A case of reverse takotsubo cardiomyopathy caused by an eating disorder.

Takotsubo cardiomyopathy is an acquired transient cardiomyopathy that causes severe systolic dysfunction in the absence of coronary disease. Here we present a case of reverse takotsubo cardiomyopathy. A 67-year-old female was admitted for weakness and falls due to severe malnutrition. During her stay she was diagnosed with an eating disorder. She also developed chest pain during her hospitalization and was taken urgently for catheterization which showed normal coronary arteries with akinetic basal and inferior walls and hyperkinesis of the apex. Her ejection fraction decreased to 25% from 60% five days previously. She was diagnosed with reverse takotsubo. She was placed on an appropriate heart failure regimen and eventually transferred to inpatient rehabilitation. In its typical form, takotsubo causes apical ballooning due to hyperkinetic basal and inferior wall motion and apical hypokinesis. Reverse takotsubo causes a depressed basal segment with apical hyperkinesis usually brought on by severe emotional or physical stress. Our case is the first documented report of an eating disorder causing the reverse type of takotsubo cardiomyopathy. .

Left ventricular pseudoaneurysm after mitral valve replacement.

Development of left ventricular pseudoaneurysm is a rare complication of mitral valve surgery and requires urgent surgical intervention. We describe a case of pseudoaneurysm of membranous septum following repeat mitral valve replacement with the use of multimodality imaging.

Sudden cardiac death after manual or automated snow removal.

To examine the proximate circumstances of sudden cardiac death (SCD) in the setting of major snowstorms, we reviewed records from the medical examiners' offices of 3 counties in the weeks before, during, and after 2 heavy snowfalls that occurred in the greater metropolitan Detroit area. Of those who experienced SCD due to atherosclerotic cardiovascular disease (n = 271), 36 (33 men, 3 women) were engaged in snow removal, representing the largest number of exertion-related deaths after heavy snowfalls reported to date.

Therapeutic angiogenesis: a fantastic new adventure.

A significant proportion of patients with coronary artery disease have symptoms refractory to medical treatment, yet are unsuitable for conventional revascularization techniques, like percutaneous coronary intervention and coronary artery bypass surgery. Such patients are potential candidates for alternative forms of coronary revascularization, like therapeutic angiogenesis. This strategy is designed to promote the development of supplemental collateral blood vessels that will act as endogenous bypass conduits. Two major avenues for achieving therapeutic angiogenesis are currently under intense investigation: gene therapy (the introduction of new genetic material into somatic cells to synthesize proteins that are missing, defective, or desired for specific therapeutic purposes) and protein-based therapy (administration of the growth factors, instead of the genes encoding for the growth factors responsible for angiogenesis). This article provides a concise review of the "components" of gene and protein-based therapy, namely, the growth factors, the vector (for gene therapy), the route of delivery, the therapeutic target, the desired therapeutic effect, and quantifiable clinical end points for trials of angiogenesis. Based on preliminary studies, the authors believe that therapeutic angiogenesis represents a promising novel therapy for treatment of the ischemic heart. In the future, angiogenesis will likely be offered as an adjunct to conventional revascularization strategies in subsets of patients who are only "suboptimally" revascularized with conventional techniques, and might evolve into a stand-alone treatment for some patients with nonrevascularizable disease.