Background: Takotsubo cardiomyopathy is an acute cardiomyopa-thy characterized by transient left ventricular systolic dysfunction induced by emotional or physical stress, including respiratory failure. Aim: The aim of this study was to analyze the clinical features of patients who developed takotsubo cardiomyopathy in respiratory department. Methods: We retrospectively evaluated the characteristics, causes, and outcomes of takotsubo cardiomyopathy experienced in our respiratory department Results: Of 14 patients, 35% were women over 50 years of age. The most frequent trigger was bronchoscopy. Laryngeal reflex in response to irritation of trachea results in elevation of catecholamine level, thereby inducing takotsubo cardiomyopathy. At onset, more than half of the patients did not show typical symptoms such as chest discomfort. 57.1% of cases showed type 2 respiratory failure and 42.9% showed acidosis which might related to elevation of catecholamine level as well. 50.0% of patients had comorbidities of chronic obstructive pulmonary disease (COPD) or asthma, treated regularly with β2stimulant. Since there are abundant β2-stimulant receptors in apical myocardium, repeated treatment with β2-stimulant may have contributed to the disease onset. Some cases complicated with heart failure, but all patients improved. Conclusions: In respiratory department, it is necessary to be aware of takotsubo cardiomyopathy especially when conducting procedures including tracheal manipulation, when using repetitive β2-stimulant, and when a patient shows exacerbation of respiratory failure with hypercap-nia, even without any chest complaints. AP093 SAPS II OR APACHE II IS BETTER TO PREDICT MORTALITY IN MEDICAL ICU PATIENTS

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A 70-year-old woman was admitted to the hospital with chest discomfort after quarreling with her neighbors. Electrocardiography revealed ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6. Coronary angiography demonstrated normal arteries, but left ventriculography showed apical akinesis and basal hyperkinesis. Takotsubo cardiomyopathy was diagnosed on the basis of these characteristic findings. The creatine kinase and creatine kinase-MB concentrations were elevated at admission and reached maximum levels 6 hours after admission. The plasma level of brain natriuretic peptide was 10.7 pg/mL (reference range, <18.4 pg/mL) on the first hospital day. ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6 persisted at 72 hours after admission. On the third hospital day, sudden rupture of the left ventricle occurred, and despite extensive resuscitation efforts, the patient died. Takotsubo cardiomyopathy presents in a manner similar to that of acute myocardial infarction, but ventricular systolic function usually returns to normal within a few weeks. To our knowledge, this is the first reported case of fatal left ventricular rupture associated with takotsubo cardiomyopathy. We suggest that takotsubo cardiomyopathy may be a newly recognized cause of sudden cardiac death.

Initial deltaBase value seems to be a good indicator of the severity of basal hyperkinesis in patients with takotsubo cardiomyopathy. In contrast to other diagnoses, a high BNP concentration is not associated with a poor prognosis in this condition.

The autonomic properties in 27 patients with the electrocardiographic morphology of Brugada syndrome were investigated using 24-h Holter monitoring: 10 patients had a history of ventricular fibrillation (VF; Br-VF group) and 17 did not (Br-N group); there were 26 healthy subjects enrolled in this study. All subjects underwent normal Holter data monitoring and power spectral analysis. Few extrasystoles were observed in either group, and the mean heart rate (HR), maximum HR, and total heart beats over 24 h were obtained. All of these measurements were significantly lower in the Br-VF group than in the Br-N and healthy subject groups. The RR interval variability was analyzed over 512 beats every 10 min. The high-frequency component (0.15-0.40 Hz; HF), low-frequency component (0.04-0.15 Hz; LF) and the LF/HF ratio were analyzed over 24 h. The HF was significantly higher and LF/HF ratio lower in the Br-VF group than in the healthy subjects. The HF was also significantly higher than in the Br-N group. During the night (00.00-05.00 h), the HF was significantly higher in the Br-VF group, and the LH/HF lower. During the day (12.00-17.00 h), the HF was significantly higher in the Br-VF group, but there was no difference in the LF/HF. These results indicate that high vagal tone and low sympathetic tone are specific properties of symptomatic Brugada syndrome.

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An 83 year old woman presented to the emergency department with chest pain and dyspnoea. Chest radiography showed pneumothorax of the left lung. Arteries were normal on coronary angiography. Left ventriculography showed asynergy of apical akinesis and basal hyperkinesis. Within 18 days, the asynergy improved without any specific treatment. In the present case the left ventricular dysfunction may have been induced by altered catecholamine dynamics as a result of pneumothorax.