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2.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015233

RESUMO

Haemophagocytic lymphohistiocytosis (HLH) is an immune dysregulation disorder with variable presentations and non-specific features making it extremely difficult to diagnose early in the clinical course. Here, we are presenting a case of a young man who presented in cardiogenic shock with findings of anterolateral wall ischaemia on ECG. Echocardiography findings were consistent with takotsubo cardiomyopathy (TCM). Cardiac catheterisation showed clean coronary arteries and pulmonary artery pressure measurements showed high output cardiac failure. After extensive workup, the patient was diagnosed with HLH. In spite of aggressive supportive and definitive therapy, he eventually died due to a complicated clinical course. We did a comprehensive literature review and found that this is the first reported case of HLH presenting as TCM as the initial clinical manifestation.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Linfo-Histiocitose Hemofagocítica/complicações , Cardiomiopatia de Takotsubo/etiologia , Adulto , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia/métodos , Evolução Fatal , HIV/imunologia , Humanos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/terapia , Masculino , Volume Sistólico , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/terapia
3.
Eur J Radiol ; 113: 217-224, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927950

RESUMO

INTRODUCTION: T1 and T2 mapping have been shown to be reliable markers of interstitial myocardial fibrosis, edema, and inflammation. The aim of this study was to evaluate myocardial involvement in acute phase Takotsubo syndrome using native and post-contrast T1 mapping, ECV fraction, and T2 mapping. MATERIAL AND METHODS: We investigated 14 patients with acute Takotsubo syndrome and 14 healthy controls. CMR included cine imaging, black-blood STIR imaging, early and late gadolinium enhancement imaging, native and post-contrast T1 mapping, and T2 mapping. Wall motion, T2 ratio, early gadolinium enhancement ratio, extracellular volume fraction, T1 and T2 relaxation times were analyzed. RESULTS: Patients had significantly impaired left ventricular function (46 ± 10%) and acute wall motion abnormalities compared with controls (62 ± 2%). Native T1 and T2 values, T2 ratio, and ECV fraction were significantly higher in patients compared with controls. In patients, native T1 and T2 values as well as T2 ratio were significantly higher in segments with abnormal wall motion compared with normokinetic segments. Native T1 values, T2 relaxation times, T2 ratio, and ECV fraction were significantly higher, post-contrast T1 relaxation times significantly lower in segments with abnormal wall motion compared with segments of controls; except for T2 ratio and post-contrast T1 relaxation times this also held true for patients' segments with normal wall motion. CONCLUSIONS: Native T1 and T2 mapping, as well as ECV fraction, discriminate between visually affected vs. unaffected segments in patients with acute Takotsubo syndrome and reveal significant T1 and T2 tissue changes even in visually unaffected segments. Thus, mapping may allow for better detection in convalescent stages of disease and additionally may have the potential to serve as a marker of disease progress. These preliminary findings warrant further investigation in a larger patient cohort.


Assuntos
Cardiomiopatia de Takotsubo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/patologia , Meios de Contraste , Feminino , Fibrose/patologia , Gadolínio , Humanos , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Cardiomiopatia de Takotsubo/fisiopatologia , Função Ventricular Esquerda/fisiologia
5.
J Med Case Rep ; 13(1): 22, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30678717

RESUMO

INTRODUCTION: Simultaneous occurrence of transient global amnesia and Takotsubo syndrome has been only rarely reported. Here we report another patient with a transient global amnesia and concomitant Takotsubo syndrome. CASE PRESENTATION: Our patient is a 64-year-old white man with a previous history of myocarditis from borreliosis who developed sudden-onset confusional state with perseverations and repetition of the same questions during a funeral for his brother-in-law. Upon neurological work-up and after spontaneous resolution of most of the neurological deficits, transient global amnesia was diagnosed. Blood tests revealed moderate renal insufficiency, elevated troponin-T, and elevated N-terminal prohormone of brain natriuretic peptide. Electrocardiography showed left anterior hemiblock and negative T-waves in V2-V6. Upon transthoracic echocardiography the apical type of a Takotsubo syndrome was suspected. Since coronary angiography was normal and electrocardiography and echocardiographic abnormalities resolved under candesartan, bisoprolol, acetyl-salicylic acid, and atorvastatin within a few days after onset, Takotsubo syndrome was diagnosed. CONCLUSIONS: Since Takotsubo syndrome may be associated with transient global amnesia a causal relation may exist. A possible trigger for both conditions could be severe emotional stress from the loss of a close relative. A possible common pathomechanism could be overstimulation of adrenergic receptors in the myocardium, the cerebrum, or the coronary or cerebral arteries. Whether pre-existing myocardial compromise promotes the development of Takotsubo syndrome requires further investigations.


Assuntos
Amnésia Global Transitória/fisiopatologia , Hipertensão/fisiopatologia , Miocardite/fisiopatologia , Estresse Psicológico/fisiopatologia , Cardiomiopatia de Takotsubo/fisiopatologia , Amnésia Global Transitória/tratamento farmacológico , Amnésia Global Transitória/etiologia , Amnésia Global Transitória/psicologia , Anti-Hipertensivos/uso terapêutico , Aspirina/uso terapêutico , Atorvastatina/uso terapêutico , Benzimidazóis/uso terapêutico , Bisoprolol/uso terapêutico , Angiografia Coronária , Eletrocardiografia , Fibrinolíticos/uso terapêutico , Pesar , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/psicologia , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/psicologia , Tetrazóis/uso terapêutico , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(1): e13841, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30608400

RESUMO

Mental and physical stress is thought to play an important causative factor in apical ballooning syndrome (ABS) likely secondary to the vasomotor dysfunction. However, there are currently few data related to the impact of physical stress in this unique cardiomyopathy.A total 18 patients, including 8 females with history of ABS and 10 post-menopausal controls, underwent physical and mental tests. Assessments included the pain-induced peripheral artery tonometry scores (PIPATs) and mental stress peripheral artery tonometry scores (PATs).Compared with control group, PIPATs were significantly attenuated in patients with ABS in both baseline and post-mental stress (0.94 ±â€Š0.08 vs1.30 ±â€Š0.54, P <.05 and 0.87 ±â€Š0.19 vs1.24 ±â€Š0.21 P = .01, respectively); mental stress PATs were significantly lower in patients with ABS, both in Stroop test (0.79 ±â€Š0.30 vs 1.24 ±â€Š0.43, P = .01) and arithmetic test (0.91 ±â€Š0.27 vs 1.36 ±â€Š0.57, P = .01). PIPATs correlated significantly with mental stress PATs, both in arithmetic and Stroop test (P <.05).The PIPATs were attenuated in female with history of ABS and the vascular response to pain may provide a different pathogenesis mechanism on detecting patients with ABS.


Assuntos
Manometria , Dor/complicações , Estresse Psicológico/fisiopatologia , Cardiomiopatia de Takotsubo/fisiopatologia , Braço/irrigação sanguínea , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Estresse Psicológico/psicologia , Cardiomiopatia de Takotsubo/psicologia
8.
Heart Fail Clin ; 15(1): 41-53, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30449379

RESUMO

Stress-induced cardiomyopathy is characterized by reversible myocardial injury with distinctive regional wall motion abnormalities of the left ventricle, usually precipitated by an emotional or physical stressor. This condition has a strong predilection for older women and has a trend of increasing incidence. The diagnosis can be made based on symptoms, biomarkers, electrocardiogram, coronary angiogram, and noninvasive imaging. It is frequently complicated by acute heart failure, cardiogenic shock, arrhythmias, left ventricular outflow tract obstruction, and ventricular thrombi. Evidence of the treatment of stress-induced cardiomyopathy is limited. Prognosis is not benign; it carries substantial mortality, similar to that of acute coronary syndrome.


Assuntos
Cardiomiopatia de Takotsubo , Técnicas de Diagnóstico Cardiovascular , Gerenciamento Clínico , Humanos , Prognóstico , Fatores de Risco , Fatores Sexuais , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/terapia
9.
BMJ Case Rep ; 11(1)2018 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-30567218

RESUMO

Pheochromocytoma is a rare catecholamine-secreting tumour that is typically located in the adrenal medulla or along the sympathetic ganglia. The typical symptoms are episodic in nature and include tachycardia, sweating and headache. These tumours can present as transient, reversible cardiomyopathy similar to takotsubo cardiomyopathy (TCM). TCM is characterised by transient hypokinesis of the left ventricular apex and is typically induced by emotional stress. We describe the case of a 26-year-old woman with a medical history significant for headaches who presented initially to her family physician with nausea, vomiting, headache and hypertension. She was started on lisinopril 10 mg daily. One week later, she presented to the emergency department with substernal severe chest pressure. Her troponin level was elevated. Coronary angiogram showed normal coronary arteries and left ventriculogram showed inverse TCM pattern. Serum catecholamines were very elevated confirming pheochromocytoma. She was successfully treated with alpha-blockers followed by surgical resection.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Antagonistas Adrenérgicos alfa/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Lisinopril/uso terapêutico , Feocromocitoma/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Neoplasias das Glândulas Suprarrenais/fisiopatologia , Neoplasias das Glândulas Suprarrenais/terapia , Adulto , Angiografia Coronária , Eletrocardiografia , Feminino , Cefaleia , Humanos , Hipertensão/etiologia , Náusea , Feocromocitoma/fisiopatologia , Feocromocitoma/terapia , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/terapia , Resultado do Tratamento , Vômito
10.
BMJ Case Rep ; 11(1)2018 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-30567259

RESUMO

We present a case of reverse takotsubo syndrome (rTS) in a 68-year-old woman who presented with acute chest pain and flu-like symptoms. She was found to have elevated troponin and abnormal ECG. Urgent coronary angiogram revealed non-obstructive mild coronary artery disease of the left anterior descending artery. Left ventriculography demonstrated hypokinesis of the left ventricular base with sparing of the mid-ventricle and apex. Nasal viral PCR was positive for Influenza A. The diagnosis was confirmed with repeat echocardiogram 2 weeks later revealing resolution of regional wall motion abnormalities. rTS is a type of TS, mimicking acute coronary syndrome. It is seen in younger patients and often occurs with intense emotional and physical stress. Though many triggers have been reported, rTS associated with influenza A has not been previously documented.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Dor no Peito/etiologia , Vírus da Influenza A/patogenicidade , Influenza Humana/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Antivirais/uso terapêutico , Aspirina/uso terapêutico , Atorvastatina/uso terapêutico , Dor no Peito/fisiopatologia , Angiografia Coronária , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Vírus da Influenza A/imunologia , Influenza Humana/tratamento farmacológico , Influenza Humana/fisiopatologia , Oseltamivir/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/fisiopatologia , Resultado do Tratamento
11.
BMC Cardiovasc Disord ; 18(1): 229, 2018 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-30526522

RESUMO

BACKGROUND: Takotsubo syndrome (TTS) is an acute cardiac condition with reversible heart failure which is often triggered by psychological and physical stressful events. Although pulmonary embolism (PE) was reported as a trigger for TTS, the concurrence of TTS and PE has been rarely reported, let alone that triggered by PE. Here we describe a case of a postmenopausal female presenting with symptoms similar to myocardial ischemia, which may be caused by PE, and review the available literature that may help clinicians with their practice to similar situations since no published guidelines are available. CASE PRESENTATION: An 86-year-old female was referred to the emergency department for unrelieved chest tightness, shortness of breath and back pain. Cardiac biomarkers were mildly elevated and electrocardiogram displayed pathologic Q-waves, ST-segment elevation and inverted T-waves. Unexpectedly, coronary angiography was in absence of obstructed coronary atherosclerosis or acute plaque rupture. Chest computed tomography illustrated multiple pulmonary emboli in bilateral pulmonary arteries. She had suffered from long-term right lower extremity pain and experienced a long railway journey with less activity. Both echocardiogram and cardiac magnetic resonance demonstrated regional hypokinesia of left ventricle. She received anticoagulant and diuretic therapies, three-month follow up after discharge revealed uneventful recovery without any pulmonary emboli or regional motion abnormalities, thus she was retrospectively diagnosed with TTS caused by PE. CONCLUSION: TTS and PE are scarcely concurrent and PE can exert as a potential trigger for TTS. TTS is easily misdiagnosed, actively seeking possible risk factors of TTS is in favor of early diagnosis and timely intervention. TTS with PE is reversible, timely and effective treatments ensure the best possible outcome.


Assuntos
Embolia Pulmonar/complicações , Cardiomiopatia de Takotsubo/etiologia , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Angiografia por Tomografia Computadorizada , Diuréticos/uso terapêutico , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Imagem por Ressonância Magnética , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/fisiopatologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/fisiopatologia , Resultado do Tratamento , Função Ventricular Esquerda
13.
Pol Merkur Lekarski ; 45(265): 41-45, 2018 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-30058627

RESUMO

Anorexia nervosa (AN) is characterized by very low body mass index (BMI), related to obsessive fear of gaining weight, resulting in food restriction. In AN various cardiac complications may occur: hypotension, bradycardia, life-threatening ventricular arrhythmias, pericardial effusion, reduction of left ventricular mass and impairment of its function. Stress-induced takotsubo cardiomyopathy (TC) is reported rarely since sympathetic activity in AN patients is lower than in healthy individuals. Different mechanisms are suggested to be involved in TC pathogenesis, including low estrogens levels or dyselectrolitemia, but hypoglycemia, which results in sympathetic stimulation, seems to be more important. A CASE REPORT: The authors describe a case of a 39-year-old female with so far untreated advanced AN, admitted to hospital due to profound hypoglycemia (17 mg/dl), cachexia (BMI 11) and with heart failure. Echocardiography revealed severe left ventricular (LV) dysfunction in the form of apical TC with markedly decreased ejection fraction (28%) and global longitudinal strain (-10.2%). She received therapy focused on metabolic disturbances correction. Daily echocardiography was performed to follow LV function recovery, including longitudinal strain normalization, which was observed after two weeks. TC should be considered as a potential AN complication, but it may be triggered by hypoglycemia of any etiology. Longitudinal strain assessment is a convenient and accurate mode of LV function monitoring in TC patients.


Assuntos
Anorexia Nervosa/complicações , Hipoglicemia/complicações , Recuperação de Função Fisiológica , Cardiomiopatia de Takotsubo/etiologia , Função Ventricular Esquerda , Adulto , Ecocardiografia , Feminino , Humanos , Hipoglicemia/etiologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/fisiopatologia
15.
Mult Scler Relat Disord ; 24: 1-2, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29804030

RESUMO

BACKGROUND: We report a case of a woman affected by relapsing remitting Multiple Sclerosis who developed acute left ventricular dysfunction in the context of a severe brainstem relapse, one month after an attempt of in-vitro fertilization. DISCUSSION: The characteristics of our case are consistent with the hypothesis of a possible causal association between an acute medulla oblongata lesion and the occurrence of Takotsubo cardiomyopathy. CONCLUSION: Our case adds to previous reports in this field and calls for awareness of this exceptional extra-neurological manifestation of MS. It seems also to confirm the possible association between MS relapses and ovarian stimulation.


Assuntos
Bulbo/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/etiologia , Feminino , Fertilização In Vitro , Humanos , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Recidiva , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/fisiopatologia
16.
Biomed Res Int ; 2018: 5281485, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29725598

RESUMO

Background: Takotsubo cardiomyopathy (TC) aetiology has not been completely understood yet. One proposed pathogenic mechanism was coronary microvascular dysfunction (MVD). This study compared coronary flow and myocardial perfusion in patients with TC, microvascular angina (MVA), and a control group (CG). Methods: Out of 42 consecutive patients presented to our centre with TC from 2013 to 2017; we retrospectively selected 27 patients. We compared them with a sex- and age-matched group of 27 MVA cases and 27 patients with normal coronary arteries (CG). The flow was evaluated in the three coronary arteries as TIMI flow and TIMI frame count (TFC). Myocardial perfusion was studied with Blush-Score and Quantitative Blush Evaluator (QuBE). Results: TFC, in TC, revealed flow impairment in the three arteries compared to the CG (left anterior descending artery (LAD): 22 ± 8, 15 ± 4; p = 0.001) (right coronary artery: 12 ± 4, 10 ± 3; p = 0,025) (left circumflex: 14 ± 4, CG 11 ± 3; p = 0,006). QuBE showed myocardial perfusion impairment in the LAD territory in TC comparing with both the CG (8,9 (7,2-11,5) versus 11,4 (10-15,7); p = 0,008) and the MVA group (8,9 (7,2-11,5) versus 13,5 (10-16); p = 0,006). Conclusions: Our study confirmed that coronary flow is impaired in TC, reflecting a MVD. Myocardial perfusion defect was detected only in the LAD area.


Assuntos
Microvasos/fisiopatologia , Cardiomiopatia de Takotsubo/fisiopatologia , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Angiografia Coronária/métodos , Circulação Coronária/fisiologia , Vasos Coronários/fisiopatologia , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Estudos Retrospectivos
17.
Heart Vessels ; 33(10): 1214-1219, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29696359

RESUMO

Takotsubo syndrome (TTS) has been recognized as a benign condition mainly due to its reversibility. However, recent researches have demonstrated that serious cardiac complications could occur during hospitalization. Thus, the aim of this study is to detect factors associated with in-hospital cardiac complications in patients with TTS. A total of 154 consecutive patients with TTS were enrolled retrospectively. In-hospital cardiac complications were observed in 61 patients (40%), including 44 patients with pulmonary edema (29%) and 25 patients with cardiogenic shock (16%). Multivariate logistic regression analysis identified lower systolic blood pressure on admission (OR 0.97, 95% CI 0.96-0.99, p = 0.001), history of diabetes mellitus (OR 2.92, 95% CI 1.01-8.41, p = 0.04), and ß-blocker use before admission (OR 16.9, 95% CI 1.57-181.7, p = 0.006) as independent predictors of in-hospital cardiac complications, while chest pain at onset was identified as a negative predictor of cardiac complications during hospitalization (OR 0.20, 95% CI 0.07-0.55, p = 0.001). Patients with cardiac complications more often needed hemodynamic support and longer hospital stay than those without (21.2 ± 19.4 vs. 11.8 ± 16.8 days, p = 0.002). TTS should be no longer recognized as a benign disease, but requiring careful management. We should obtain vital signs and patient's medical history carefully as soon as possible after admission to predict in-hospital cardiac complications.


Assuntos
Pacientes Internados , Edema Pulmonar/epidemiologia , Choque Cardiogênico/epidemiologia , Cardiomiopatia de Takotsubo/complicações , Idoso , Cateterismo Cardíaco , Causas de Morte/tendências , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Japão/epidemiologia , Masculino , Prognóstico , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Estudos Retrospectivos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Volume Sistólico/fisiologia , Taxa de Sobrevida/tendências , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia , Ventriculografia de Primeira Passagem/métodos
18.
Clin Res Cardiol ; 107(7): 597-606, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29675571

RESUMO

BACKGROUND: Takotsubo syndrome (TTS), a form of acute transient heart failure, has been associated with severe complications and considerable mortality rates. N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) might serve as a marker to identify high-risk patients but has not yet been investigated regarding prognostic implications in TTS. Aim of this study was to determine the short- and long-term prognostic utility of NT-proBNP in patients with TTS. METHODS: The predictive value of admission NT-proBNP was assessed in an international, multicenter study including 177 consecutive TTS patients. Predefined endpoints were 30-day major adverse cardiac events (MACE) consisting of all-cause death, cardiogenic shock, and pulmonary edema as well as long-term mortality in median 2.3 years after the acute event. RESULTS: Stratification according to median admission NT-proBNP (4511 pg/ml) resulted in significantly higher 30-day MACE [22.5 versus 9.1%; odds ratio (OR) 2.90, 95% confidence interval (CI) 1.20-6.99 p = 0.015] and long-term mortality rates [16.3 versus 9.4%; hazard ratio (HR) 2.72, 95% CI 1.13-6.56 p = 0.021] in patients > median. The best admission NT-proBNP cutoffs to predict 30-day MACE and long-term mortality were determined at 5560 and 8178 pg/ml respectively, with subsequent improved risk stratification for short-term MACE (OR 3.61, 95% CI 1.49-8.72; p = 0.003) and long-term mortality (HR 4.40; 95% CI 1.85-10.44, p < 0.001). Multivariate regression analysis identified admission NT-proBNP as an independent predictor of 30-day MACE (p < 0.001) and long-term mortality (p = 0.012). CONCLUSIONS: Admission NT-proBNP is an independent predictor for short- and long-term adverse events in TTS patients and, therefore, a useful marker for risk stratification immediately at presentation.


Assuntos
Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Cardiomiopatia de Takotsubo/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Feminino , Alemanha , Humanos , Itália , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Razão de Chances , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/mortalidade , Cardiomiopatia de Takotsubo/fisiopatologia , Fatores de Tempo
19.
Clin Cardiol ; 41(4): 551-555, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29663451

RESUMO

The Takotsubo cardiomyopathy is often considered autochthonous to the heart, although the primary problem may be not in the heart muscle itself. Instead, similar to several Takotsubo-like cardiac pathologies seen in acute neurological diseases, it may reflect the capacity of the nervous system to injure the heart. Persuasive evidence exists that shocking emotional stress promotes direct heart injuries. Moreover, clinical and laboratory research shows that cardiac structural damage can occur in the presence of a normal heart, especially in the context of seizures, stroke, and traumatic brain injury or under conditions of psychological stress. The aim of this review is to summarize the clinical implications of these observations, several of which focus on the pivotal role of the insula of Reil in the brain-heart connection, to unravel the mystery of Takotsubo cardiomyopathy pathogenesis.


Assuntos
Córtex Cerebral/fisiopatologia , Frequência Cardíaca , Coração/inervação , Estresse Psicológico/complicações , Cardiomiopatia de Takotsubo/etiologia , Função Ventricular Esquerda , Potenciais de Ação , Animais , Humanos , Prognóstico , Fatores de Risco , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/psicologia
20.
J Med Case Rep ; 12(1): 86, 2018 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-29602306

RESUMO

BACKGROUND: Coronary artery fistula, first described by Krause in 1865, is an abnormal communication between the coronary artery and one of the four chambers of the heart or one of the great vessels. The communications are often congenital but may also be acquired from trauma or invasive cardiovascular procedures. Half of the cases present with angina pectoris whereas the remaining half are incidentally detected on echocardiogram or angiogram performed for an unrelated reason. Takotsubo cardiomyopathy or stress-induced cardiomyopathy is characterized by transient left ventricular dysfunction with minimal elevation of cardiac biomarkers in the absence of underlying coronary artery disease. Almost 90% of reported patients are postmenopausal women with a history of recent emotional or physical stress. CASE PRESENTATION: We report an unusual case of a 64-year-old Hispanic woman presenting with typical symptoms suggestive of acute coronary syndrome after an extreme familial conflict. There was mild troponin elevation. Cardiac catheterization revealed microfistulas originating from the third portion of the left anterior descending artery draining to the left ventricular cavity. The ventriculogram demonstrated the apical ballooning. We postulate that high local concentration of catecholamine triggered by stress resulted in angina pectoris due to worsening coronary steal from the coronary fistula. Also, the stress-induced adrenergic stimulation unmasked the classical akinetic apex and apical ballooning characteristic of Takotsubo cardiomyopathy. CONCLUSIONS: This case report highlights the rare but important association between two uncommon conditions. To the best of our knowledge, only one similar case has been reported describing a patient with microfistulas to left ventricular cavity and concurrent Takotsubo cardiomyopathy.


Assuntos
Vasos Coronários/patologia , Cardiomiopatia de Takotsubo/complicações , Fístula Vascular/complicações , Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Angina Pectoris/fisiopatologia , Antiarrítmicos/uso terapêutico , Aspirina/uso terapêutico , Cateterismo Cardíaco/métodos , Catecolaminas/metabolismo , Dor no Peito , Angiografia Coronária , Ecocardiografia , Feminino , Humanos , Metoprolol/uso terapêutico , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/terapia , Resultado do Tratamento , Fístula Vascular/diagnóstico , Fístula Vascular/patologia , Fístula Vascular/terapia
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