, risk factors, and management of patients with MINOCA differ from those with atherosclerotic ACS. The objective of this review is to provide a contemporary understanding of the epidemiology, pathophysiology, clinical presentation, and management of MINOCA. RECENT FINDINGS: MINOCA is increasingly being recognized as an important and distinct cause of myocardial infarction among patients presenting with ACS. The predominant pathophysiologic mechanisms of MINOCA include both coronary (epicardial vasospasm, coronary microvascular disorder, spontaneous coronary artery dissection, coronary thrombus/embolism) and noncoronary (Takotsubo cardiomyopathy, myocarditis) pathologies. Coronary imaging with intravascular ultrasound and optical coherent tomography, coronary physiology testing, and cardiac magnetic resonance imaging offers important investigative modalities to facilitate diagnosis for appropriate management of MINOCA patients. SUMMARY: MINOCA is an important cause of ACS observed in certain patients with unique challenges for diagnosis and management. A high index of suspicion and a comprehensive diagnostic evaluation are critical for early recognition and successful management.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio , Cardiomiopatia de Takotsubo , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Fatores de Risco
8.
Int J Infect Dis ; 111: 43-46, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34384897

RESUMO

A 72-year-old patient was admitted to the intensive care unit due to acute respiratory distress syndrome caused by COVID-19. On day 20, the patient experienced shock. The electrocardiogram showed ST segment elevation in leads V3-V6 and severe left ventricular dysfunction with an ejection fraction of 35%-40%. The left ventricle showed basal hypokinesis and apical akinesis, while the creatine kinase level was normal, indicating Takotsubo cardiomyopathy. On day 24, the patient died of multiple organ failure. In post-mortem biopsy, SARS-CoV-2 antigen was detected in cardiomyocytes by immunostaining. Moreover, SARS-CoV-2 RNA was detected in heart tissue. We need to further analyse the direct link between SARS-CoV-2 and cardiomyocytes.


Assuntos
COVID-19 , Cardiomiopatia de Takotsubo , Idoso , Biópsia , Humanos , Miócitos Cardíacos , RNA Viral , SARS-CoV-2
10.
J Card Surg ; 36(11): 4413-4415, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34459034

RESUMO

BACKGROUND: Takotsubo cardiomyopathy (TC) is defined as a temporary and reversible systolic abnormality of the left ventricle's apical area resembling myocardial infarction in the nonexistence of coronary artery disease. Only a few cases have been reported after cardiac operations or after pericardiocentesis. AIM: To emphasize the need to be aware of the possibility of the occurrence of this potentially fatal complication after cardiac surgery. MATERIALS AND METHODS: A 66-year-old man underwent a pericardiectomy. He progressed to exacerbation of hemodynamic instability postoperatively and was diagnosed with TC, finally, he had to be supported by an intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO). RESULTS: Patient's left ventricle function recovered fully in 2 weeks. DISCUSSION: We discussed the pathogenesis and treatment of postoperative TC. CONCLUSION: TC has to be carefully considered in the differential diagnosis in case of acute left ventricle dysfunction following cardiac surgery.


Assuntos
Infarto do Miocárdio , Cardiomiopatia de Takotsubo , Idoso , Humanos , Balão Intra-Aórtico , Masculino , Pericardiectomia , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/terapia , Função Ventricular Esquerda
11.
J Int Med Res ; 49(8): 3000605211034997, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34344220

RESUMO

Takotsubo syndrome is a condition that mimics acute coronary syndrome. The exact pathogenesis of the condition is unclear but it tends to occur more frequently in elderly women and a large proportion of cases have acute, former, or chronic neurologic or psychiatric disorders. Here we describe a 55-year-old female patient, who was brought to the emergency department presenting with a new-onset manic episode characterized by grandiosity, distractibility, decreased need for sleep, and increased goal-directed behaviours. She experienced chest pain approximately two days later, and non-ST elevation myocardial infarction was observed. The emergent coronary angiogram showed patent coronary arteries, and a diagnosis of Takotsubo syndrome was made. We suggest clinical multidisciplinary vigilance for somatic complaints, especially cardiac ones, in people with psychiatric disorders in order to make timely therapeutic interventions.


Assuntos
Síndrome Coronariana Aguda , Cardiomiopatia de Takotsubo , Síndrome Coronariana Aguda/diagnóstico , Idoso , Angiografia Coronária , Serviço Hospitalar de Emergência , Feminino , Humanos , Mania , Pessoa de Meia-Idade , Cardiomiopatia de Takotsubo/diagnóstico por imagem
13.
Tex Heart Inst J ; 48(3)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34388240

RESUMO

Takotsubo cardiomyopathy (TTC), a persistently obscure dysfunctional condition of the left ventricle, is uniquely transient but nevertheless dangerous. It features variable ventricular patterns and is predominant in women. For 30 years, pathophysiologic investigations have progressed only slowly and with inadequate focus. It was initially proposed that sudden-onset spastic obliteration of coronary flow induced myocardial ischemia with residual stunning and thus TTC. Later, it was generally accepted without proof that, in the presence of pain or emotional stress, the dominant mechanism for TTC onset was a catecholamine surge that had a direct, toxic myocardial effect. We think that the manifestations of TTC are more dynamic and complex than can be assumed from catecholamine effects alone. In addition, after reviewing the recent medical literature and considering our own clinical observations, especially on spasm, we theorize that atherosclerotic coronary artery disease modulates and physically opposes obstruction during spasm. This phenomenon may explain the midventricular variant of TTC and the lower incidence of TTC in men. We continue to recommend and perform acetylcholine testing to reproduce TTC and to confirm our theory that coronary spasm is its initial pathophysiologic factor. An improved understanding of TTC is especially important because of the condition's markedly increased incidence during the ongoing COVID-19 pandemic.


Assuntos
COVID-19/epidemiologia , Vasoespasmo Coronário , Ventrículos do Coração/fisiopatologia , Isquemia Miocárdica , Cardiomiopatia de Takotsubo , Catecolaminas/metabolismo , Vasoespasmo Coronário/fisiopatologia , Humanos , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/fisiopatologia , SARS-CoV-2 , Cardiomiopatia de Takotsubo/epidemiologia , Cardiomiopatia de Takotsubo/metabolismo , Cardiomiopatia de Takotsubo/fisiopatologia
14.
BMC Psychiatry ; 21(1): 387, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348698

RESUMO

BACKGROUND: Several fatal medical complications have been associated with alcohol withdrawal, such as seizure, cardiac arrhythmia, and takotsubo cardiomyopathy. However, there have been no reports on hypovolemic shock during alcohol withdrawal, although two physical signs of alcohol withdrawal, i.e., diaphoresis and fever, can lead to hypovolemia and its medical consequences. CASE PRESENTATION: We describe a patient with alcohol use disorder who exhibited hypovolemic shock and its associated acute renal failure during alcohol withdrawal with severe diaphoresis and fever even though he had consumed almost the full amount of food he was offered. Given his excessive diaphoresis and fever that were related to alcohol withdrawal, his water intake was insufficient. Infusion with extracellular fluid resolved all these medical issues. CONCLUSIONS: The increased adrenergic activity associated with alcohol withdrawal might substantially increase a patient's water-intake requirement through diaphoresis and fever and may cause severe hypovolemia and its associated medical complications.


Assuntos
Alcoolismo , Choque , Síndrome de Abstinência a Substâncias , Cardiomiopatia de Takotsubo , Alcoolismo/complicações , Humanos , Masculino , Choque/etiologia , Síndrome de Abstinência a Substâncias/complicações
15.
BMJ Case Rep ; 14(8)2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362750

RESUMO

We describe a case of a woman in her 80s with persistent atrial fibrillation (AF) despite being on flecainide who was admitted for AF with rapid ventricular response. Attempts with direct-current cardioversions were unsuccessful despite increased doses of the antiarrhythmic therapy. At atrioventricular (AV) nodal ablation, very high right ventricular capture thresholds resulted in abortion of the procedure as back-up ventricular pacing could not be assured with adequate margin for safety. Shortly following the electrophysiology (EP) study, the patient developed cardiogenic shock with new apical left ventricular regional wall motion abnormality suggestive of apical ballooning and a toxic-appearing wide QRS complex electrocardiogram (EKG). The patient was successfully treated with sodium bicarbonate infusion for presumed flecainide toxicity. The regional wall motion abnormality and EKG changes resolved along with normalisation of capture thresholds after 2 days of treatment. The patient underwent an uncomplicated successful AV nodal ablation several weeks later.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Marca-Passo Artificial , Cardiomiopatia de Takotsubo , Fibrilação Atrial/terapia , Estimulação Cardíaca Artificial , Feminino , Flecainida/efeitos adversos , Humanos
16.
BMJ Case Rep ; 14(8)2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376418

RESUMO

Takotsubo cardiomyopathy (TCM) secondary to an infusion reaction is extremely rare in the literature. Here, we present an unusual case of TCM in a patient with cervical squamous cell carcinoma who presented with acute hypoxic respiratory failure following the initiation of the first-cycle paclitaxel infusion therapy.


Assuntos
Neoplasias da Mama , Síndrome do Desconforto Respiratório , Cardiomiopatia de Takotsubo , Feminino , Humanos , Paclitaxel/efeitos adversos , Cardiomiopatia de Takotsubo/induzido quimicamente , Cardiomiopatia de Takotsubo/diagnóstico
17.
BMJ Open ; 11(8): e046727, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376444

RESUMO

INTRODUCTION: Takotsubo syndrome (TTS) is a sudden reversible weakening of the left ventricle function induced by severe stress and resembles many features as acute coronary syndrome. Even though many guidelines had been published about TTS, there is no consensus regarding the long-term treatment. Aspirin is one of the most common prescribed medicines at discharge for patients with the intention to reduce thrombus events and improve the overall prognosis. However, existing studies yielded conflicting results concerning its effects. This study aims to evaluate the impact of long-term maintenance treatment of aspirin in TTS and provides insights in clinical management. METHODS AND ANALYSIS: After searching through electronic databases (PubMed, Embase, Cochrane Library, Web of Science, National Library of Medicine Gateway, CNKI, Wanfang and VIP), grey literatures, conference abstract and trial registries for clinical studies investigating the impact of aspirin on patients with TTS, a systemic review and meta-analysis will be conducted. The search will be limited from inception of each database to 1 August 2020. The outcomes including all-cause death, TTS recurrence, stroke, transient ischaemic attack or myocardial infarction at 30-day and 5-year follow-up will be examined. Risk of bias will be assessed by Newcastle-Ottawa quality assessment scale for observational studies and Cochrane Effective Practice and Organization of Care evaluation tool for interventional studies. Grading of Recommendations Assessment, Development and Evaluations method will be applied to assess the quality of evidence. If available, the effects of aspirin on the above outcomes for patients with TTS will be evaluated using random-effect modelling with relative risk at 95% CIs. Subgroup analysis and sensitivity analysis will also be performed when possible. ETHICS AND DISSEMINATION: Ethics approval was not required due to the retrospective nature of the study. Results of the review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020212729.


Assuntos
Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Cardiomiopatia de Takotsubo , Aspirina/uso terapêutico , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Estudos Retrospectivos , Revisões Sistemáticas como Assunto
18.
Cardiovasc Ultrasound ; 19(1): 31, 2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429107

RESUMO

BACKGROUND: Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of 'takotsubo' stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing. CONCLUSION: This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.


Assuntos
COVID-19/epidemiologia , Angiografia Coronária/métodos , Ecocardiografia/métodos , Eletrocardiografia/métodos , Cardiomiopatia de Takotsubo/diagnóstico , Comorbidade , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Cardiomiopatia de Takotsubo/epidemiologia
19.
J Radiol Case Rep ; 15(6): 26-32, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34276878

RESUMO

We present a case of Takotsubo Cardiomyopathy (TC) which is a non ischemic cardiomyopathy. It is stress related and also known as broken heart syndrome. The patient presented to our emergency department with symptoms of chest pain and breathlessness. The patient was diagnosed as acute coronary syndrome and various tests including ECG, Screening ECHO, Coronary CT and Cardiac Magnetic Resonance (CMR) were done before arriving at the diagnosis of TC. Currently CMR is the modality of choice as it detects the wall motion abnormalities (WMA), presence of wall edema and late gadolinium enhancement (LGE) characteristics can be well appreciated. No intervention was done and the case was managed medically.


Assuntos
Imageamento por Ressonância Magnética , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Idoso , Feminino , Humanos
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