cardiovascular-agents and Takotsubo-Cardiomyopathy

Myocardial infarction (MI) in the absence of obstructive coronary artery disease (MINOCA) is prevalent in around 5% of acute myocardial infarction (AMI) presentations. MINOCA is a heterogeneous entity with many different etiologies. It is important for health care providers to familiarize themselves with the disease process, presentation, and possible underlying causes in order to guide appropriate management strategies. In this article, the authors review the contemporary definition, etiologies and assessment, and management for AMI patients with MINOCA.

Topics: Aortic Dissection; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Coronary Artery Disease; Coronary Circulation; Coronary Vasospasm; Coronary Vessels; Humans; Myocardial Infarction; Myocarditis; Platelet Aggregation Inhibitors; Risk Factors; Severity of Illness Index; Takotsubo Cardiomyopathy; Thromboembolism

Topics: Animals; Behavior Therapy; Cardiovascular Agents; Diagnostic Imaging; Electrocardiography; Humans; Stress, Psychological; Takotsubo Cardiomyopathy

Efficacy of chronic drug therapy in prevention of stress-induced cardiomyopathy recurrences is not well established. We therefore aimed to evaluate in this meta-analysis whether pharmacological treatment can effectively prevent takotsubo cardiomyopathy (TTC) recurrences, according to available studies.. There is no evidence for preventing TTC recurrence by drug therapy.. After a PubMed search, we conducted a meta-analysis of available studies (clinical nonrandomized registries) on efficacy of drug therapy in preventing recurrence of TTC.. A total of 23 (4.5%) TTC recurrences occurred in the 511 patients included in the analysis. Seven studies on the effects of β-blockers on prevention of TTC recurrence were evaluated; the odds ratio (OR) was 0.44 and the 95% confidence interval (CI) was 0.15-1.31. In 5 studies on the effects of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, the OR was 0.42 and the 95% CI was 0.08-2.36; in 3 studies on statins, the OR was 0.74 and the 95% CI was 0.07-7.3; and in 4 studies on aspirin, the OR was 0.33 with a 95% CI of 0.05-2.17 (P value not significant in all cases).. A meta-analysis of the efficacy of different medications through the clinical TTC registries available showed no clinical evidence for a standard drug treatment in the chronic management of TTC. β-Blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, and aspirin do not seem to significantly reduce recurrences of TTC. Randomized, adequately powered studies are needed to further assess this issue.

Topics: Cardiovascular Agents; Humans; Odds Ratio; Recurrence; Risk Assessment; Risk Factors; Secondary Prevention; Takotsubo Cardiomyopathy; Time Factors; Treatment Outcome

How can an earthquake cause cardiogenic shock? Can a bereft lover really die from a broken heart? Takotsubo cardiomyopathy is an intriguing reversible condition which still mystifies and excites the layman and physician alike. This article explores the clinical essentials for recognizing and managing this group of complex patients.

Topics: Biomarkers; Cardiac Catheterization; Cardiovascular Agents; Echocardiography; Electrocardiography; Extracorporeal Membrane Oxygenation; Heart-Assist Devices; Hemodynamics; Humans; Hydrazones; Magnetic Resonance Imaging; Prognosis; Pyridazines; Shock, Cardiogenic; Simendan; Takotsubo Cardiomyopathy

Biventricular takotsubo cardiomyopathy is associated with more hemodynamic instability than is isolated left ventricular takotsubo cardiomyopathy; medical management is more invasive and the course of hospitalization is longer. In March 2011, a 62-year-old woman presented at our emergency department with abdominal pain, nausea, and vomiting. On hospital day 2, she experienced chest pain. An electrocardiogram and cardiac enzyme levels suggested an acute myocardial infarction. She underwent cardiac angiography and was found to have severe left ventricular systolic dysfunction involving the mid and apical segments, which resulted in a left ventricular ejection fraction of 0.10 to 0.15 in the absence of obstructive coronary artery disease. Her hospital course was complicated by cardiogenic shock that required hemodynamic support with an intra-aortic balloon pump and dobutamine. A transthoracic echocardiogram revealed akinesis of the mid-to-distal segments of the left ventricle and mid-to-apical dyskinesis of the right ventricular free wall characteristic of biventricular takotsubo cardiomyopathy. After several days of medical management, the patient was discharged from the hospital in stable condition. To the best of our knowledge, this is the first review of the literature on biventricular takotsubo cardiomyopathy that compares its hemodynamic instability and medical management requirements with those of isolated left ventricular takotsubo cardiomyopathy. Herein, we discuss the case of our patient, review the pertinent medical literature, and convey the prevalence and importance of right ventricular involvement in patients with takotsubo cardiomyopathy.

Topics: Cardiovascular Agents; Echocardiography; Female; Hemodynamics; Humans; Middle Aged; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Dysfunction, Right; Ventricular Function, Left; Ventricular Function, Right

The scientific literature clearly establishes the occurrence of cardiovascular (CV) accidents and myocardial ischemic episodes is unevenly distributed during the 24 h. Such temporal patterns result from corresponding temporal variation in pathophysiologic mechanisms and cyclic environmental triggers that elicit the onset of clinical events. Moreover, both the pharmacokinetics and pharmacodynamics of many, though not all, CV medications have been shown to be influenced by the circadian time of their administration, even though further studies are necessary to better clarify the mechanisms of such influence on different drug classes, drug molecules, and pharmaceutical preparations. Twenty-four-hour rhythmic organization of CV functions is such that defense mechanisms against acute events are incapable of providing the same degree of protection during the day and night. Instead, temporal gates of excessive susceptibility exist, particularly in the morning and to a lesser extent evening (in diurnally active persons), to aggressive mechanisms through which overt clinical manifestations may be triggered. When peak levels of critical physiologic variables, such as blood pressure (BP), heart rate (HR), rate pressure product (systolic BP × HR, surrogate measure of myocardial oxygen demand), sympathetic activation, and plasma levels of endogenous vasoconstricting substances, are aligned together at the same circadian time, the risk of acute events becomes significantly elevated such that even relatively minor and usually harmless physical and mental stress and environmental phenomena can precipitate dramatic life-threatening clinical manifestations. Hence, the delivery of CV medications needs to be synchronized in time, i.e., circadian time, in proportion to need as determined by established temporal patterns in risk of CV events, and in a manner that averts or minimizes undesired side effects.

Topics: Aortic Aneurysm; Arrhythmias, Cardiac; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Agents; Cardiovascular Diseases; Circadian Rhythm; Heart Rate; Humans; Myocardial Ischemia; Myocardium; Stroke; Takotsubo Cardiomyopathy; Time Factors

Transient cardiac ballooning is usually a reversible clinical entity. A patient typically presents with chest pain, electrocardiogram (ECG) abnormalities like ST-segment elevation (most commonly reported) or depression, and elevated cardiac enzymes, but has no or nonobstructive coronary artery disease. Left ventriculography reveals transient akinesis of the involved portion of the myocardial wall with compensatory hyperkinesis of the remaining myocardium, leading to ballooning of the noncontracting myocardial wall during systole. Acute regional myocardial dysfunction ensues, which normalizes on average within 1 to 6 weeks. The hypotheses for these pathophysiologic changes range from direct cardiac myocyte injury to postischemic myocardial stunning to neurotransmitter actions. The objective of this article is to present a succinct description of a small case series accompanied with various recently reported presentations and morphology by left ventriculogram and a detailed review of available data on underlying pathophysiology. In addition, a discussion on current diagnostic guidelines, treatment, prognosis, and potential future investigations is included.

Topics: Adult; Aged; Angina Pectoris; Biomarkers; Cardiovascular Agents; Coronary Angiography; Electrocardiography; Female; Heart Ventricles; Humans; Middle Aged; Myocardium; Practice Guidelines as Topic; Stress, Psychological; Stroke Volume; Takotsubo Cardiomyopathy; Treatment Outcome; Up-Regulation; Ventricular Function, Left

Topics: Adult; Amphetamine-Related Disorders; Amphetamines; Cardiovascular Agents; Central Nervous System Stimulants; Humans; Male; Substance Abuse Detection; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Function, Left

Topics: Cardiovascular Agents; Defibrillators; Electric Countershock; Female; Grief; Humans; Middle Aged; Recurrence; Tachycardia, Ventricular; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Function, Left; Wearable Electronic Devices

Coronary artery anomalies can provoke intermittent vasospasm and endothelial dysfunction, which can cause takotsubo cardiomyopathy. However, in takotsubo cardiomyopathy, apical myocardial regions are typically affected, and these do not correlate with a specific epicardial coronary distribution territory. We report the case of a 74-year-old woman who presented with acute respiratory failure and suspected myocardial infarction. She had a left coronary artery anomaly, dominant right coronary artery supply, takotsubo cardiomyopathy, depressed left ventricular ejection fraction, and no atherosclerotic disease. In the absence of exercise ischemia, we considered the anomalous artery to be an incidental finding. After 6 weeks of medical therapy, the patient's ejection fraction was normal; one year later, she remained asymptomatic. The anomalous left coronary artery in the presence of dominant right coronary supply did not explain the diffuse apical regional wall-motion abnormalities in our patient. To our knowledge, this is the first report of coexisting takotsubo cardiomyopathy and anomalous coronary artery in a patient presenting with acute dyspnea.

Topics: Aged; Cardiovascular Agents; Coronary Vessel Anomalies; Dyspnea; Female; Humans; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Function, Left

Takotsubo cardiomyopathy (TTC) has been widely recognized in recent decades and is triggered by either physical or psychological stressors.. 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.. To the best of our knowledge, this is the first report of newly diagnosed TTC associated with pituitary apoplexy.

Topics: Adrenocorticotropic Hormone; Aged; Cardiovascular Agents; Female; Hormone Replacement Therapy; Humans; Pituitary Apoplexy; Takotsubo Cardiomyopathy; Thyroxine; Treatment Outcome; Ventricular Function, Left

Topics: Abortion, Induced; Adult; Cardiovascular Agents; Depressive Disorder, Major; Electrocardiography; Female; Humans; Pregnancy; Takotsubo Cardiomyopathy; Treatment Outcome

Topics: Adult; Anger; Cardiovascular Agents; Coronary Angiography; Echocardiography; Electrocardiography; Female; Heart Septal Defects; Humans; Pulmonary Atresia; Risk Factors; Stress, Psychological; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Function, Left

To date there is no validated evidence for standardized treatment of patients with Takotsubo syndrome (TTS). Medication therapy after final TTS diagnosis remains unclear. Previous data on patient outcome is ambivalent. Aim of this study was to evaluate medication therapy in TTS and to analyze patient outcome.. Within an observational retrospective cohort study we analyzed our medical records and included 72 patients with TTS that underwent cardiovascular magnetic resonance imaging (CMR) after a median of 2 days interquartile range (IQR 1-3.5). We investigated medication therapy at discharge. Medication implementation and major adverse clinical events (MACE) were prospectively evaluated after a median follow-up of 24 months (IQR 6-43). Left ventricular function, myocardial oedema and late gadolinium enhancement were analyzed in a CMR follow-up if available.. Antithrombotic therapy was recommended in 69 (96%) patients including different combinations. Antiplatelet monotherapy was prescribed in 28 (39%) patients. Dual antiplatelet therapy was recommended in 29 (40%) patients. Length of therapy duration varied from one to twelve months. Only in one case oral anticoagulation was prescribed due to apical ballooning with a left ventricular ejection fraction <30%. In all other cases oral anticoagulation was recommended due to other indications. ß-adrenoceptor antagonists and ACE inhibitors were recommended in 63 (88%), mineralocorticoid receptor antagonists were prescribed in 31 (43%) patients. After a median of 2 months (IQR 1.3-2.9) left ventricular function significantly recovered (49.1% ± 10.1 vs. 64.1% ± 5.7, P < 0.001) and myocardial oedema significantly decreased (13.5 ± 11.3 vs. 0.6% ± 2.4, P = <0.001) in the CMR follow-up. The 30-day mortality was 1%. MACE rate after 24 months was 12%.. Although therapy guidelines for TTS currently do not exist, we found that the majority of patients were treated with antithrombotic and heart failure therapy for up to twelve months. Left ventricular function and myocardial oedema recovered rapidly within the first two months. Outcome analysis showed a low bleeding rate and a high short-term survival. Therefore, TTS patients might benefit from antithrombotic and heart failure therapy at least for the first two months.

Topics: Aged; Aged, 80 and over; Cardiovascular Agents; Drug Therapy, Combination; Edema, Cardiac; Female; Hemorrhage; Humans; Kaplan-Meier Estimate; Magnetic Resonance Imaging; Male; Medical Records; Middle Aged; Patient Discharge; Recovery of Function; Retrospective Studies; Risk Factors; Stroke Volume; Takotsubo Cardiomyopathy; Time Factors; Treatment Outcome; Ventricular Function, Left

Topics: Ablation Techniques; Aged; Cardiac Resynchronization Therapy Devices; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Diagnosis, Differential; Disease Management; Echocardiography; Female; Heart Septum; Humans; Takotsubo Cardiomyopathy; Time; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Outflow Obstruction

Takotsubo cardiomyopathy consists of a transient dysfunction of the left ventricle. It is characterised by an impaired left ventricular segmentary contractility, without significant coronary lesions in the coronary angiography. It usually occurs after an episode of physical or emotional stress. We present the case of a 70 year-old woman, who, in the postoperative period of an ankle osteosynthesis, developed a Takotsubo cardiomyopathy in the context of a sepsis caused by Staphylococcus aureus. She presented with acute lung oedema and a clinical picture of low cardiac output. The echocardiogram showed left ventricular medioapical akinesia. Coronary angiography was normal. She was treated with supportive measures with good progress. At 33 days from onset she was able to be discharged from hospital to home with normal systolic function on echocardiography.

Topics: Aged; Ankle Fractures; Atrial Fibrillation; Bacteremia; Cardiovascular Agents; Female; Fracture Fixation, Internal; Humans; Postoperative Complications; Staphylococcal Infections; Takotsubo Cardiomyopathy

In recent years, our understanding of the physiologic mechanisms of transient takotsubo cardiomyopathy has improved because of the growing use of emergent heart catheterization in patients who present with severe ischemic syndromes. However, even this procedure has revealed only that, in most patients with takotsubo syndrome, the sudden onset of ventricular dysfunction is not due to fixed coronary artery occlusions. We present a case of transient takotsubo cardiomyopathy with an exceptional feature--uneven impairment of both right and left ventricular function, or biventricular takotsubo--and we discuss a novel, comprehensive theory that we have devised to explain the pathophysiology of this syndrome's many manifestations.

Topics: Aged, 80 and over; Cardiovascular Agents; Echocardiography; Electrocardiography; Female; Hemodynamics; Humans; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Dysfunction, Right; Ventricular Function, Left; Ventricular Function, Right

Women are more likely to have atypical cardiovascular symptoms compared with men. This may lead to delayed diagnosis of coronary artery disease (CAD) and suboptimal treatment. The exercise stress test is the initial test for women with suspected or known CAD. The addition of imaging (eg, echocardiography, nuclear medicine, computed tomography scan, magnetic resonance imaging) to the exercise component may improve the diagnostic value of the test. Drugs used to manage CAD in women include antiplatelets, beta blockers, lipid-lowering drugs, angiotensin-converting enzyme inhibitors, calcium channel blockers, and nitrates. Invasive therapy with angioplasty or bypass surgery is performed less frequently in women than in men. Women may present with acute coronary syndrome and atypical symptoms. Initial treatment should be the same for men and women. Takotsubo cardiomyopathy is a rare condition that is seen more frequently in older, postmenopausal women.

Topics: Acute Coronary Syndrome; Cardiovascular Agents; Cardiovascular Diseases; Diagnostic Imaging; Exercise Test; Female; Humans; Takotsubo Cardiomyopathy; Women's Health

Topics: Cardiovascular Agents; Humans; Takotsubo Cardiomyopathy

Topics: Cardiovascular Agents; Humans; Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TC) is increasingly recognised in patients presenting with features of acute coronary syndrome. We present a single centre experience of TC with medium term follow up.. Fifty-two consecutive patients presenting with a diagnosis of TC were included. The clinical presentation, complications, baseline and follow-up echocardiograms and cardiac magnetic resonance imaging were analysed.. Fifty-one patients were female. A stressful event preceded presentation in 37 (71%) patients. Chest pain was the most common symptom (83%). Two patients presented with an out-of-hospital cardiac arrest. ST segment elevation (40%) and global T wave inversion (44%) were the most frequent electrocardiogram changes. Left ventricular assessment demonstrated typical apical ballooning in 41 patients and 11 patients demonstrated the mid-wall variant. In-hospital complications occurred in 11 patients (21%) and included acute pulmonary oedema (n = 2), cardiogenic shock (n = 5); two of whom had a significant left ventricular outflow gradient, atrial fibrillation (n = 1), left ventricular thrombus (n = 2) and a cerebrovascular event (n = 2). Left ventricular function at presentation and follow up was compared in 40 patients. The mean ejection fraction in this group at presentation was 47% (20-70%) compared with that at follow up of 63% (44-76%). There were no significant complications or recurrences at follow up.. While TC is a reversible condition with low rates of complications and recurrence at follow up it is, as demonstrated in our cohort, associated with significant in-hospital morbidity in a proportion of patients.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Cardiac Catheterization; Cardiovascular Agents; Chest Pain; Diagnosis, Differential; Electrocardiography; Female; Follow-Up Studies; Heart Arrest; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Platelet Aggregation Inhibitors; Pulmonary Edema; Queensland; Shock, Cardiogenic; Stress, Psychological; Stroke Volume; Takotsubo Cardiomyopathy; Ultrasonography; Ventricular Dysfunction, Left

Topics: Aged; Cardiovascular Agents; Echocardiography; Electrocardiography; Female; Humans; Stress, Psychological; Tachycardia, Ventricular; Takotsubo Cardiomyopathy; Treatment Outcome

Topics: Cardiovascular Agents; Dental Anxiety; Female; Humans; Middle Aged; Takotsubo Cardiomyopathy; Tooth Extraction; Treatment Outcome; Vasoconstrictor Agents

A 34-year-old female with a diarrhoeal illness and palpitations was found to have an abnormal ECG and troponin T. Subsequent coronary angiography identified angiographically normal epicardial coronary arteries with moderate impairment of left ventricular systolic function due to mid-ventricular akinesis with apical hyperkinesis. Cardiac MRI, performed 1 week later, demonstrated complete resolution of ventricular dysfunction and a diagnosis of atypical variant stress cardiomyopathy, due to gastrointestinal illness, was proposed.

Topics: Adult; Anxiety; Cardiovascular Agents; Coronary Angiography; Diarrhea; Female; Humans; Remission, Spontaneous; Takotsubo Cardiomyopathy; Troponin T; Ventricular Dysfunction, Left

Apical ballooning syndrome mimics acute coronary syndromes and it is characterized by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery stenosis.. This is a case of a 40-year-old Caucasian male without any health related problems that was submitted to an urgent coronary angiography because of acute chest pain and marked precordial T-wave inversions suggestive of acute myocardial ischemia. Coronary angiography showed no significant stenosis of the coronary arteries. Left ventriculography showed systolic apical ballooning with mild basal hypercontraction.. Physicians should be aware of the presentation of apical ballooning syndrome, and the chest pain after following acute stress should not be readily attributed to anxiety.

Topics: Acute Coronary Syndrome; Adult; Cardiovascular Agents; Chest Pain; Coronary Angiography; Coronary Stenosis; Diagnosis, Differential; Humans; Male; Predictive Value of Tests; Risk Factors; Stress, Psychological; Takotsubo Cardiomyopathy; Unemployment

The authors present a case of a 70-year-old woman in whom clinical picture of an acute coronary syndrome with ST segment elevation was suggestive of takotsubo cardiomyopathy (TC). Chest pain, extensive ECG changes and typical TC left ventricular contraction pattern were preceded by emotional and physical stress, while in coronary angiography no atherosclerotic lesions were found. There was however left anterior descending coronary artery myocardial bridging with total systolic compression. Following treatment with beta-blocker and diltiazem, spectacular left ventricle function improvement, with near total recovery after 6 months was observed. Magnetic resonance imaging detected the presence of subendocardial late gadolinium enhancement indicative of postmyocardial scar.

Topics: Adrenergic beta-Antagonists; Aged; Cardiovascular Agents; Diagnosis, Differential; Diltiazem; Drug Therapy, Combination; Female; Humans; Magnetic Resonance Imaging; Myocardial Bridging; Myocardial Infarction; Takotsubo Cardiomyopathy; Ventricular Dysfunction, Left

Topics: Aged; Atrioventricular Block; Cardiac Pacing, Artificial; Cardiovascular Agents; Chest Pain; Coronary Angiography; Drug Therapy, Combination; Electrocardiography; Female; Humans; Middle Aged; Pacemaker, Artificial; Sick Sinus Syndrome; Takotsubo Cardiomyopathy; Treatment Outcome

Topics: Accidents; Adrenal Cortex Function Tests; Adult; Cardiovascular Agents; Coronary Angiography; Epinephrine; Female; Humans; Injections, Intravenous; Magnetic Resonance Imaging; Takotsubo Cardiomyopathy; Treatment Outcome

A post-menopausal lady with severe babesiosis developed a basal-type stress-induced cardiomyopathy. Left ventricular function normalized at three months. We believe this is the first reported case of stress cardiomyopathy complicating severe babesiosis. Cardiac biomarker elevation disproportionate to the area of myocardial dysfunction, electrocardiographic changes, the patient's clinical condition, and close follow-up of left ventricular function parameters are all vital in diagnosing stress cardiomyopathy and may exclude the need for coronary angiography. There may be a possible association between severe babesiosis and stress cardiomyopathy.

Topics: Anti-Infective Agents; Babesiosis; Cardiovascular Agents; Echocardiography; Electrocardiography; Female; Humans; Middle Aged; Severity of Illness Index; Stroke Volume; Takotsubo Cardiomyopathy; Time Factors; Treatment Outcome; Ventricular Function, Left

Takotsubo cardiomyopathy, the syndrome caused by an extreme release and circulation of catecholamines, shares several histopathological and clinical similarities with cardiac changes after brain death noted in animal investigations and human observation. Overwhelming stimulation of myocardial inotropic β receptors may alter their responsiveness and induce other biochemical processes, producing reduced cardiac contractility. Treatment methods in Takotsubo cardiomyopathy that use extracorporeal circulatory support and medications that do not rely on β-receptor stimulation and preemptive blockade of β receptors or calcium channels before brain death may be relevant to donor care.

Topics: Adult; Cardiovascular Agents; Echocardiography; Extracorporeal Membrane Oxygenation; Humans; Takotsubo Cardiomyopathy; Tissue Donors

We present a case of Takotsubo cardiomyopathy recognized in a patient just before induction of anesthesia. The patient's anxiety about surgery could have been an inciting factor. As the patient's surgery was cancelled and rescheduled for a later date, treatment and strategies to prevent recurrence of the syndrome are discussed.

Topics: Anxiety; Cardiovascular Agents; Chronic Disease; Echocardiography; Electrocardiography; Female; Humans; Middle Aged; Otitis Media; Secondary Prevention; Takotsubo Cardiomyopathy; Treatment Outcome; Tympanoplasty

Stress cardiomyopathy is a newly described reversible cardiomyopathy, characterized by transient cardiac dysfunction usually precipitated by intense emotional or physical stress. Apart from the classical apical ballooning syndrome (Takotsubo), it is now increasingly recognized that the spectrum of stress cardiomyopathies is quite wide, with significant individual variations in clinical and morphological pattern. Very recently, it has been suggested that, in young boys in stressful situations, atypical forms of stress cardiomyopathy could be associated with malignant arrhythmias. We describe the case of a 14-year-old boy, in whom stress cardiomyopathy with mid-ventricular ballooning started with an arrhythmic storm.

Topics: Adolescent; Adrenergic Agonists; Anesthesia, General; Cardiovascular Agents; Electric Countershock; Electrocardiography; Epinephrine; Humans; Male; Stress, Psychological; Tachycardia, Ventricular; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Fibrillation

Stress cardiomyopathy is a reversible left ventricular dysfunction triggered by emotional stress. We describe a variant of transient left ventricular ballooning in a patient in which basal and midventricular segments are affected. This confirms that there is not just one ventricular dysfunction pattern in Takotsubo cardiomyopathy. The involvement of only the basal and midventricle segments is an intriguing observation with no clear explanation; furthermore, there are no predictive factors for the differently sited wall motion abnormalities.

Topics: Cardiovascular Agents; Coronary Angiography; Drug Therapy, Combination; Echocardiography; Electrocardiography; Humans; Male; Middle Aged; Myocardial Contraction; Recovery of Function; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Function, Left

Stress cardiomyopathy is described as acute myocardial infarction provoked by a stressful event with evidence of a significant focal wall motion but with little or no significant coronary artery disease. In this case report, a particularly bad bout of coughing resulted in chest pressure, troponin release, and evidence of antero-apical dyskinesis despite angiographic normal coronary arteries. The patient made a full recovery of function after an uncomplicated hospital stay.

Topics: Aged, 80 and over; Biomarkers; Cardiovascular Agents; Cough; Echocardiography; Female; Humans; Radionuclide Ventriculography; Stroke Volume; Takotsubo Cardiomyopathy; Treatment Outcome; Troponin T; Ventricular Function, Left

Several cases of inverted Takotsubo cardiomyopathy--a variant form with hyperdynamic left ventricular apex and akinesia of the left ventricular base and mid-portion--have been reported recently, especially in association with cerebrovascular accidents and catecholamine cardiomyopathies. Herein, we describe 2 cases of inverted Takotsubo cardiomyopathy: one that occurred in a middle-aged woman who had a septic condition, and another in a young woman who was in the postpartal state. Such cases have not been reported previously.

Topics: Adult; Anti-Bacterial Agents; Cardiovascular Agents; Coronary Angiography; Drug Therapy, Combination; Echocardiography; Female; Hemodynamics; Humans; Intra-Aortic Balloon Pumping; Postpartum Period; Pregnancy; Puerperal Disorders; Sepsis; Takotsubo Cardiomyopathy; Treatment Outcome

The apical ballooning syndrome is a relatively rare and underrecognized transient cardiomyopathy precipitated by emotional or physical stress. The role of myocardial bridging in its cause is unknown and extremely rarely reported. We present a case of a 68-year-old woman with apical ballooning syndrome and transient myocardial bridging of the left anterior descending coronary artery, clinically manifested as pulmonary edema. Ischemic ECG changes and mild elevation of cardiac biomarkers were present. She recovered well on medical treatment, and follow-up echocardiography revealed complete recovery of the left ventricular systolic function, whereas repeated coronary angiography after 1 year showed no signs of myocardial bridging. To the best of our knowledge, this is the first report of transient myocardial bridging in a patient with Takotsubo cardiomyopathy with documented normalization of the left ventriculogram and disappearance of left anterior descending coronary artery myocardial bridging.

Topics: Aged; Biomarkers; Cardiovascular Agents; Coronary Angiography; Echocardiography; Electrocardiography; Female; Humans; Myocardial Bridging; Pulmonary Edema; Radionuclide Ventriculography; Takotsubo Cardiomyopathy; Treatment Outcome; Up-Regulation

We report a possible new therapeutic strategy, using extracorporeal cardiopulmonary support (ECLS), for severe refractory cardiogenic shock (SRCS) in a patient with Tako-tsubo cardiomyopathy (TC). TC is a syndrome characterized by left ventricular wall motion abnormalities, without coronary artery disease, mimicking the diagnosis of acute coronary syndrome. This ventricular dysfunction can be reversible; however, it can progress into refractory cardiogenic shock with limited therapeutic options available. For the first time in a Tako-tsubo patient with refractory cardiogenic shock, we used ECLS treatment in order to rest the heart, sustain circulation and end-organ perfusion, and promote potential ventricular recovery. ECLS might be the selected treatment for SRCS in patients with TC, and seems to be an effective and useful ultimate therapeutic strategy for preventing death.

Topics: Aged; Cardiovascular Agents; Echocardiography, Transesophageal; Extracorporeal Circulation; Female; Hemodynamics; Humans; Intra-Aortic Balloon Pumping; Recovery of Function; Severity of Illness Index; Shock, Cardiogenic; Stress, Psychological; Takotsubo Cardiomyopathy; Treatment Failure; Ventricular Function, Left

Topics: Aged; Cardiac Catheterization; Cardiovascular Agents; Diagnosis, Differential; Dyspnea; Echocardiography; Edema; Female; Humans; Leg; Myocardial Infarction; Takotsubo Cardiomyopathy

Tako-tsubo cardiomyopathy has been gradually recognized worldwide. However, medications for the prevention remain not to be investigated in part because the precise mechanism is unclear. We sought to examine medications before the onset of tako-tsubo cardiomyopathy, and to prove the limitation of these medications for the prevention.. This study consisted of 21 patients with tako-tsubo cardiomyopathy who received one or more medications for hypertension or suspected angina pectoris. Each patient was assessed with history, medications, coronary angiography and left ventriculography. All patients but 1 were female, and age ranged 41 to 87 years (73+/-11 years). Twelve patients received calcium channel blockers, 7 patients received nitrates, and one patient received beta blocker. Three patients received angiotensin coverting enzyme inhibitors, and 4 patients received angiotensin II receptor blockers. One patient died of serious pneumonia, but there was no patient who died of tako-tsubo cardiomyopathy itself. During the 3 year follow-up, one patient receiving angiotensin receptor blocker had the recurrence of tako-tsubo cardiomyopathy due to recurrent epileptic seizure.. Tako-tsubo cardiomyopathy can occur despite treatment with calcium channel blockers, nitrates or beta-blockers, suggesting limitation of these medications to prevent tako-tsubo cardiomyopathy.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Cardiovascular Agents; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Pharmaceutical Preparations; Takotsubo Cardiomyopathy

Cardiomyopathy is a generic term for any heart disease in which the heart muscle is involved and functions abnormally. Recent developments and ongoing research in cardiology have led to descriptions of 3 previously less recognized or incompletely characterized cardiomyopathies. These entities are being increasingly noticed in adult patient populations. Primary care providers and cardiovascular specialists need to be aware of the clinical features of these illnesses and the best strategies for diagnosis and management. We have discussed the causes and diagnostic methods for these newly described cardiomyopathies and ways to manage them.

Topics: Adolescent; Adult; Aged; Arrhythmogenic Right Ventricular Dysplasia; Cardiovascular Agents; Female; Humans; Middle Aged; Takotsubo Cardiomyopathy; Ventricular Dysfunction, Left

Stress cardiomyopathy is a reversible left ventricular dysfunction precipitated by emotional stress. Affected patients are generally women, whose symptoms are similar to myocardial infarction with reversible apical dyskinesis associated with hypercontractile basal segments and no evidence for hemodynamically significant coronary arterial stenoses by angiography. We report the case of an 82-year-old woman who presented with acute onset of chest pain after emotional stress and with reversible left ventricular dysfunction consisting of akinesis of the midventricular segments and hyperkinesis of the basal and apical segments.

Topics: Aged, 80 and over; Angina Pectoris; Cardiovascular Agents; Coronary Angiography; Echocardiography, Four-Dimensional; Electrocardiography; Female; Humans; Myocardial Contraction; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Dysfunction, Left