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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526518

RESUMO

Immune checkpoint inhibitors (ICIs) are increasingly used to treat certain malignancies due to their higher efficacy compared with conventional chemotherapy. As familiarity with these agents increases, it is becoming apparent that a significant number of patients treated with ICIs experience adverse events. With time, more immune-related adverse events (IRAEs) are being recognised. It is important to be vigilant for IRAEs and recognise that a patient may have multiple IRAEs affecting multiple organ systems. Common cardiovascular adverse events associated with ICIs include myocarditis, arrhythmias and pericarditis. This case report identifies a patient presenting with takotsubo syndrome followed by ketoacidosis (associated with sodium-glucose transport protein 2 (SGLT2) inhibitor) in the setting of combination ipilimumab and nivolumab therapy for metastatic melanoma.


Assuntos
Neoplasias Encefálicas/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Cetoacidose Diabética/induzido quimicamente , Melanoma/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Cardiomiopatia de Takotsubo/induzido quimicamente , Idoso , Compostos Benzidrílicos/efeitos adversos , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Angiografia Coronária , Diabetes Mellitus Tipo 2/complicações , Cetoacidose Diabética/complicações , Ecocardiografia , Glucosídeos/efeitos adversos , Humanos , Ipilimumab/efeitos adversos , Imagem por Ressonância Magnética , Masculino , Melanoma/complicações , Melanoma/secundário , Nivolumabe/efeitos adversos , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico por imagem
2.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495195

RESUMO

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.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Insuficiência Adrenal/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Testes de Função do Córtex Suprarrenal , Insuficiência Adrenal/induzido quimicamente , Insuficiência Adrenal/complicações , Insuficiência Adrenal/tratamento farmacológico , Idoso , Asma/tratamento farmacológico , Proteína C-Reativa/metabolismo , Diagnóstico Diferencial , Ecocardiografia , Eczema/tratamento farmacológico , Eletrocardiografia , Glucocorticoides/efeitos adversos , Terapia de Reposição Hormonal , Humanos , Hidrocortisona/uso terapêutico , Hiperpotassemia/etiologia , Hiponatremia/etiologia , Masculino , Pneumonia/complicações , Pneumonia/diagnóstico , Cardiomiopatia de Takotsubo/complicações
3.
Kardiologiia ; 60(7): 136-140, 2020 Aug 11.
Artigo em Russo | MEDLINE | ID: mdl-33155952

RESUMO

A 29-year old female patient without a history of cardiovascular diseases was admitted on emergency to a surgical hospital with acute calculous cholecystitis in 3 months after uncomplicated term birth. During laparoscopic cholecystectomy, she developed arterial hypotension with pulmonary edema, which required intravenous sympathomimetics. On the next day, after improvement of the condition and stabilization of hemodynamics, cardiac ultrasound showed diffuse left ventricular (LV) hypokinesis with the ejection fraction (EF) of 38 %. Electrocardiogram detected transient left bundle branch block followed by persistent negative T waves in leads I, aVL, and V2 V6. Troponin I concentration was increased to 1.2 ng /ml. Beta-blocker and angiotensin-converting enzyme inhibitor were administered. At 10 days, the LV contractile function completely recovered with LV EF of 59 %. Magnetic resonance imaging did not reveal any signs of myocardial infarction or myocarditis. A differential diagnosis was performed between peripartum cardiomyopathy and Takotsubo syndrome. Considering the fast recovery of LV systolic function, the patient was discharged with a diagnosis of Takotsubo syndrome.


Assuntos
Cardiomiopatias , Hipotensão , Edema Pulmonar , Cardiomiopatia de Takotsubo , Adulto , Cardiomiopatias/diagnóstico , Feminino , Humanos , Período Periparto , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico
4.
Am J Cardiol ; 132: 29-35, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32762963

RESUMO

There are limited data on the incidence of complications and in-hospital outcomes, in patients with Takotsubo cardiomyopathy (TC), as compared with acute myocardial infarction (AMI). From 2007 to 2014, a retrospective cohort of TC was compared with AMI using the National Inpatient Sample database. Complications were classified as acute heart failure, ventricular arrhythmic, cardiac arrest, high-grade atrioventricular block, mechanical, vascular/access, pericardial, stroke, and acute kidney injury. Temporal trends, clinical characteristics, and in-hospital outcomes were compared. During the 8-year period, 3,329,876 admissions for AMI or TC were identified. TC diagnosis was present in 88,849 (2.7%). Compared with AMI admissions, those with TC were older, female, and of white race. Use of pulmonary artery catheter and mechanical ventilation was higher, but hemodialysis lower in TC. The overall frequency of complications was higher in TC (38.2% vs 32.6%). Complication rates increased in both groups over time, but the delta was greater for TC (23% [2007] vs 43% [2014]) compared with AMI (27% vs 36%). The TC cohort had a higher rate of heart failure (29% vs 16.6%) and strokes (0.5% vs 0.2%), but lower rates of other complications (all p <0.001). In-hospital mortality was lower for TC (2.6% vs 3.1%; p <0.001). TC was an independent predictor of lower in-hospital mortality in admissions with complications. In conclusion, compared with AMI, TC is associated with greater likelihood of heart failure, but lower rates of other complications and mortality. There has been a temporal increase in the rates of in-hospital complications and mortality due to TC.


Assuntos
Parada Cardíaca/epidemiologia , Infarto do Miocárdio/mortalidade , Medição de Risco/métodos , Cardiomiopatia de Takotsubo/mortalidade , Idoso , Feminino , Seguimentos , Parada Cardíaca/etiologia , Mortalidade Hospitalar/tendências , Humanos , Incidência , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Cardiomiopatia de Takotsubo/complicações , Fatores de Tempo , Estados Unidos/epidemiologia
6.
J Interv Cardiol ; 2020: 4340930, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32405274

RESUMO

Background: The prognosis of Takotsubo syndrome (TTS) is comparable to that of the non-ST-elevation myocardial infarction (NSTEMI). The GRACE scale is used to assess the risk of premature and long-term mortality in patients with NSTEMI in order to select the most favorable treatment strategy. Methods: 101 patients with TTS hospitalized in four centers of invasive cardiology in Podlaskie Voivodeship during the period 2008-2012 were included in the study. The patients were divided into two groups: I-52 patients (GRACE ≤ 140 points) and II-49 patients (GRACE > 140 points). Results: The mean GRACE score in the study group was 138.66. The in-hospital stay of Takotsubo in the patients with higher GRACE scores was associated with higher incidence of pneumonia (36.7% vs 7.69%, p=0.0004), rhythm abnormalities (17.3% vs 3.85%, p=0.026), and serious complications (cardiogenic shock, pulmonary edema, and sudden cardiac arrest) (30.6% vs 5.77%, p=0.001). The mean observation period was 7.2 years. A significantly higher risk of 6-month (18.37% vs 3.85%, p=0.019), 1-year (22.45 vs 3.85%, p=0.005), 3-year (40.82 vs 3.85%, p < 0.0001), 5-year (42.86% vs 3.85%, p < 0.0001), and 7-year mortalities (53.06% vs 9.62%, p < 0.0001) was observed in the group of patients with a GRACE score ≥140. At multivariate analysis including low BMI, low eGFR, and a higher GRACE score, all these factors were independent predictor of death (p=0.042; p=0.010; p=0.041). The ROC curve presents the discriminatory scores of the GRACE scale for the follow-up prognostication. The area under ROC curve (AUC) for the GRACE scale was 0.805 (95% CI: 0.718-0.892, p < 0.0001), with a cut-off value of 153 points, sensitivity of 74%, and specificity of 77% for TTS. Conclusion: The GRACE scale is highly valuable for the prognostication of death risk in patients with TTS in the early and long-term observation.


Assuntos
Efeitos Adversos de Longa Duração , Infarto do Miocárdio sem Supradesnível do Segmento ST , Cardiomiopatia de Takotsubo , Idoso , Feminino , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/etiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Polônia/epidemiologia , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/mortalidade , Cardiomiopatia de Takotsubo/terapia
8.
Int Heart J ; 61(2): 400-403, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32173705

RESUMO

Takotsubo cardiomyopathy (TC) is a temporal dysfunction of the left ventricle (LV) due to psychological or physiological stress; however, it rarely causes LV thrombus. We report a case of a 49-year-old woman who developed LV thrombi due to TC despite anticoagulation therapy. The thrombi caused acute systemic infarction, with the most severe occlusion being in the right renal artery. The patient underwent percutaneous catheter aspiration thrombectomy of the right renal artery and her renal function recovered shortly after. The results of this case suggest that catheter aspiration thrombectomy is effective in the treatment of thromboembolism in TC.


Assuntos
Infarto/terapia , Rim/irrigação sanguínea , Cardiomiopatia de Takotsubo/complicações , Trombectomia , Tromboembolia/terapia , Feminino , Humanos , Infarto/etiologia , Pessoa de Meia-Idade , Tromboembolia/complicações , Tromboembolia/diagnóstico por imagem
9.
BMC Cardiovasc Disord ; 20(1): 67, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32028901

RESUMO

BACKGROUND: Cardiac tamponade is a rare but serious complication of Takotsubo cardiomyopathy (TC). Two cases of cardiac tamponade subsequent to TC have been reported. The pericardial effusion in these cases was hemorrhagic and caused by ventricular rupture. Cardiac tamponade induced by an inflammatory effusion complicated with TC has not been reported. This is the first case report of TC, which developed cardiac tamponade during the recovery phase with a large volume non-hemorrhagic inflammatory effusion. CASE PRESENTATION: We describe a case of an 81-year-old woman admitted to our hospital because of severe chest pain. Her symptoms began soon after her son's hospitalization. We diagnosed her with TC based on results of an electrocardiogram, echocardiogram, and emergent coronary angiography. Her symptoms and left ventricular dysfunction improved gradually. She developed newly confirmed chest pain and dyspnea on day 9 after admission. A large pericardial effusion developed, resulting in cardiac tamponade. Her symptoms and hemodynamic status improved immediately after the pericardiocentesis. The effusion was non-hemorrhagic and exudative. No specific signs of infection, collagen disease, or malignant tumors were observed, except for TC. CONCLUSIONS: We experienced a case of circulatory collapse induced by TC-related inflammatory pericardial effusion at recovery phase. This case emphasizes the importance of careful follow-up even after improved left ventricular dysfunction in a patient with TC.


Assuntos
Tamponamento Cardíaco/etiologia , Derrame Pericárdico/etiologia , Cardiomiopatia de Takotsubo/complicações , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/fisiopatologia , Tamponamento Cardíaco/cirurgia , Feminino , Hemodinâmica , Humanos , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/fisiopatologia , Derrame Pericárdico/cirurgia , Pericardiocentese , Recuperação de Função Fisiológica , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/fisiopatologia , Resultado do Tratamento , Função Ventricular Esquerda
10.
BMJ Case Rep ; 13(2)2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32060115

RESUMO

A 41-year-old woman was admitted with progressive paraesthesia and weakness and was diagnosed with Guillain-Barré syndrome. Following an initial period of recovery with intravenous immunoglobulin treatment, she developed acute chest pain associated with electrocardiographic changes. Investigations excluded acute coronary syndrome and instead confirmed a diagnosis of takotsubo cardiomyopathy, which was treated medically. The patient made an excellent neurological and cardiac recovery. Here we discuss the rarely described association between these two conditions and suggest that patients admitted with Guillain-Barré syndrome may benefit from routine screening with echocardiography.


Assuntos
Síndrome de Guillain-Barré/complicações , Cardiomiopatia de Takotsubo/complicações , Adulto , Técnicas de Imagem Cardíaca , Feminino , Humanos
11.
Dig Dis ; 38(3): 204-210, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31408862

RESUMO

BACKGROUND: Takotsubo syndrome (TTS) is an acute cardiac dysfunction in the absence of viral causes or obstructive coronary disease completely reversible within 4-8 weeks. Inflammatory bowel diseases (IBD) are a group of diseases caused by the interaction between immune system, genetic, and environmental factors against intestinal mucosa. Both these syndromes are characterized by complex mechanisms involving endothelial dysfunction and affective disorders. AIM: To assess the possibility of an association between IBD and TTS. METHODS: First, we present a case of TTS in a patient affected by active stenosing Crohn's disease. Articles in English language were collected from PubMed and Google Scholar databases with the search terms "takotsubo," "IBD," "crohn disease," "ulcerative colitis". RESULTS: Both TTS and IBD show multiple common features: preference for female patients, recurrent course of disease, association with endothelial dysfunction, and affective disorders. Patients affected by IBD could show specific triggers for TTS, such as malabsorption, electrolytes disturbances, and affective disorders. CONCLUSIONS: Despite pathophysiological similarities between TTS and IBD in active phase, future studies are needed to confirm this apparently possible association and to assess the presence of a pathophysiological link between these diseases.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Cardiomiopatia de Takotsubo/complicações , Idoso , Idoso de 80 Anos ou mais , Doença de Crohn/complicações , Feminino , Humanos
12.
Am J Med ; 133(5): 627-634.e4, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31668900

RESUMO

BACKGROUND: The association of takotsubo syndrome with future risk of cardiovascular and noncardiovascular morbidity and mortality is unclear. We assessed the long-term risk of morbidity and mortality in patients with takotsubo syndrome. METHODS: We performed a matched cohort study of 174 patients with takotsubo syndrome between 1989 and 2006 in Quebec, Canada, with 15 years of follow-up on future hospitalization outcomes. We matched takotsubo patients to 2 comparison groups, including 1736 patients with acute myocardial infarction and 1740 population controls. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of takotsubo syndrome with subsequent in-hospital mortality, cardiovascular morbidity, and other hospitalization outcomes. RESULTS: During 15 years of follow-up, patients with takotsubo syndrome had a risk of in-hospital mortality similar to patients with myocardial infarction (HR 1.06; 95% CI, 0.81-1.38), but a lower risk of cardiovascular rehospitalization (HR 0.79; 95% CI, 0.66-0.95). Compared with population controls, however, takotsubo was associated with 1.59 times the risk of in-hospital mortality (95% CI, 1.21-2.09), 2.71 times the risk of cardiovascular rehospitalization (95% CI, 2.24-3.28), and 1.86 times the risk of hospitalization for stress and anxiety disorders (95% CI, 1.21-2.85). Associations were significantly stronger the first few years after the initial admission for takotsubo, and weakened over time. CONCLUSIONS: Takotsubo syndrome is associated with a risk of mortality similar to that of myocardial infarction after 15 years, but a lower risk of cardiovascular rehospitalization. Patients with takotsubo syndrome nonetheless have more in-hospital mortality and cardiovascular morbidity than population controls.


Assuntos
Cardiomiopatia de Takotsubo/mortalidade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Quebeque/epidemiologia , Fatores de Risco , Cardiomiopatia de Takotsubo/complicações
13.
Int J Cardiovasc Imaging ; 36(2): 299-307, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31673849

RESUMO

Tako-tsubo cardiomyopathy (TTC) is characterized by the presence of transient left ventricular (LV) dysfunction. Whether left atrial (LA) function is also impaired in this setting is unclear. To assess prospectively LA peak systolic longitudinal strain (LAS) by two-dimensional strain at the acute phase of TTC and after recovery and its association with in-hospital complications. 40 patients with typical TTC (mean age 79.5 ± 10 years) underwent transthoracic-Doppler echocardiography at the acute phase and at follow-up (32 ± 18 days later), including the measurement of the LAS (mean of maximal strain from the 4-2 chamber views). A control group of 15 patients (75 ± 7 years, 13 women) without overt cardiovascular disease served as a comparative group. In-hospital complication was a composite of death, heart failure, cardiogenic shock, LV thrombus, and sustained ventricular arrhythmia. In the TTC group, LAS improved significantly between the two examinations from 15 ± 5.5% to 27 ± 8% (p < 0.01) whereas LA volume did not change (p = NS). In the control group LAS was 30 ± 4% (p < 0.01 vs. TTC acute phase, p = NS vs. TTC follow-up). In TTC, at the acute phase LAS was independently correlated to LV global longitudinal strain (LVGLS), and after recovery to E/e', and the change of LAS was independently correlated to the change of the LVGLS (all, p < 0.01). Furthermore LAS was independently correlated to in-hospital complications (p < 0.01). LA function (reservoir) is transiently impaired in TTC and associated to in-hospital complications. Furthermore, the improvement of LAS parallel the dynamic improvement of LVGLS suggests that TTC induces a transient global left heart dysfunction.


Assuntos
Função do Átrio Esquerdo , Ecocardiografia Doppler , Átrios do Coração/diagnóstico por imagem , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Progressão da Doença , Feminino , Átrios do Coração/fisiopatologia , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/mortalidade , Cardiomiopatia de Takotsubo/fisiopatologia , Função Ventricular Esquerda
14.
Arterioscler Thromb Vasc Biol ; 40(1): 279-287, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31766870

RESUMO

OBJECTIVE: Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified. Approach and Results: TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0-38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×103 cells/µL emerged as independent predictors for thrombus formation or embolism. CONCLUSIONS: Intraventricular thrombus or embolism occur in 3.3% of patients in the acute phase of TTS. A simple risk score including clinical parameters associated with intraventricular thrombus formation or embolism identifies patients at increased risk. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.


Assuntos
Embolia/etiologia , Sistema de Registros , Medição de Risco/métodos , Cardiomiopatia de Takotsubo/complicações , Trombose/etiologia , Idoso , Austrália/epidemiologia , Angiografia Coronária , Eletrocardiografia , Embolia/diagnóstico , Embolia/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Ventrículos do Coração , Humanos , Incidência , Imagem Cinética por Ressonância Magnética , Masculino , Ventriculografia com Radionuclídeos , Fatores de Risco , Taxa de Sobrevida/tendências , Cardiomiopatia de Takotsubo/diagnóstico , Trombose/diagnóstico , Trombose/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia
16.
Intern Med ; 59(6): 789-792, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31787694

RESUMO

We herein report a case of congenital long QT syndrome (LQTS) in which the QT interval was prolonged by Takotsubo syndrome (TTS), inducing ventricular fibrillation (VF). The patient was a 55-year-old woman who had been diagnosed with LQTS. Cardiopulmonary arrest occurred while coughing during sleep. VF was observed, and her heartbeat returned after two defibrillations. An electrocardiogram showed marked QT prolongation and large negative T waves. Echocardiography demonstrated hyperkinesis at the base of the left ventricle and akinesis at the apex. As there was no significant stenosis in the coronary artery, she was diagnosed with TTS.


Assuntos
Síndrome do QT Longo/complicações , Cardiomiopatia de Takotsubo/complicações , Fibrilação Ventricular/etiologia , Ecocardiografia , Eletrocardiografia , Feminino , Frequência Cardíaca , Humanos , Síndrome do QT Longo/diagnóstico , Pessoa de Meia-Idade , Cardiomiopatia de Takotsubo/diagnóstico
19.
Kardiologiia ; 60(11): 777, 2020 Dec 15.
Artigo em Russo | MEDLINE | ID: mdl-33487160

RESUMO

The presented data show that tacotsubo syndrome (TS) is characterized by the absence of coronary artery obstruction, cardiac contractile dysfunction, apical ballooning, and heart failure, and in some patients, ST-segment elevation and prolongation of the QTc interval. Every tenth patient with TS develops ventricular arrhythmias. Most of TS patients have elevated markers of necrosis (troponin I, troponin Т, and creatine kinase МВ (CK-МВ), which are considerably lower than in patients with acute myocardial infarction (AMI) with ST-segment elevation. The level of N-terminal pro-B-type natriuretic peptide (NT-proBNP), in contrast, is considerably higher in patients with TS than with AMI. Differential diagnosis of TS and AMI should be based on a multifaceted approach using coronary angiography, echocardiography, analysis of ECG, magnetic resonance imaging, single-photon emission computed tomography, and measurement of troponins, CK-MB, and NT-proBNP.


Assuntos
Cardiomiopatias , Infarto do Miocárdio , Cardiomiopatia de Takotsubo , Biomarcadores , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Infarto do Miocárdio/diagnóstico , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Troponina T
20.
Undersea Hyperb Med ; 46(5): 581-601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683356

RESUMO

Introduction: We aimed to document identified cases of immersion pulmonary edema (IPE) in divers from Oceania (the Indo-Pacific region) from January 2002 to May 2018, inclusive. Method: Cases were identified using various sources, including searches of the Divers Alert Network Asia-Pacific (DAN AP) Fatality Database, published case reports, and interviews with survivors who had reported their incident to DAN AP. Where available, investigations, pathology and autopsy results were obtained. Only incidents diagnosed as IPE by diving physicians or pathologists with experience in the investigation of diving accidents were included. Individual case histories and outcomes, together with brief individual summaries of the associations and possible contributing factors were recorded. Results: Thirty-one IPE incidents in divers from Oceania were documented. There were two surface snorkelers, 22 scuba air divers and seven nitrox divers which included three closed-circuit rebreathers (CCR). The mean (SD) age was 53 (12) years, 58% of victims were females, and the average dive profile was to a maximum depth of 19 meters of seawater for 25 minutes. Six victims (19%) had previous episodes of IPE. There were nine recorded fatalities. Cardiac anomalies dominated the associated or possible contributing factors. These included valvular disease in 29%, transient cardiomyopathies in 26% and dysrhythmias in 16%. Conclusions: Previously reported associations of IPE such as exertion, stress, cold exposure, negative inspiratory pressure, hypertension, overhydration, ascent or surfacing, tight wetsuit, aspiration and certain medications were identified. Cardiac conditions were frequent and included chronic disorders (valvular pathology, coronary artery disease) and transient disorders (dysrhythmias, transient myocardial dysfunction, takotsubo or stress cardiomyopathy). It is likely that the chronic cardiac disorders may have contributed to the IPE, whereas the transient cases could be either sequelae, contributors or coincidental to the IPE.


Assuntos
Mergulho/efeitos adversos , Edema Pulmonar/etiologia , Adulto , Idoso , Autopsia , Doença das Coronárias/patologia , Suscetibilidade a Doenças/etiologia , Suscetibilidade a Doenças/patologia , Evolução Fatal , Feminino , Cardiopatias/complicações , Humanos , Imersão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Oceania/epidemiologia , Esforço Físico , Edema Pulmonar/diagnóstico , Edema Pulmonar/epidemiologia , Edema Pulmonar/patologia , Fatores de Risco , Água do Mar , Distribuição por Sexo , Natação , Cardiomiopatia de Takotsubo/complicações , Adulto Jovem
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