Cardiac rupture as a life-threatening outcome of Takotsubo syndrome: A systematic review.

BACKGROUND: Takotsubo syndrome (TS) is a reversible cause of heart failure; however, a minority of patients can develop serious complications, including cardiac rupture (CR). OBJECTIVES: Analyze case reports of CR related to TS, detailing patient characteristics to uncover risk factors and prognosis for this severe complication. METHODS: We conducted a systematic search of MEDLINE and Embase databases to identify case reports of patients with TS complicated by CR, from inception to October 2023. RESULTS: We included 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and an apical ballooning pattern was observed in all cases (100%). ST-segment elevation was reported in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery was attempted in 16 (36%) cases, and 28 (64%) patients did not survive. CONCLUSIONS: CR related to TS is a rare complication associated with high mortality and affecting elderly females, specially from White/Caucasian or East Asian/Japanese descent, presenting with anterior or lateral ST-segment elevation, and an apical ballooning pattern. Although data is limited and additional prospective studies are needed, the awareness of this life-threatening complication is crucial to early identify high-risk patients. CONDENSED ABSTRACT: Cardiac rupture is a rare complication of Takotsubo syndrome. We conducted a systematic review of cases complicated by cardiac rupture, and we identified 44 subjects (40 females and 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity, all with an apical ballooning pattern (100%). The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.

Recurrent takotsubo syndrome: case report and literature review

Introduction: Takotsubo syndrome is a cardiomyopathy that can lead to severe myocardial involvement. It is characterized by the presence of signs and symptoms suggestive of ventricular dysfunction associated with an adrenergic discharge during a stressful event. This case report presents a literature review, as well as a comparison with other similar cases. Case presentation. A 56-year-old female with a previous episode of Takotsubo was admitted to the emergency department due to symptoms of acute coronary syndrome and a history of Takotsubo syndrome. Her electrocardiogram showed T-wave inversion in leads V1-V4 and a raise in troponins. Percutaneous coronary angiography revealed no coronary lesions, and an echocardiogram revealed segmental alterations compatible with Takotsubo syndrome, requiring medical therapy with beta-blockers and angiotensin-converting enzyme (ACE) inhibitors, with subsequent improvement in ventricular function. Conclusions. Recurrence in Takotsubo cardiomyopathy is a rare complication that should be suspected. The risk factors associated with recurrence are not known. Although therapy with ACE inhibitors and beta-blockers seems to have an impact on the recovery of ventricular function in patients with this condition, further studies are necessary to establish the best pharmacological treatment.

Introducción. La miocardiopatía de Takotsubo (MT) es una afección cardiaca que puede generar compromiso miocárdico severo y se caracteriza por la presencia de signos y síntomas sugestivos de disfunción ventricular que se asocian a una descarga adrenérgica durante un evento estresor. En este reporte de caso se realizó una revisión de la literatura y se hizo una comparación con otros casos similares al presentado. Presentación del caso. Mujer de 56 años, quien asistió al servicio de urgencias por síntomas sugestivos de un síndrome coronario agudo. A la paciente, que tenía antecedente de MT, se le realizó un electrocardiograma que mostró inversión de la onda T en las derivaciones V1-V4 y elevación de troponinas, una angiografía coronaria que evidenció arterias epicárdicas sin lesiones y un ecocardiograma que reveló alteraciones segmentarias compatibles con MT, por lo que se estableció manejo con betabloqueadores e inhibidores de la enzima convertidora de angiotensina (IECA), con lo cual se logró mejoría de la función ventricular. Conclusiones. La MT es una afección poco frecuente de la cual no se conocen los factores de riesgo asociados a su recurrencia. Aunque la terapia con IECA y betabloqueadores parece tener un impacto en la recuperación de la función ventricular en pacientes con esta condición, se requieren estudios adicionales para establecer el mejor manejo farmacológico.

Características clínicas, demográficas y epidemiológicas de una cohorte de pacientes con síndrome de Takotsubo entre 2011 y 2016 en Medellín, Colombia / Clinical, demographic and epidemiological characteristics of a cohort of patients with Takotsubo's syndrome from 2011 to 2016 in Medellin, Colombia

Resumen Introducción: El síndrome de Takotsubo es una disfunción ventricular aguda de carácter temporal, usualmente reversible, secundaria a eventos estresantes que comprometen el eje cerebro-corazón. Objetivo: describir las características clínicas, epidemiológicas y desenlaces de una cohorte de pacientes con síndrome de Takotsubo en Medellín-Colombia. Materiales y métodos: Estudio observacional, descriptivo, ambispectivo, realizado en una cohorte de pacientes. Se revisaron las historias clínicas de pacientes que ingresaron al servicio de urgencias de una institución de tercer nivel de complejidad de la ciudad de Medellín entre enero de 2011 y diciembre de 2016 con diagnóstico de síndrome de Takotsubo. Se diseñó un cuestionario para recolectar variables demográficas, clínicas, de laboratorio e imagenológicas. Se obtuvieron medidas de frecuencia y análisis estadístico con el programa SPSS versión 21. Resultados: El 66,7% de los pacientes fueron mujeres, la mortalidad fue del 11,1% y la recurrencia del 5,6%. La mayoría de los casos tuvieron un desencadenante conocido (94,5%), siendo la infección el más frecuente (44,4%). El 77,8% de los pacientes presentó disnea al ingreso y el 27,8% requirió uso de algún vasopresor. El promedio de la fracción de eyección del ventrículo izquierdo inicial fue del 34.17+7.8 con evidencia de mejoría en el control, promedio luego del control= 54,81+10.2. Discusión y conclusiones: El síndrome de Takotsubo es una condición infrecuente, las mujeres son la población más afectada y la mayoría de los casos obedece a un factor desencadenante. La mortalidad reportada está dentro de lo esperado y se evidenció un buen pronóstico a mediano plazo. MÉD.UIS. 2020;34(1):27-33.

Abstract Introduction: Takotsubo syndrome is an acute, usually reversible, temporal ventricular dysfunction secondary to stressful events that compromise the brain-heart axis. The study's objective is to describe the clinical, epidemiological characteristics and outcomes of a cohort of patients with Takotsubo syndrome in Medellin-Colombia. Methods: Observational, descriptive, ambispective study performed in a cohort of patients. We reviewed the medical records of patients who entered the emergency department of a third-level complex institution of Medellin between January 2011 and December 2016 with Takotsubo syndrome diagnosis. A questionnaire was designed to collect demographic, clinical, laboratory, and imaging variables. Frequency measures and statistical analyses were obtained with the SPSS version 21 program. Results: 66.7% of the patients were women, mortality was 11.1%, and recurrence was 5.6%. The majority of the cases had a known trigger (94.5%), being the infection the most frequent (44.4%), 77.8% of the patients presented dyspnea on admission, and 27.8% required the use of vasopressor. The mean baseline left ventricular ejection fraction was 34.17 + 7.8 with evidence of improvement in control, average after control = 54.81 + 10.2. Discussion and conclusions: Takotsubo syndrome is an uncommon condition. Women are the most affected population and most cases are due to a secondary cause. The reported mortality is within expectations, and a good medium-term cardiac prognosis was evidenced. MÉD.UIS. 2020;34(1):27-33.

Takotsubo syndrome: the broken-heart syndrome.

Takotsubo syndrome - also known as broken-heart syndrome, Takotsubo cardiomyopathy, and stress-induced cardiomyopathy - is a recently discovered acute cardiac disease first described in Japan in 1991. This review aims to update understanding on the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of Takotsubo syndrome, highlighting aspects of interest to cardiologists and general practitioners.

Takotsubo syndrome induced by brachytherapy in a patient with endocervical adenocarcinoma.

BACKGROUND: Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential. CASE REPORT: We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered ECG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed. CONCLUSIONS: Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS.

Takotsubo. The great imitator of acute myocardial infarction / Takotsubo. El gran simulador del infarto agudo del miocardio

Abstract Takotsubo myocardiopathy, known as broken-heart syndrome due to its relationship with stressful situations, is characterized by causing symptoms which are suggestive of myocardial infarction, in the context of temporary left ventricular systolic dysfunction, with no angiographic evidence of ob structive coronary artery disease. It is much more common in older adults, predominantly in women. It is diagnosed by clinical, echocardiographic and angiographic findings. Treatment is eminently medical, generally associated with spontaneous and progressive recovery of the left ventricular systolic function. However, when the clinical presentation simulates an acute myocardial infarction in a setting where angiography is not available, there must be a clear therapeutic decision, without underestimating that a confirmed diagnosis, depending on the patient's ventricular function and/or comorbidities, may trigger cardiogenic shock and be fatal. A case of Takotsubo myocardiopathy is described, along with its management and follow-up. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/aamc.2019.1314).

Resumen La miocardiopatía de Takotsubo, conocida como síndrome del corazón roto por su relación con situaciones de estrés; se caracteriza por ocasionar síntomas sugestivos de infarto de miocardio en contexto de una disfunción sistólica temporal del ventrículo izquierdo sin demostración angiográfica de enfermedad arterial coronaria obstructiva. Es mucho más común en adultos mayores predominantemente mujeres. El diagnóstico se hace mediante hallazgos clínicos, ecocardiográficos y angiográficos. El tratamiento es eminentemente médico, generalmente relacionado con la recuperación espontánea y progresiva de la función sistólica del ventrículo izquierdo; sin embargo, el escenario de su presentación clínica que simula un infarto agudo de miocardio en un ambiente sin la disponibilidad de angiografía requiere tener claro decisión terapéutica sin desestimar que confirmado el diagnostico de acuerdo al compromiso de la función ventricular y/o comorbilidades del paciente puede desencadenar shock cardiogénico y ser fatal. Se describe un caso de miocardiopatía de Takotsubo su manejo y seguimiento. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/aamc.2019.1314).

Usefulness of MRI in takotsubo cardiomyopathy: a review of the literature.

Takotsubo cardiomyopathy (TC) is a disease that can be misinterpreted as a more serious acute coronary syndrome. Its clinical characteristics resemble those of a myocardial infarct, while its imaging characteristics are critical on correctly characterizing and diagnosing the disease. From angiography, where coronary anatomy is evaluated, to cardiac magnetic resonance (CMR), where morphology and tissue characterization is assessed, the array of imaging options is quite extent. In particular, CMR has achieved great improvements (stronger magnetic fields, better coils, etc.) in the last decade which in turn has made this imaging technology more attractive in the evaluation and diagnosis of TC. With its superior soft tissue resolution and dynamic imaging capabilities, CMR is currently, perhaps, the most useful imaging technique in TC as apical ballooning or medio-basal wall motion abnormalities (WMA), presence of wall edema and late gadolinium enhancement (LGE) characteristics are critical in the diagnosis and characterization of this pathology. In this review, CMRs role in TC will be evaluated in light of the current available evidence in medical literature, while also revising the clinical and physiopathologic characteristics of TC.

Initial clinical presentation of Takotsubo cardiomyopathy with-a focus on electrocardiographic changes: A literature review of cases.

AIM: To review the initial presentation and demonstrate the importance of Takotsubo cardiomyopathy. METHODS: A PubMed search using the terms "Takotsubo cardiomyopathy (TC)" and "apical ballooning syndrome" yielded 211 publications. Only those that were relevant were fully reviewed. The gender, age, precipitating stressor, main complaint at presentation, electrocardiogram (ECG) at admission and serum cardiac markers of patients diagnosed with TC, were extracted as available. The data were organized in tables and graphics, and the incidence of the disorder was calculated and analyzed. RESULTS: A total of 250 clinical cases were examined. The predominant gender that was affected was female, with a prevalence of 87.5%. The mean age of presentation was 64 ± 14 years. The cases were divided by age into 10-year intervals. The age interval of 60-69 years showed the highest frequency of TC, accounting for 79 cases. The most common precipitating stressor was physical (50% of cases). Chest pain was the primary complaint at presentation (58.8% of cases) followed by dyspnea (30% of cases). The ST segment changes category was the most common (60%), followed by T wave changes (39.6%). Of the 60% of cases with ST segment changes, 12% had concomitant T wave changes. This means that for 27.6% of the cases, the primary abnormality in the ECG was T wave changes; 87.6% of cases with TC had a change in the ST segment, in the T wave or in both. The percentage of ECGs presenting with changes in the anterior wall was 54.4% (35.6% of ST segment elevation + 1.6% of ST segment depression + 17.2% of T wave inversion). The percentage of patients presenting with changes in the lateral segment of the heart was 46.8%, while the percentage of patients with changes in the inferior heart was 21.6% and the percentage of patients with changes in the apical region was only 16%. The prevalence of elevated creatinine kinase and/or troponin on initial presentation was 89.3%. CONCLUSION: It is essential that every physician consider Takotsubo cardiomyopathy as a possible differential diagnosis when a patient is classified with acute coronary syndrome. To do so, it is necessary to know the clinical presentation of this syndrome in its early stages.

Tako-tsubo syndrome: atypical nuclear medicine findings.

The Tako-Tsubo syndrome is a reversible form of an acute stress-related cardiomyopathy that was reported during the last decade. It typically presents with a constellation of symptoms, electrocardiographic changes, and elevated cardiac enzyme levels consistent with an acute coronary syndrome. However, when the patient undergoes cardiac angiography, left ventricular apical ballooning finding is seen, but no significant coronary artery stenosis. This balloon-like morphology, being the hallmark of this entity, can be detected by imaging. We present a case report of a patient who was admitted to our hospital and met all the diagnostic criteria of the Tako-Tsubo syndrome. Myocardial perfusion imaging (MPI) showed an anteroapical perfusion defect at rest, moderated systolic dysfunction, and intraventricular asynchrony all assessed by gated-SPECT phase analysis. Two months later, all MPI findings returned to normal parameters.