For additional examples, see stressors associated with takotsubo. To earn cme for this chapter, you need to subscribe. Takotsubo cardiomyopathy mimics acute myocardial infarction in its presentation and has a recognized recurrence rate. The ability to rapidly perform bedside echocardiography with echodoppler imaging places this modality in the heart of clinical. Named after the takotsubo, which is an octopus trap.
Editorwe report a case of a takotsubo cardiomyopathy just before induction of general anaesthesia for a semiurgent surgery. Its also known as stress cardiomyopathy or broken heart syndrome. Takotsubo is a type of cardiomyopathy a disease of the heart muscle. Takotsubo cardiomyopathy tcm, also known as stressinduced cardiomyopathy, is a cardiomyopathy characterized by acute reversible apical ventricular dysfunction and apical akinesis in the absence of obstructive coronary artery disease. Initial recognition of takotsubo cardiomyopathy occurred in japan in 1990, with the first report emerging from the united states in 1998. This ecg demonstrates resolution of the stsegment elevation, and now shows diffuse twave inversion and poor rwave progression. The prognosis of patients with takotsubo cardiomyopathy is generally favorable. Takotsubo cardiomyopathy or takotsubo syndrome tts, also known as stress cardiomyopathy, is a type of nonischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart. Variants of the classical left ventricular apical ballooning, including mid or basal left. Pdf on sep 1, 2010, spyridon koulouris and others published takotsubo. Stress cardiomyopathy also called apical ballooning syndrome, takotsubo cardiomyopathy, broken heart syndrome, and stressinduced cardiomyopathy is a syndrome characterized by transient regional systolic dysfunction of the left ventricle lv, mimicking myocardial infarction, but in the absence of angiographic evidence of obstructive coronary artery disease or acute plaque. Takotsubo cardiomyopathy is a recognised form of transient left ventricular dysfunction that is presumably caused by emotional, physical or medical stress. Takotsubo cardiomyopathy brokenheart syndrome harvard health. Ppt takotsubo cardiomyopathy powerpoint presentation free.
It can be diagnosed in several ways, including one or more. Risk factors and management of takotsubo cardiomyopathy. Apical ballooning syndrome or takotsubo cardiomyopathy. Shape of the trap is similar to the appearance of lv apical ballooning noted in patients with this form of cardiomyopathy. The mainstay of treatment initially is supportive care with beta. We believe that the published inhospital mortality. Takotsubo cardiomyopathy tc also known as transient apical ballooning or stress cardiomyopathy is a reversible clinical entity characterized by transient cardiac apical ballooning 1. We present a case of a multifactor induced takotsubo cardiomyopathy in a young 18yearold man. This transient cardiac dysfunction may affect women of childbearing age in the antepartum, intrapartum or postpartum period. Download pdf versions of our information resources. Tc is seen almost exclusively in postmenopausal women following extreme emotional or physiologic stress. Takotsubo cardiomyopathy tcm is a temporary and reversible heart condition. Chemotherapyinduced takotsubo cardiomyopathy, a case.
However, sinus node dysfunction is relatively infrequent in the setting of takotsubo cardiomyopathy. A consensus document article pdf available in giornale italiano di cardiologia 2006 911. In takotsubo cardiomyopathy also called transient apical ballooning and stress cardiomyopathy, left ventricular dysfunction, which can be remarkably depressed, recovers within a few weeks. Takotsubo cardiomyopathy in the setting of acute alcohol. Electrocardiogram ecg from the same patient discussed in the previous ecg, obtained several days after the initial presentation. Cureus risk factors and management of takotsubo cardiomyopathy. It was first described in japan in 1990 by sato et al. In takotsubo cardiomyopathy also called transient apical ballooning and stress cardiomyopathy, left ventricular dysfunction, which can be remarkably depressed, recovers within a. Abstract takotsubo cardiomyopathy tc, or broken heart syndrome, is an increasingly recognized condition that mimics acute myocardial infarction with morphologically characteristic left ventricular dysfunction in the absence of coronary artery disease.
Takotsubo cardiomyopathy is an important differential diagnosis of acute coronary syndrome. Takotsubo cardiomyopathy was named after the shape of an ancient japanese octopus trap, but is also known as stress or stressinduced cardiomyopathy sc, transient apical ballooning syndrome or cardiomyopathy. Stress cardiomyopathy or takotsubo syndrome ts is an acute, reversible disorder of the heart characterised by left ventricular dysfunction. Hypertrophic cardiomyopathy hcm is an autosomal dominant heart. Mar 12, 2019 takotsubo cardiomyopathy is rare in pregnancy and is characterized by left ventricular dysfunction with apical ballooning. Lack of genetic susceptibility in takotsubo cardiomyopathy. Information on takotsubo cardiomyopathy or broken heart syndrome including symptoms diagnosis and treatment. Recurrence of takotsubo cardiomyopathy is a wellknown reported longterm issue in the takotsubo cohort. Until 2000, a few case reports were published, but the. Cardiac function usually recovers spontaneously in most patients within days or weeks 4, 5. Most patients respond well to medical management with resolution of cardiac dysfunction within weeks. Booklet about the emotional impact of living with cardiomyopathy. Psychiatric illness in takotsubo stress cardiomyopathy. Iatrogenic epinephrineinduced takotsubo cardiomyopathy in.
Takotsubo cardiomyopathy is a reversible cardiomyopathy that typically occurs in older women over the age of 50 and can mimic acs 6, 7. Overview left ventricular apical akinesis octopus trap mimics acute coronary syndrome st elevation elevated troponin no coronary stenosis unknown etiology. Stress cardiomyopathy is an acute reversible heart failure syndrome initially believed to represent a benign condition due to its selflimiting clinical course, but now recognized to be associated with a nonnegligible rate of serious complications such as ventricular arrhythmias, systemic thromboembolism, and cardiogenic shock. Takotsubo cardiomyopathystressinduced cardiomyopathy 2. Takotsubo cardiomyopathy tcm is a condition characterized by. Emotional triggers were not as common as physical triggers 27. Takotsubo cardiomyopathy is a condition which affects the heart muscle, giving the left ventricle a distinctive shape. Persistent longterm structural, functional, and metabolic. Takotsubo cardiomyopathy in a patient with preexisting. Takotsubo cardiomyopathy also known as transient apical ballooning, stressinduced cardiomyopathy, and simply stress cardiomyopathyis a nonischemic cardiomyopathy in which there is sudden temporary lv systolic dysfunction. T akotsubo cardiomyopathy tcm is a transient left ventricular lv wall motion abnormality often associated with acute medical illnesses, catastrophic life events, and intense physical or emotional stress. Mechanisms of stress takotsubo cardiomyopathy nature. The initial case of tcm reported in the setting of aaw involved a 64yearold man with alcohol dependence admitted with hypokalemiarelated cardiomyopathy. This weakening may be triggered by emotional stress, such as the death of a loved one, a breakup, rejection from a partner or constant anxiety.
Takotsubo cardiomyopathy is rapidly reversible heart failure syndrome that usually mimics the symptoms of acute. Its diagnosis continues to be controversial 18 table 1. Takotsubo cardiomyopathy has recently been recognized in patients with typical signs of acute myocardial infarction mostly due to emotional stress 4. It is characterized by normal or nearnormal coronary arteries, regional wall motion abnormalities that extend beyond a single coronary vascular bed, and often, a precipitating stressor. Several chemotherapy molecules, monoclonal antibodies and tyrosine kinase inhibitors, have been linked to takotsubo cardiomyopathy tc.
Takotsubo cardiomyopathy is a weakening of the left ventricle, the hearts main pumping chamber, usually as the result of severe emotional or physical stress, such as a sudden illness, the loss of a loved one, a serious accident, or a natural disaster such as an earthquake. Patients typically present with chest pain, electrocardiographic changes consistent with acute ischemia or infarct, and elevated cardiac enzymes in the. Takotsubo cardiomyopathy tcm also known as stress induced cardiomyopathy is characterized by new onset left ventricular dysfunction with variable wall motion abnormalities in the absence of significant coronary artery disease 1,2,3. The takotsubo registry is an international, observational registry in patients with takotsubo cardiomyopathy. Takotsubo cardiomyopathy is an increasingly recognized acute heart failure syndrome precipitated by intense emotional stress. Four other cases of tcm occurring in the setting of aaw were identified. It constitutes an important differential diagnosis from acute myocardial infarction mi and probably accounts for 12% of all cases of suspected mi 2. Variants of the classical left ventricular apical ballooning, including mid or basal left ventricular wall motion.
Was later described elsewhere as well and is being increasingly recognized. Results takotsubo cardiomyopathy is typically characterized by the following. Takotsubo cardiomyopathy an overview sciencedirect topics. Takotsubo cardiomyopathy tc, also known as stressinduced cardiomyopathy, apical ballooning syndrome, and broken heart syndrome, is an increasingly diagnosed condition. This registry data should lead to a better understanding of this emerging disease entity which mimics myocardial infarction and to improve disease managment and outcome. Takotsubo stress cardiomyopathy broken heart syndrome.
Dec 16, 2008 the prognosis of patients with takotsubo cardiomyopathy is generally favorable. Takotsubo cardiomyopathy brokenheart syndrome harvard. Takotsubo cardiomyopathy in cancer patients cardio. Of 1750 patients with takotsubo cardiomyopathy, 89. Takotsubo cardiomyopathy is characterized by transient left ventricular apical ballooning, which results in temporary left ventricular dysfunction. Figure 1 download figure open in new tab download powerpoint. Takotsubo cardiomyopathy in a cardiology department revista. Ppt takotsubo cardiomyopathy powerpoint presentation.
Clinical features and outcomes of takotsubo stress. Takotsubo cardiomyopathy tts, also known as stress cardiomyopathy, is a type of non ischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart. We are reporting a case of a 73yearold woman with a history of asymptomatic sinus bradycardia who developed sick. Cardiac catheterization showed mild coronary artery. We, hereby, present a case of a patient having three. For example, in 2000, only 2 publications were recorded, compared with nearly 300 in 2010.
Takotsubo cardiomyopathy tc or syndrome was first described more than 2 decades ago by dote and colleagues in japan, but has since been increasingly recognised around the world. Is the implantation of permanent devices necessary heart rhythm. Takotsubo cardiomyopathy is a temporary heart condition that develops in response to an intense emotional or physical experience. Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a clinical syndrome that generally presents as chest pain mimicking acute coronary syndrome or as an acute heart failure. Aug 27, 2010 stress cardiomyopathy or takotsubo syndrome ts is an acute, reversible disorder of the heart characterised by left ventricular dysfunction. In this condition, the hearts main pumping chamber changes shape, affecting the hearts ability to pump blood effectively. Computerassisted scopus or medline searches of the literature for the terms apical ballooning, ampulla cardiomyopathy, takotsubo cardiomyopathy, and takotsubo cardiomyopathy between 1989 and december 2007 demonstrated an exponentially increasing frequency of publications. Stress takotsubo cardiomyopathya novel pathophysiological.
Thereafter, scientific interest in this condition has increased steadily and dramatically. Takotsubo cardiomyopathy, also known as transient left ventricular apical ballooning, stress cardiomyopathy, and broken heart syndrome, is a condition that mimics acute myocardial infarction. Stressrelated cardiomyopathy such as takotsubo cardiomyopathy occurs primarily in postmenopausal women. Over the past years, echocardiography has been shown to play a pivotal role in the accurate evaluation of left ventricular function particularly in patients with ischemic heart disease and various manifestations of cardiomyopathy.
Chemotherapyinduced takotsubo cardiomyopathy, a case report. Given the findings in the animal model, treatment with a combined. To date, early cardiac catheterization is the only definite way to distinguish between acute coronary syndrome and takotsubo. Stress cardiomyopathy, or takotsubo syndrome, is a transient and reversible disorder that occurs suddenly after emotional or physical stress. February 2020 takotsubo cardiomyopathy dont go breaking. Sign up today for full access to all episodes and earn cme. Takotsubo cardiomyopathy probably accounts for 12% of all cases of suspected acute myocardial infarction, its true prevalence is unknown because of under diagnosis. Cancer is a chronic condition that induces significant emotional and physical stress, which may increase the risk for developing takotsubo cardiomyopathy tcm. Uncertainty about the mechanism of takotsubo events is reflected in diverse classifications for this entity, considered a cardiomyopathy in the united states and an acute heart failure syndrome in europe. A pathophysiologic study of takotsubo cardiomyopathy with f18 fluorodeoxyglucose positron emission tomography. Takotsubo cardiomyopathy tc is an acute cardiac syndrome, which presents like acs misdiagnosis poses a bleeding risk to the patient through thrombolysis awareness of tc and the at risk demographic is therefore vital clinicians should include tc in their differential.
We present a case of a 62yearold female who presented with chest pain and shortness of breath. Apr 14, 2010 for instance, widespread use of echocardiography has contributed to more frequent recognition of takotsubo stress cardiomyopathy. The case for takotsubo cardiomyopathy syndrome as a. It is thought to be brought on by extremely stressful events, and affects how the heart works. This registry data should lead to a better understanding of this emerging disease entity which mimics myocardial infarction and. In takotsubo cardiomyopathy also called transient apical ballooning and stress. Takotsubo cardiomyopathy journal of hospital medicine. Takotsubo cardiomyopathy is associated with increased risk of ventricular arrhythmias, atrial fibrillation, and bradyarrhythmias. Takotsubo cardiomyopathy tc, also known as transient left ventricular apical. Overview left ventricular apical akinesis octopus trap mimics acute coronary syndrome st elevation elevated troponin no coronary stenosis unknown etiology triggered by emotional stressor 3. A 61yrold female was undergoing semiurgent ureteral stenting under general anaesthesia after the diagnosis of a right upper urinary tract dilatation associated with delayed secretion of contrast dye, 5 days after uneventful.
Her electrocardiogram was suggestive of myocardial ischemia and her troponin levels were elevated. Although associated with increased levels of catecholamines, pathophysiological mechanisms are unknown. A 61yrold female was undergoing semiurgent ureteral stenting under general anaesthesia after the diagnosis of a right upper urinary tract dilatation associated with delayed secretion of contrast dye, 5 days after uneventful laparoscopic removal of bilateral benign. The case for takotsubo cardiomyopathy syndrome as a variant. Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction, the longterm clinical and functional consequences of takotsubo cardiomyopathy are illdefined. Stress cardiomyopathy diagnosis and treatment jacc. Hyponatremia an unusual trigger of takotsubo cardiomyopathy.
In this article, we describe the case of a 45yearold woman who developed tc after receiving an intraarterial and intravenous polychemotherapy for locally advanced epidermoid carcinoma of the anal canal. The pathophysiological aspects of the disease are still a matter of debate and a standard treatment consensus is lacking. Jul 31, 2019 takotsubo cardiomyopathy tcm is a transient cardiac syndrome that involves left ventricular apical akinesis and mimics acute coronary syndrome. These prevalences were comparable to those described in the literature regarding takotsubo cardiomyopathy ttc 8,10, 11, 23,24,25 and ppg.
Takotsubo cardiomyopathy is a transient left ventricular dysfunction with wallmotion abnormalities which mimics myocardial infarction without acute coronary disease. Takotsubo cardiomyopathy tc is an acute cardiac syndrome, which presents like acs misdiagnosis poses a bleeding risk to the patient through thrombolysis awareness of tc and the at risk demographic is therefore vital clinicians should include tc in their differential diagnosis in cases of acs. Takotsubo cardiomyopathy tcm, also known as broken heart syndrome, is a type of heart failure characterized by transient ventricular dysfunction in the absence of obstructive coronary lesions. Epinephrineinduced takotsubo cardiomyopathy federal.
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