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1.
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
2.
Br J Radiol ; 93(1115): 20200514, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32795180

RESUMO

Takotsubo cardiomyopathy (TC) is a reversible condition in which there is transient left ventricular (LV) dysfunction characterised most commonly by basal hyperkinesis and mid-apical LV ballooning and hypokinesia. It is said to be triggered by stress and mimics, such as acute coronary syndrome (ACS) clinically. Diagnosis is usually suspected on echocardiography due to the characteristic contraction pattern in a patient with symptoms and signs of ACS but normal coronary arteries on catheter angiography. Cardiac magnetic resonance (CMR), with its latest advancements, is the diagnostic modality of choice for diagnosis, prognosis and follow-up of patients. The advances in CMR (including T1, T2, ECV mapping and threshold-based late gadolinium enhancement (LGE) measurements have revolutionised the role of CMR in tissue characterisation and prognostication in patients with TC. In this review, we highlight the current role of CMR in management of TC and enumerate the CMR findings in TC as well the current advances in the field of CMR, which could help in prognosticating these patients.


Assuntos
Algoritmos , Imagem por Ressonância Magnética/métodos , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Circulação Coronária , Edema Cardíaco/diagnóstico por imagem , Fibrose/diagnóstico por imagem , Gadolínio , Humanos , Aumento da Imagem/métodos , Imagem por Ressonância Magnética/tendências , Imagem Cinética por Ressonância Magnética , Contração Miocárdica , Miocárdio/patologia , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/fisiopatologia
4.
Int J Cardiovasc Imaging ; 36(11): 2251-2253, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32712735

RESUMO

This study sought to identify parameters that could guide towards an ischemic origin in patients hospitalized for myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA). MINOCA is challenging in clinical practice, as the pathophysiology is multifaceted. A total of 135 patients with MINOCA who underwent cardiovascular magnetic resonance imaging (CMR) in a single tertiary University Hospital, were retrospectively included. The study cohort was classified into 4 groups according to the CMR diagnosis (i.e., myocarditis, myocardial infarction, Takotsubo cardiomyopathy, normal or uncommon diagnosis). According to the CMR, 62% had myocarditis, 14.1% myocardial infarction, 4.4% of Takotsubo and 19.3% showed a normal CMR or uncommon diagnoses. In the multivariate analysis, three criteria were independently correlated with the underlying diagnosis of myocardial infarction: (1) the absence of inflammatory response (HR: 5.71 IC95% [1.79-18.28]; p = 0.002), (2) the presence of coronary atheroma in invasive coronary angiography (HR: 6.56 IC95% [2.27-18.92]; p = 0.001) and (3) a peak of troponin ratio elevated than normal levels of 150 (HR: 4.12 IC95% [1.45-11.65]; p = 0.01). The prevalence of myocardial infarction in MINOCA was 4.9% in the absence of these three criteria, 3.4% with one of the criteria present, 34.5% with two criteria present and 71.4% with all three criteria. The negative predictive value for MI was 96% in the presence of at least two criteria. Our study shows that the absence of inflammatory response, a high troponin and the presence of angiographic coronary atheroma are independently correlated with a myocardial infarction underlying cause of MINOCA.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/diagnóstico por imagem , Miocardite/diagnóstico por imagem , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Adulto , Idoso , Biomarcadores/sangue , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/fisiopatologia , Miocardite/sangue , Miocardite/fisiopatologia , Admissão do Paciente , Placa Aterosclerótica , Valor Preditivo dos Testes , Estudos Retrospectivos , Cardiomiopatia de Takotsubo/sangue , Cardiomiopatia de Takotsubo/fisiopatologia , Troponina/sangue , Função Ventricular Esquerda
5.
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
7.
Cardiovasc Ther ; 2020: 1615826, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32695227

RESUMO

Background: Stress cardiomyopathy (SCM) is a transient reversible left ventricular dysfunction that more often occurs in women. Symptoms of SCM patients are similar to those of acute coronary syndrome (ACS), but little is known about biomarkers. The goals of this study were to identify the potentially crucial genes and pathways associated with SCM. Methods: We analyzed microarray datasets GSE95368 derived from the Gene Expression Omnibus (GEO) database. Firstly, identify the differentially expressed genes (DEGs) between SCM patients in normal patients. Then, the DEGs were used for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Finally, the protein-protein interaction (PPI) network was constructed and Cytoscape was used to find the key genes. Results: In total, 25 DEGs were identified, including 10 upregulated genes and 15 downregulated genes. These DEGs were mainly enriched in ECM-receptor interaction, dilated cardiomyopathy (DCM), human papillomavirus infection, and focal adhesion, whereas in GO function classification, they were mainly enriched in the extracellular region, positive regulation of the multicellular organismal process, establishment of localization, and intracellular vesicle. Conclusion: Seven hub genes contained APOE, MFGE8, ALB, APOB, SAA1, A2M, and C3 identified as hub genes of SCM, which might be used as diagnostic biomarkers or molecular targets for the treatment of SCM.


Assuntos
Antígenos de Superfície/genética , Apolipoproteína B-100/genética , Apolipoproteínas E/genética , Complemento C3/genética , Proteínas do Leite/genética , Albumina Sérica Humana/genética , Proteína Amiloide A Sérica/genética , Cardiomiopatia de Takotsubo/genética , Transcriptoma , Função Ventricular Esquerda/genética , alfa-Macroglobulinas/genética , Bases de Dados Genéticas , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Redes Reguladoras de Genes , Humanos , Mapas de Interação de Proteínas , Transdução de Sinais , Cardiomiopatia de Takotsubo/fisiopatologia
9.
BMC Cardiovasc Disord ; 20(1): 236, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429846

RESUMO

BACKGROUND: Takotsubo cardiomyopathy (TTC) has been widely recognized in recent decades and is triggered by either physical or psychological stressors. CASE PRESENTATION: A 70-year-old woman presented to the Emergency Department due to confusion, hypotension, fever, chills, and cough. She had a one-year history of diabetes insipidus. Pituitary function examination at admission revealed decreased thyroid, sex and adrenal hormones. Pituitary MRI displayed findings suggestive of nonhemorrhagic pituitary apoplexy. Electrocardiogram (ECG) revealed T-wave inversion and extended QT interval. Transthoracic echocardiogram (TTE) showed left ventricular apical dysplasia and ballooning, accompanied by reduced left ventricular ejection fraction. Coronary angiography (CAG) revealed no obvious coronary arterial stenosis. The left ventriculogram demonstrated an octopus clathrate appearance. Most ECG and TTE changes recovered 10 days later. CONCLUSIONS: To the best of our knowledge, this is the first report of newly diagnosed TTC associated with pituitary apoplexy.


Assuntos
Apoplexia Hipofisária/complicações , Cardiomiopatia de Takotsubo/etiologia , Hormônio Adrenocorticotrópico/uso terapêutico , Idoso , Fármacos Cardiovasculares/uso terapêutico , Feminino , Terapia de Reposição Hormonal , Humanos , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/tratamento farmacológico , Apoplexia Hipofisária/fisiopatologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/fisiopatologia , Tiroxina/uso terapêutico , Resultado do Tratamento , Função Ventricular Esquerda
12.
J Med Life ; 13(1): 3-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32341693

RESUMO

Takotsubo cardiomyopathy is a reversible cardiomyopathy with a unique morphological feature of the left ventricle characterized by an apical ballooning appearance known for approximately known 25 years. Catecholamine drive plays an essential role in the pathogenesis and pathophysiology of Takotsubo cardiomyopathy; hence, it is also called stress cardiomyopathy. Physical stress could also have an impact and leads to a greater variety of characteristics in Takotsubo cardiomyopathy. Supportive and symptomatic medication remains the mainstay therapy with priority to improving the function of the left ventricle for several days and full recovery in 3-4 weeks. Due to its similarity with myocardial infarction, Takotsubo cardiomyopathy requires careful diagnosis and management for the best possible outcome.


Assuntos
Cardiomiopatia de Takotsubo/patologia , Humanos , Prognóstico , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/terapia
13.
Am J Cardiol ; 125(11): 1700-1709, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32278461

RESUMO

Clinical spectrum of hypertrophic cardiomyopathy (HC) has been expanded to include patients with mild or no thickening of the left ventricle (LV), who nevertheless have outflow tract obstruction at rest or after exercise, due to systolic anterior motion (SAM) and ventricular septal contact, with mitral valve elongation and papillary muscles anomalies. Apical ballooning mimicking a takotsubo syndrome (TS) wall motion pattern can occur in HC with mild septal thickening when latent obstruction becomes unrelenting. To define the prevalence of anatomic abnormalities characteristic of HC in patients diagnosed with TS, we analyzed echocardiograms of 44 unselected TS patients, age 67±12 years, 95% women including studies performed before the event (n = 11, median 515 days) and after recovery of left ventricular function (n = 33, median 92 days, interquartile range = 29 to 327) and compared the findings to 60 age and sexed matched controls. Analysis of echocardiograms was blinded to event timing, and patient vs. control status. During the ballooning event, 13 patients (30%) had SAM including 9 with LV outflow obstruction, peak gradients 71±40 mmHg, as well as: ventricular septal thickening (16 ± 4 mm), elongated anterior leaflets (30 ± 3mm), and increased mitral coaptation to posterior wall distance (17 ± 5 mm), consistent with diagnosis of the HC phenotype. Compared to 31 TS patients without SAM, study patients with SAM had longer anterior leaflets (30 ± 3 vs 26 ± 4 mm, p = 0.006), thicker septum (16 ± 4 vs 12 ± 3 mm), increased coaptation to posterior wall distance (17 ± 5 vs 14 ± 4 mm, p < 0.04) and reduced distance from coaptation to septum (19 ± 5 vs 27 ± 5, p < 0.001). In the 13 patients with SAM, morphologic characteristics of HC persisted after normalization of LV function. In conclusion, a subset of patients experiencing TS events demonstrates a constellation of morphologic abnormalities characteristic of HC that persist after recovery of LV wall motion. These findings suggest that dynamic outflow obstruction may cause apical ballooning in susceptible patients.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Septo Interventricular/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Tamanho do Órgão , Recuperação de Função Fisiológica , Cardiomiopatia de Takotsubo/fisiopatologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Septo Interventricular/patologia
15.
Circ J ; 84(4): 592-600, 2020 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-32147633

RESUMO

BACKGROUND: Recent insights have emphasized the importance of inflammatory response in takotsubo syndrome (TTS). We sought to evaluate the predictors of systemic inflammatory response syndrome (SIRS) and its impact on cardiovascular mortality after TTS.Methods and Results:The 215 TTS patients were retrospectively included between September 2008 and January 2018. SIRS was diagnosed in 96 patients (44.7%). They had lower left ventricular ejection fraction (LVEF) on admission (34.5% vs. 41.9%; P<0.001) and higher peak brain natriuretic peptide and troponin. At a median follow-up of 518 days, SIRS was associated with increased in-hospital mortality (14.6% vs. 5.0%; P=0.019), overall mortality (29.4% vs. 10.8%; P=0.002), and cardiovascular mortality (10.6% vs. 2.1%; P=0.026). A history of cancer (OR, 3.36; 95% CI: 1.54-7.31; P=0.002) and LVEF <40% at admission (OR, 2.31; 95% CI: 1.16-4.58; P=0.017) were identified as independent predictors of SIRS. On multivariate Cox regression analysis, SIRS (HR, 12.8; 95% CI: 1.58-104; P=0.017), age (HR, 1.09; 95% CI: 1.02-1.16; P=0.01), and LVEF <40% at discharge (HR, 9.88; 95% CI: 2.54-38.4; P=0.001) were independent predictors of cardiovascular death. CONCLUSIONS: SIRS was found in a large proportion of TTS patients and was associated with enhanced myocardial damage and adverse outcome in the acute phase. At long-term follow-up, SIRS remained an independent factor of cardiovascular death.


Assuntos
Mortalidade Hospitalar , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Cardiomiopatia de Takotsubo/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Admissão do Paciente , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Cardiomiopatia de Takotsubo/sangue , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia , Fatores de Tempo , Troponina/sangue , Função Ventricular Esquerda
16.
Cardiovasc Pathol ; 47: 107204, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32169829

RESUMO

BACKGROUND: Takotsubo Cardiomyopathy is characterized by transient left ventricular systolic dysfunction, which often mimics a myocardial infarction and is usually triggered by emotional or physical stress. There are four variants of Takotsubo Cardiomyopathy, based on the affected left ventricular area. CASE: We report a 75-year-old female with a past medical history of diabetes mellitus, hypertension, hyperlipidemia, and chronic kidney disease who presented with chest pain that had started after a stressful, emotional event. Her electrocardiogram showed no ischemic changes, troponin was mildly elevated, and cardiac catheterization revealed nonobstructive coronary artery disease. Echocardiogram showed a decreased ejection fraction and apical akinesia with basal hyperkinesia consistent with classical Takotsubo Cardiomyopathy. DECISION-MAKING: The patient symptomatically improved on optimal heart failure therapy, and a follow-up echocardiogram showed improvement in her systolic function. Over a year later, the patient was readmitted with chest pain, which also began after an emotional event. ECG showed nonspecific ST-T wave changes, and troponin was mildly elevated. Echocardiogram demonstrated a reduced ejection fraction and inferior akinesia with apical hyperkinesia consistent with reverse Takotsubo Cardiomyopathy. A repeat cardiac catheterization exhibited mild nonobstructive coronary artery disease unchanged from her previous report. A follow-up echocardiogram showed full recovery of her systolic function. CONCLUSION: Classical and reverse Takotsubo Cardiomyopathy due to different stressors have been reported in the literature individually, but up to our knowledge, both variants of Takotsubo Cardiomyopathy occurring in the same patient has not been reported previously.


Assuntos
Ecocardiografia , Eletrocardiografia , Ventrículos do Coração , Volume Sistólico , Cardiomiopatia de Takotsubo/diagnóstico , Função Ventricular Esquerda , Idoso , Biomarcadores/sangue , Biópsia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/terapia , Resultado do Tratamento , Troponina/sangue
17.
Open Heart ; 7(1): e001197, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32201588

RESUMO

Objective: A score to distinguish Takotsubo syndrome (TS) from acute coronary syndrome would be useful to facilitate appropriate patient investigation and management. This study sought to derive and validate a simple score using demographic, clinical and ECG data to distinguish women with non-ST elevation myocardial infarction (NSTEMI) from NSTE-TS. Methods: The derivation cohort consisted of women with NSTE-TS (n=100) and NSTEMI (n=100). Logistic regression was used to derive the score using ECG values available on the postacute ward round on day 1 post-hospital admission. The score was then temporally validated in subsequent consecutive patients with NSTE-TS (n=40) and NSTEMI (n=70). Results: The five variables in the score and their relative weights were: T-wave inversion in ≥6 leads (+3), recent stress (+2), diabetes (-1), prior cardiovascular disease (-2) and ST-depression in any lead (-3). When calculated using ECG values obtained at admission, discrimination between conditions was very good (area under the curve (AUC) 0.87 95% CI 0.83 to 0.92). The optimal score cut-point of ≥1 to predict NSTE-TS had 73% sensitivity and 90% specificity. When applied to the validation cohort at admission, AUC was 0.82 (95% CI 0.75 to 0.90) and positive and negative predictive values were 78% and 81%, respectively. On day 1 post-admission, AUC was 0.92 (95% CI 0.87 to 0.97), with positive and negative predictive values of 77% and 91%, respectively. Conclusion: This NSTE-TS score is easy to use and may prove useful in clinical practice to distinguish women with NSTE-TS from NSTEMI. Further validation in external cohorts is needed.


Assuntos
Técnicas de Apoio para a Decisão , Eletrocardiografia , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Testes Imediatos , Cardiomiopatia de Takotsubo/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Nova Zelândia , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Fatores Sexuais , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Fatores de Tempo
18.
Cardiovasc Drugs Ther ; 34(1): 95-100, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32076930

RESUMO

BACKGROUND: Although Takotsubo syndrome (TS) was once considered to be rare and largely benign, it is now recognized to represent a major cause of cardiac morbidity and mortality, especially in ageing women. The biochemical precipitant of attacks of TS is an increase in catecholamine concentrations within the myocardium, engendering inflammatory activation via biased post-receptor signalling at myocardial ß2-adrenoceptor level. Cases of TS have been reported in patients treated with catecholamines, and with antidepressants which limit catecholamine re-uptake. In the current investigation, we sought to delineate the extent and potential impact of this "iatrogenic" form of TS. METHODS/RESULTS: Patients' data from a regional registry of 301 consecutive cases of TS were evaluated after exclusion of patients (n = 20) in whom TS had occurred in association with life threatening extracardiac disease states. A total of 55 (18%) of patients were identified as having antecedent exposure to potentially "iatrogenic" agents (tricyclic antidepressants in 24 cases, ß2-adrenoceptor agonists in 15). Demographics, including proportion of male patients, did not differ significantly between patients with and without "iatrogenic" TS, but plasma concentrations of the catecholamine metabolite normetanephrine tended to be greater (median 1149 pmol/L vs 938 pmol/L; p = 0.03). Long-term survival (median follow-up 3 years) was marginally (p = 0.13) worse for patients with "iatrogenic" TS. CONCLUSION: Potentially iatrogenic precipitation of TS attacks (via iatrogenic elevation of catecholamine levels and ß2-adrenoceptor stimulation) is common, associated with greater elevation of plasma normetanephrine concentrations, and also with a trend towards increased long-term mortality when compared to the remainder of TS patients.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Antidepressivos Tricíclicos/efeitos adversos , Doença Iatrogênica , Miocárdio/metabolismo , Normetanefrina/sangue , Cardiomiopatia de Takotsubo/induzido quimicamente , Função Ventricular Esquerda/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Cardiomiopatia de Takotsubo/sangue , Cardiomiopatia de Takotsubo/mortalidade , Cardiomiopatia de Takotsubo/fisiopatologia , Fatores de Tempo
19.
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
20.
J Card Surg ; 35(3): 721-724, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32027403

RESUMO

BACKGROUND: Takotsubo syndrome has been widely recognized as a stress cardiomyopathy and only recently has been also reported following cardiac surgery. AIMS: We present a case of takotsubo syndrome two days following a mitral valve replacement with a mechanical prosthesis. MATERIALS AND METHODS: A 64-year-old female patient underwent mitral valve replacement with a mechanical prosthesis. Two days later she presented clinical symptoms and diagnostic evidence supporting the diagnosis of takotsubo syndrome. RESULTS: Patient underwent full left ventricle function recovery and was discharged home on 10th postoperative days. DISCUSSION: The peculiar aspect of this case consist of the early postoperative transthoracic echocardiography, which showed, clearly, an optimal left ventricle function the day before sudden onset of the symptoms, thus allowing for a clear differential diagnosis with other potential causes of postoperative left ventricle failure. CONCLUSION: This case confirms that takotsubo syndrome has to be carefully considered in differential diagnosis in case of acute left ventricle dysfunction following cardiac surgery.


Assuntos
Implante de Prótese de Valva Cardíaca , Valva Mitral/cirurgia , Complicações Pós-Operatórias/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/fisiopatologia , Função Ventricular Esquerda
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