The authors describe two cases of takotsubo cardiomyopathy developing after an abrupt withdrawal of carvedilol and bisoprolol. Takotsubo or stress cardiomyopathy is characterized by acute and reversible cardiac dysfunction without coronary artery disease. It is triggered by acute emotional or physical stress, drugs or drug withdrawal. The immediate discontinuation of the long acting vasodilator beta-blocker, carvedilol has not yet been described to cause takotsubo cardiomyopathy. The authors recommend cautious withdrawal of beta-blockers.
A pitvarfibrilláció ritka szövődménye a myocardialis infarctust okozó coronariaembolisatio. A szerzők egy 55 éves férfi kórtörténetét mutatják be, akinél egy évvel korábban paroxysmalis pitvarfibrilláció kíséretében coronariaembolisatiónak tartott akut myocardialis infarctus zajlott le. Egy évvel később ismételten mellkasi fájdalom, új keletű STeleváció és pitvarfibrilláció miatt került akut felvételre. Az első esetben a bal elülső leszálló coronariában, jelen esetben a circumflexa coronaria ágban láttak embolisatiónak megfelelő elzáródást. A transoesophagealis echokardiográfia fülcsethrombust igazolt. A pitvarfibrilláció jelen esetben is spontán megszűnt. A szerzők tudomása szerint ez az első eset, amikor pitvarfibrilláció kapcsán recidív akut myocardialis infarctus kerül leírásra. Orv. Hetil., 2016, 157(5), 191-193. Kulcsszavak: pitvarfibrilláció, akut myocardialis infarctus, coronariaembolisatio, thromboembolia Recurrent acute myocardial infarction as a thromboembolic complication of atrial fibrillationCoronary thromboembolism with subsequent myocardial infarction is a rare complication of atrial fibrillation. The authors present the history of a 55-year-old male with a history of acute myocardial infarction caused by thromboembolism in the distal part of left anterior descending coronary artery and paroxysmal atrial fibrillation, who presented one year later with new chest pain, ST-segment elevation and atrial fibrillation. Coronarography confirmed the presence of thrombus in the circumflex coronary artery. Transesophageal echocardiogram showed left atrial appendage thrombus. To the knowledge of the authors this is the first report of recurrent myocardial infarction caused by atrial fibrillation. Keywords: atrial fibrillation, acute myocardial infarction, coronary artery embolism, thromboembolismTomcsányi, J., Takó, K., Sármán, B. [Recurrent acute myocardial infarction as a thromboembolic complication of atrial fibrillation]. Orv. Hetil., 2016, 157(5), 191-193. A pitvarfibrilláció egyik lehetséges szövődménye a thromboemboliás esemény, ennek a száma az életkor előrehaladtával egyre inkább növekszik [1]. A thromboemboliás kockázat becslésére korábban a CHADS 2 és újabban a CHA 2 DS 2 -VASc score-ok szerepelnek. Ezek elsősorban a stroke rizikójára vonatkoznak [2]. A pitvarfibrilláció okozta coronariaembolisatióról leginkább kór-bonctani vizsgálatok állnak rendelkezésre, illetve egy-egy esetriport [3][4][5][6][7][8]. Esetünket azért tartjuk bemutatásra érdemesnek, mert a recidív coronariaembolisatio okozta myocardialis infarctus felhívja a figyelmet az emboliaforrás keresésének fontosságára. Pitvarfibrillációban gyakran alacsony CHADS 2 mellett jelentkezik a coronariaembolisatio, és ilyenkor mindenképpen antikoagulálás szüksé-ges, mert ezzel kivédhető az olyan eset, amikor a beteg ismételt akut myocardialis infarctust szenved el.
We report a new entity of the Takotsubo syndrome. While the classic form of Takotsubo syndrome presents as transient apical ballooning, in reverse Takotsubo syndrome we see just the opposite, i.e. transient dilatation of the basal segments and a hyperkinetic apex. The reverse Takotsubo phenomenon was seen in a 36-year-old female patient who had an injection of lidocaine with adrenaline for plastic surgery of the ear. Coronary artery disease was excluded as the cause of this patient's prolonged chest pain and troponin positivity. Echocardiography revealed akinesis of the basal segments and a hyperkinetic apex. The wall motion abnormalities resolved in three days.
ST-segment elevation is the hallmark of acute transmural myocardial ischemia caused by acute occlusion of a coronary artery. ST-segment elevation is the major criterion for the patients with chest pain to immediate reperfusion therapy. Despite its clinical importance, the mechanism of ST-elevation remains unclear. Two patients are reported with proximal left anterior descending coronary occlusion but without ST-segment elevation. The distinct ECG patterns were tall, with symmetrical T-waves and upsloping and digoxin-like ST-segment depression. Patients with these ECG patterns need immediate coronary intervention.
The presented cases shed light to the fact that the apical dilatation of the left ventricle is only one of the possible presentations of stress induced cardiomyopathy. The main feature of this entity is not the tako-tsubo-like left ventricular dilatation, which is not always present, but the almost universal QT prolongation and negative T waves. These ECG features come a few days after the appearance of the reversible left ventricular dysfunction.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.