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1.
Isr Med Assoc J ; 23(2): 107-110, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33595216

RESUMO

BACKGROUND: Takotsubo syndrome (TTS) is a non-ischemic cardiomyopathy characterized by an acute reversible left ventricular dysfunction with typical apical ballooning, usually with subsequent complete spontaneous recovery. TTS shares several features with acute coronary syndrome (ACS), including clinical presentation, ECG changes, and elevated troponin. OBJECTIVES: To identify different features that may help differentiate between TTS and ACS with presentation based on presenting symptoms and physical examination. METHODS: We compared 35 patients who TTS had been diagnosed with 60 age- and sex- matched patients with ACS (both ST and non-ST segment elevation myocardial infarction) who were hospitalized in Galilee Medical Center through 2011-2015.Basic characteristics and clinical features of the two groups were compared using appropriate statistical tests. RESULTS: Of the patients with TTS, 21 (60%) reported an emotional trigger (60%) before admission, although they did not have increased prevalence of psychiatric disease compared to ACS patients (5.7% vs. 5%, P = 0.611). There was no difference in the type of chest pain or accompanied symptoms between the groups. Of notice, ECG changes in the TTS group were prominent in the anterior leads, and the patients presented with higher heart rate (86 ± 17 vs. 79 ± 15, P = 0.029) and lower systolic blood pressure (129 ± 26 vs. 142 ± 30, P = 0.034) on admission compared to the ACS group. CONCLUSIONS: There was no reliable feature that could distinguish TTS from ACS based on clinical presentation. TTS should always be in the differential diagnosis in patients with acute chest pain, especially in elderly women.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Eletrocardiografia , Cardiomiopatia de Takotsubo/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Diagnóstico Diferencial , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cardiomiopatia de Takotsubo/diagnóstico , Troponina/metabolismo
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.
Arkh Patol ; 83(1): 5-11, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33512121

RESUMO

The article presents published and own data about Takotsubo syndrome, a relatively rare heart disease that is similar to acute coronary syndrome, but without significant damage of coronary arteries. The leading pathogenetic factor is the catecholamine-induced stress damage of myocardium with involvement of microvessels. There is a certain underestimation of Takotsubo syndrome by both clinicians and pathologists, so some cases of Takotsubo syndrome are misdiagnosed as acute coronary syndrome. Morphological manifestations of Takotsubo syndrome are characterized by mucoid edema of interstitial myocardial tissue, round-cell infiltration of stroma and focal damage of cardiomyocytes.


Assuntos
Cardiomiopatias , Cardiomiopatia de Takotsubo , Vasos Coronários , Humanos , Miocárdio , Miócitos Cardíacos , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia
5.
J Card Surg ; 36(2): 764-769, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33336409

RESUMO

The COVID-19 pandemic has had far-reaching consequences beyond the disease itself, including economic, social, political, religious, and psychological implications. This novel coronavirus has been shown to have cardiovascular manifestations in the form of arrhythmias, conduction disturbances, myocarditis, stress cardiomyopathy, myocardial injury and myocardial ischemia or infarction from increased microvascular and/or macrovascular coagulopathy. However, in addition to these direct effects, we are now starting to recognize indirect cardiovascular effects of COVID-19 in the form of increased incidence of Takutsobo cardiomyopathy in patients without any evidence of coronavirus infection presumably due to the increased psychological stress of social isolation and societal turbulence. In this case series, we present two post-menopausal women, presenting with chest pain and acute coronary syndrome, who are finally diagnosed with stress cardiomyopathy, triggered by increased emotional stress-related to the pandemic. There is data from a retrospective cohort analysis showing a fourfold increase in the incidence of acute coronary syndrome resulting from stress cardiomyopathy during the pandemic period compared to similar times periods before the pandemic. Hence, health care providers need to be cognizant of the emotional ramifications of the ongoing pandemic in the form of increased risk of Takotsubo cardiomyopathy. Moreover, urgent measures need to be taken to help the at-risk population cope with the ongoing stressors to help decrease the incidence of this cardiomyopathy.


Assuntos
/complicações , Eletrocardiografia , Angústia Psicológica , Estresse Psicológico/complicações , Cardiomiopatia de Takotsubo/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pandemias , Estresse Psicológico/psicologia , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/psicologia
6.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334739

RESUMO

Takotsubo cardiomyopathy (TTC) is a rare but life-threatening condition that is still not completely understood. Characterised by rapidly reversible ventricular dysfunction without any prior coronary artery disease, it can imitate a myocardial infarction and lead to death if not managed appropriately. This report examines a case of intraoperative cardiac arrest in a patient with no previous cardiac disease, and discusses the factors that may have precipitated this event, as well as the ways of distinguishing the cause of the arrest based on clinical course and investigations, eventually leading to a diagnosis of TTC.


Assuntos
Aborto Induzido/efeitos adversos , Parada Cardíaca/etiologia , Complicações Intraoperatórias/diagnóstico , Estresse Psicológico/etiologia , Cardiomiopatia de Takotsubo/diagnóstico , Aborto Induzido/psicologia , Adulto , Cardiotônicos/administração & dosagem , Catecolaminas/sangue , Ecocardiografia , Eletrocardiografia , Feminino , Parada Cardíaca/sangue , Parada Cardíaca/tratamento farmacológico , Humanos , Infusões Intravenosas , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/tratamento farmacológico , Complicações Intraoperatórias/etiologia , Gravidez , Simendana/administração & dosagem , Estresse Psicológico/sangue , Estresse Psicológico/psicologia , Cardiomiopatia de Takotsubo/sangue , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/etiologia
7.
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
9.
N Z Med J ; 133(1520): 73-82, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994595

RESUMO

AIM: Takotsubo syndrome (TS) mimics acute coronary syndrome but has a distinct pathophysiology. This study aimed to compare and contrast the clinical presentation, management and outcomes of patients with TS in five large New Zealand hospitals. METHODS: We identified 632 consecutive patients presenting to the five major tertiary hospitals in New Zealand (Middlemore Hospital, Auckland City Hospital, North Shore Hospital, Christchurch Hospital and Dunedin Hospital) between January 2006 and June 2018 and obtained clinical, laboratory, electrocardiography, echocardiography, coronary angiography and long-term follow-up data. RESULTS: Six hundred and thirty-two consecutive patients with TS (606 women, mean age 65.0+11.1 years) were included. An associated stressor was identified in two-thirds of patients, and emotional triggers were more frequent than physical triggers (62.9% and 37.1%, respectively). Overall, 12.7% of patient had depression and 11.7% anxiety but this was more common in patients from Christchurch Hospital (20.4% and 23.4%, respectively). The in-hospital mortality among the five hospitals ranges between 0 to 2.0%. The mean follow-up was 4.9+3.4 years (median 4.4 years). Fifty-four people died post-discharge, all but one from a non-cardiac cause. Forty patients had recurrent TS. Mortality post-discharge (p=0.63) and TS recurrence (p=0.38) did not differ significantly among the five hospitals. CONCLUSION: In this large New Zealand TS cohort, the clinical characteristics and presentation were similar among the five hospitals. A subset of patients had a complicated in-hospital course, but late deaths were almost all from non-cardiac causes and recurrence was infrequent. Mortality post-discharge and recurrence was similar between the hospitals.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Mortalidade Hospitalar/tendências , Hospitais Urbanos/estatística & dados numéricos , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Angiografia Coronária/métodos , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Nova Zelândia/etnologia , Alta do Paciente/tendências , Estudos Prospectivos , Recidiva , Estresse Psicológico/epidemiologia , Cardiomiopatia de Takotsubo/epidemiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Centros de Atenção Terciária/estatística & dados numéricos
11.
A A Pract ; 14(11): e01304, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32985848

RESUMO

Coronavirus disease 2019 (COVID-19) has a high incidence of cardiac involvement, commonly described as a new-onset cardiomyopathy. In this report, we describe a patient with a new manifestation of cardiac involvement in the setting of a COVID-19 diagnosis: that of takotsubo cardiomyopathy.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Cardiomiopatia de Takotsubo/virologia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico
13.
Folia Med Cracov ; 60(1): 5-14, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658207

RESUMO

BACKGROUND: Today no established biomarkers are available for the early diagnosis of takotsubo syndrome and its differentiation from ST-segment elevation myocardial infarction. We hypothesized that copeptin and copeptin/NT-proBNP ratio may serve a routine marker combination for non-invasive differentiation. METHODS: The study compared the serum concentrations of copeptin, troponin I (TnI) and NT-proBNP in 19 consecutive women diagnosed with takotsubo syndrome according to the Mayo Clinic criteria and 10 consecutive women diagnosed with ST-segment elevation myocardial infarction. RESULTS: Copeptin concentrations were significantly lower in patients with takotsubo syndrome than in patients with ST-segment elevation myocardial infarction. The diagnostic accuracy to distinguish takotsubo syndrome from ST-segment elevation myocardial infarction is highest for copeptin/NTproBNP ratio, copeptin/TnI at admission ratio and copeptin alone (AUC 0.8713, 0.8538, 0.8480, respectively). CONCLUSIONS: The serum copeptin to NTproBNP ratio could be an additional tool in the non-invasive differentiation between takotsubo syndrome and ST-segment elevation myocardial infarction. However, further researches are needed.


Assuntos
Biomarcadores/sangue , Diagnóstico Precoce , Glicopeptídeos/sangue , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Cardiomiopatia de Takotsubo/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Cardiomiopatia de Takotsubo/sangue
14.
Folia Med Cracov ; 60(1): 45-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658211

RESUMO

Takotsubo cardiomyopathy (TCM) represents an acute systolic left ventricular dysfunction typically triggered by severe psychological or physical stress. Oncological patients due to emotional distress of the diagnosis, proinflammatory and prothrombotic nature of cancer and also physical stress often following complex anticancer therapies are at high-risk of TCM. Moreover, there are also few reports of TCM associated with oncological treatment, mostly chemotherapy. Recent data from large registries indicate a surprisingly high incidence of malignancy in TCM, significant differences in clinical characteristics and unfavorable short- and long-term clinical outcomes in this specific group of patients. Therefore, we present two case reports of TCM that occurred during active anticancer therapy. Both women were admitted with suspicion of acute coronary syndrome. The first patient underwent mastectomy two years before due to hormone receptor-positive breast cancer and on admission she was during adjuvant hormonotherapy with tamoxifen. The admission of the second patient was preceded by fifteen fractions of adjuvant external beam radiotherapy due to intermediate-risk endometrial cancer after radical hysterectomy. Based on coronary angiography type I of acute coronary syndrome was excluded. Both patients negated stressful situations in the period immediately before the symptoms onset. Within hospital course baseline apical ballooning observed in both cases fully recovered and enabled subsequent completion of oncological treatment in accordance with adopted treatment protocols without recurrence of TCM. To our knowledge, presented cases are the first reports showing direct relationship between TCM and adjuvant hormonotherapy with tamoxifen or pelvic radiotherapy.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Radioterapia/efeitos adversos , Cardiomiopatia de Takotsubo/etiologia , Tamoxifeno/efeitos adversos , Idoso , Feminino , Humanos , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/terapia , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia
16.
BMJ Case Rep ; 13(6)2020 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-32540884

RESUMO

COVID-19 became a global pandemic in early 2020. While well known for its pulmonary manifestations, the virus also has a number of cardiac manifestations as well. Takotsubo syndrome has scarcely been reported in patients with COVID-19, but it is possible that the cytokine storm associated with the infection can trigger Takotsubo syndrome in patients with underlying risk factors for Takotsubo (emotional distress, physical distress, history of psychiatric disorders).


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Infecções por Coronavirus , Heparina/administração & dosagem , Metilprednisolona/administração & dosagem , Pandemias , Pneumonia Viral , Esquizofrenia/complicações , Cardiomiopatia de Takotsubo , Anticoagulantes/administração & dosagem , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Angiografia Coronária/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Eletrocardiografia/métodos , Humanos , Fatores Imunológicos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Respiração Artificial/métodos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Cardiomiopatia de Takotsubo/sangue , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia , Resultado do Tratamento
17.
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
20.
BMC Neurol ; 20(1): 201, 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32438902

RESUMO

BACKGROUND: Stress cardiomyopathy (Takotsubo cardiomyopathy) is very rare in the central nervous system (CNS) demyelinating disorders. Although this dysfunction of the heart-brain axis has been reported in several case series related to multiple sclerosis (MS), stress cardiomyopathy by neuromyelitis optica (NMO), which is rarer CNS demyelinating disorder than MS, is extremely rare. Herein, we report a case of stress cardiomyopathy associated with a medullary lesion as a presentation of NMO. CASE PRESENTATION: A 30-year-old woman was treated by veno-arterial extracorporeal membrane oxygenation due to catastrophic cardiopulmonary dysfunction after prolonged and unexplained nausea, vomiting, and cough. Myoclonus on the limbs developed afterward. Taken with suspicion of area postrema syndrome (APS), the brain MRI showed a demyelinating lesion in the medulla oblongata. APS and severe heart failure by stress cardiomyopathy were completely resolved by ECMO and hydrocortisone therapy. However, the CNS demyelinating lesion recurred after 1 month. The patient was diagnosed with NMO evident by the presence of aquaporin-4 antibody; Steroid therapy improved her symptoms. CONCLUSION: NMO should be considered as one of the differential diagnoses in patients with APS preceding severe cardiopulmonary distress.


Assuntos
Área Postrema , Neuromielite Óptica/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Adulto , Aquaporina 4/imunologia , Autoanticorpos/sangue , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Bulbo/patologia , Recidiva , Síndrome
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