Takotsubo syndrome

Takotsubo syndrome is a reversible acute heart failure frequently precipitated by an emotional or physical stress. The clinical presentation resembles acute coronary syndrome. Pathogenesis is complex and may involve brain-heart axis and neuro-hormonal stunning of the myocardium. Coronary angiography reveals normal epicardial arteries with no obstruction or spasm. NT-ProBNP maybe remarkably elevated. Regional wall motion akinesia (RWMA) of left ventricle extends beyond the territory of one coronary artery. Reduced left ventricle ejection fraction (LVEF) and RWMA recover in 6–12 weeks. Prognosis is generally good. Recent meta-analysis shows in-hospital mortality of 1–4.5% and recurrence rate of 5–10% during five year follow-up.

Miocardiopatía Takotsubo postparto: parto distócico como posible factor desencadenante / Takotsubo cardiomyopathy: dystocic labor as a possible triggering factor

La miocardiopatía Takotsubo, o miocardiopatía por estrés, se define como una disfunción del segmento apical del ventrículo izquierdo, aguda, transitoria y reversible. Normalmente se relaciona con algún tipo de agente estresante, ya sea físico o emocional, pudiendo confundirse este cuadro con un síndrome coronario agudo. Se considera una patología rara, pero que es importante incluir en el diagnóstico diferencial de los trastornos cardiacos, sospechándolo previamente por la sintomatología. Está caracterizado por alteraciones en el electrocardiograma, como elevación del segmento ST en derivaciones precordiales e inversión de la onda T, elevación de las enzimas de necrosis miocárdica o patrones alterados en la ecocardiografía, como la disfunción ventricular apical con hiperquinesia de zonas basales. En cuanto a la fisiopatología, parece que la estimulación simpática juega un papel importante, en el que la disfunción ventricular se desencadena por algún tipo de estrés físico o emocional. Éste provoca una descarga de catecolaminas con un efecto cardiotóxico debido, en su mayor parte, al efecto del adenosín monofosfato cíclico. El tratamiento consiste en las medidas soporte de una miocardiopatía, evitando los fármacos teratogénicos o perjudiciales durante el periodo de lactancia. La evolución es favorable en la mayoría de los casos y el cuadro remite por completo, por lo que el pronóstico en líneas generales se considera bueno. En este trabajo se expone el caso de un parto instrumentado, en el que se manifiesta un cuadro compatible con una miocardiopatía Takotsubo, posiblemente relacionado con un procedimiento invasivo como factor desencadenante.

Takotsubo cardiomyopathy or stress cardiomyopathy is defined as an acute, transient, and reversible dysfunction of the apical segment of the left ventricle. It is usually associated with some sort of stressor, whether physical or emotional, and could be confused with an acute coronary syndrome. It is considered a rare disease, so it is important to include it in the differential diagnosis, previously suspecting the symptoms. It is characterized by alterations in the electrocardiogram such as ST segment elevation and inversion of the T wave in precordial leads, elevation of myocardial necrosis enzymes, or altered patterns on echocardiography such as apical ventricular dysfunction with hyperkinesia of basal areas. Regarding the pathophysiology, it seems that sympathetic stimulation plays an important role, in which ventricular dysfunction is triggered by some kind of physical or emotional stress. This causes a release of catecholamines with cardiotoxic effects due, mostly, to the effect of cyclic AMP. Treatment involves cardiomyopathy supportive care, avoiding teratogenic or harmful drugs during lactation. The evolution is favorable in most cases and the clinical picture abates completely, so the prognosis is generally considered good. In this paper, we expose a case of an instrumental labor in which a clinical picture compatible with Takotsubo cardiomyopathy is presented, triggered by an invasive procedure.

Characteristic of Electrocardiogram for Female Patients with Apical Ballooning Syndrome / 中国康复理论与实践

@#Objective To analyze the electrocardiogram (ECG) characteristics of apical ballooning syndrome (ABS) in female patients in China. Methods 50 female cases of ABS patients from medical periodicals in China were analyzed. Results 50 patients were in sinus rhythm, 98% patients were abnormal in ECG. ST segment elevated in 85.7% of them, ranged 0.1-0.8 mV, and came down in 30 min-2 weeks. T wave inversion was found in 42% of them, 24% with pathological Q wave, which disappeared in 6 hours-1 month. 28% showed QT interval prolongated, 38% complicated with arrhythmia. Conclusion The abnormal ECG is common in female patients with ABS, which is transient and reversible.

Characteristic of Electrocardiogram for Female Patients with Apical Ballooning Syndrome / 中国康复理论与实践

Objective To analyze the electrocardiogram (ECG) characteristics of apical ballooning syndrome (ABS) in female patients in China. Methods 50 female cases of ABS patients from medical periodicals in China were analyzed. Results 50 patients were in sinus rhythm, 98% patients were abnormal in ECG. ST segment elevated in 85.7% of them, ranged 0.1-0.8 mV, and came down in 30 min-2 weeks. T wave inversion was found in 42%of them, 24%with pathological Q wave, which disappeared in 6 hours-1 month. 28%showed QT interval prolongated, 38%complicated with arrhythmia. Conclusion The abnormal ECG is common in female patients with ABS, which is transient and reversible.

Quantitative evaluation of left ventricular systolic dyssynchrony in patients with left ventricular apical ballooning syndrome by real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective To evaluate the left ventricular systolic dyssynchrony in patients with left ventricular apical ballooning syndrome (LVABS) quantitatively by real-time three-dimensional echocardiography(RT-3DE) and its correlation with left ventricular ejection fraction(LVEF).Methods 7patients with LVABS were enrolled in this study.The images of left ventricle in full volume mode were obtained by RT-3DE in the different time (just after admission,4 weeks and 8 weeks).Post-processing software of 4D LV Volume Tom-Tec was used for calculation of EF and 16-segmental time-volume curves was obtained.The time to the point with minimal systolic volume(Tmsv) of each segment was calculated and by which the following indexes of systolic dyssynchrony were derived:Tmsv16-SD/Dif,Tmsv-basalSD/Dif,Tmsv-mid-SD/Dif and Tmsv-apical-SD/Dif.The correlation between systolic dyssynchrony index (SDI) and LVEF was analysed.Results ① The Tmsv16-SD/Dif,Tmsv-basal-SD/Dif,Tmsv-mid-SD/Dif and Tmsv apical-SD/Dif of left ventricle in the patients of 4 weeks and 8 weeks were smaller than those of the patients just after admission.There were significant differences among them(all P ＜0.05).②The more SDI increased,the more LVEF decreased,and vice versa.SDI was negatively associated with LVEF in the different time of admission (just after admission:r =-0.758; 4 weeks:r =-0.831 ; 8 weeks:r =-0.889;all P ＜0.05).Conclusions Left ventricular systolic dyssynchrony of severe degree is observed in patients with LVABS just after admission.But the condition of dyssynchrony has been improved gradually after 4 weeks and 8 weeks.SDI is negatively correlated with LVEF.

Takotsubo cardiomyopathy during ambulatory anesthesia for bladder hydrodistension therapy: A case report / 대한마취과학회지

Stress-induced cardiomyopathy, also referred to Takotsubo cardiomyopathy or apical ballooning syndrome presents in perioperative period. We demonstrated a case of Takotsubo cardiomyopathy recognized after general anesthesia for bladder hydrodistension therapy as ambulatory surgery, which we surmise was due to inadequate blockage of surgical stress and sympathetic discharge against noxious stimulus during ambulatory anesthesia.

A Case of Pandemic 2009 H1N1 Influenza A Manifestation as Apical Ballooning Syndrome

Critical ill patients with pandemic 2009 H1N1 influenza A are associated with mortality, including cardiovascular, respiratory and renal dysfunction. Understanding of risk factor and clinical manifestation that suggest a higher mortality can recognize high risk patients earlier. There are many reports for severe acute respiratory distress syndrome, multiple organ failure and renal failure with pandemic 2009 H1N1 influenza A. But cardiovascular disease with pandemic 2009 H1N1 influenza A remains unknown. This is the report of pandemic 2009 H1N1 influenza A association with apical balloning syndrome.

Case of Takotsubo Cardiomyopathy following Pacemaker Implantation

Takotsubo cardiomyopathy, also called apical ballooning syndrome or stress-induced cardiomyopathy, is a unique reversible cardiomyopathy that is frequently precipitated by a stressful event, and is described as a typical form of acute transient left ventricular dysfunction. The classic situation is postmenopausal women presenting with chest pain or dyspnea. The overall prognosis is favorable. We report a case of a 75-year-old female patient who came to our hospital with dizziness, which was found to be caused by transient apical ballooning following permanent pacemaker implantation.

A Case of Consecutive Right and Left Ventricular Dysfunction

An acute pulmonary embolism (PE) and the apical ballooning syndrome (ABS) are both critical and need proper management during the acute stage. We experienced a case of recurrent severe dyspnea because serious right ventricular dysfunction due to PE and left ventricular dysfunction due to ABS occurred consecutively in the short-term and bedside echocardiography has an important role in management in acute settings.

A case of transient mid-ventricular ballooning syndrome / 대한내과학회지

Transient left ventricular apical ballooning syndrome is also known as takotsubo cardiomyopathy, and this is characterized by transient wall-motion abnormalities involving the left ventricular apex without significant stenosis on the coronary angiogram. We report here on a new variant of transient left ventricular ballooning in which only the mid-ventricle was affected. The patient initially presented with dyspnea and she had wall-motion abnormalities involving the mid-ventricle with hypercontractility of the apical and basal segments in the absence of a significant coronary artery stenosis. Emotional or physical stress or other preceding triggering factors might play a key role in this cardiomyopathy, but the precise etiology remains unknown. So far, the cases of this syndrome have been reported only among the North America Caucasian population and the Japanese population.