Cardiomiopatia de takotsubo desencadeada pelo uso de agonista β2: adrenérgico

Salemi, Vera Maria Cury; Atik, Edmar; Kairalla, Ronaldo Adib; Queiroz, Eduardo; Rosa, Leonardo Vieira da; Filho, Roberto Kalil

doi:10.1590/s1806-37132011000400019

Cited by 11 publications

(7 citation statements)

References 8 publications

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“…There is also a concept of “adrenergic cardiomyopathy” whereby excessive circulating epinephrine causes cardiomyopathy by binding to beta 2 adrenergic receptors [ 6 ]. Salemi et al reported a case of Takotsubo Cardiomyopathy in a patient with chronic obstructive pulmonary disease treated with inhaled beta 2 adrenergic agonist [ 7 ]. Similarly, Ioannou A et al presented a case of iatrogenic adrenaline-induced mid-ventricular Takotsubo cardiomyopathy where patient was accidentally given intravenous adrenaline [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Combined spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS): a case series

2023

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Background Spontaneous Coronary Artery Dissection (SCAD) and Takotsubo Syndrome (TTS) are two different entities with several shared risk factors, but their management is different. They can co-exist in patients with chest pain which affects their management. We present two cases of combined SCAD and TTS in patients presented with chest pain. Case presentation Case 1: 80F admitted with typical chest pain and dynamic ECG changes on the background of known anxiety/depression and social stresses. Her coronary angiogram showed SCAD affecting distal LAD. The left ventriculogram (LV gram) showed apical ballooning consistent with Takotsubo Syndrome (TTS). Patient was discharged on aspirin as well as angiotensin receptor blocker (ARB). Case 2: 60F admitted with typical chest pain in the setting of emotional trauma on the background of known cardiovascular risk factors. She was found to have ST elevation in inferior leads with no reciprocal changes. Subsequently, coronary angiogram showed SCAD affecting mid-left anterior descending artery (LAD) with normal distal wrap around LAD. Her LV gram showed apical ballooning consistent with TTS. However, transthoracic echocardiogram showed akinetic left ventricular apex. She was discharged on aspirin as well as an ACE inhibitor and warfarin to prevent LV thrombus. Conclusions SCAD and TTS can co-exist in patients with chest pain. It is important to identify SCAD in patients with TTS as it may affect their short as well as long-term management.

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Section: Discussionmentioning

confidence: 99%

Combined spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS): a case series

2023

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“…Kurisu et al in 2005 reported high levels of circulating norepinephrine in a female patient as a result of inhaled salbutamol, but the patient also had a recent family death, a classic trigger of ABS (7) and until very recently the most significant risks reported with nebulized and oral beta-2-agonist use have been cardiovascular death, ischemic heart disease, and cardiac failure, but not ABS (8). Very recently, two other cases of ABS have been reported in status asthmaticus in which the development of apical ballooning was reported as a sequela of inhaled beta-2-agonists, but both cases were observed in females (6, 9). Most cases of ABS are observed in post-menopausal women (9) where sensitivity to raised catecholamine levels may be higher (1), leaving this case to be considered a rare presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Very recently, two other cases of ABS have been reported in status asthmaticus in which the development of apical ballooning was reported as a sequela of inhaled beta-2-agonists, but both cases were observed in females (6, 9). Most cases of ABS are observed in post-menopausal women (9) where sensitivity to raised catecholamine levels may be higher (1), leaving this case to be considered a rare presentation.…”

Section: Discussionmentioning

confidence: 99%

A case of apical ballooning syndrome in a male with status asthmaticus; highlighting the role of B2 agonists in the pathophysiology of a reversible cardiomyopathy

Salahuddin

Sloane

Buescher

et al. 2013

Journal of Community Hospital Internal Medicine Perspectives

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Apical ballooning syndrome (ABS), also known as Takotsubo cardiomyopathy, was first reported by Dote and colleagues in Japanese literature in 1991 in a review of five cases. Case series have highlighted the association of severe psychological stressors as the major precipitating factors of this syndrome. Status Epilepticus and Sub-Arachnoid hemorrhage are also now established independent etiologies for this phenomenon in patients without coronary artery disease. We report a case of reversible apical ventricular dysfunction in a 50-year-old male presenting with status asthmaticus who quickly underwent intubation. Following this, he had ST elevations in precordial leads with mild cardiac enzyme leak. Subsequent cardiac catheterization revealed a left ventricular ejection fraction of 25–30% with apical aneurismal segment. No obstructive disease was observed. Three days later there was marked clinical improvement; the patient was extubated and repeat echocardiography revealed a remarkable return to normal ventricular size and systolic function. Our case demonstrates that excess use of beta-agonists may be a potential risk factor for ABS and raises the possibility of cathecholamine cardiotoxicity being mediated via beta-receptors. Furthermore, it also negates the propensity of apical ballooning so far reported only in women with respiratory distress without confounding emotional stressors.

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“…A 44% prevalence of asthma or COPD has been described in patients with TCM [4]. Furthermore, several case reports of TCM in the setting of inhaled beta-agonist use have been published [5-10]. Though poorly understood, the overuse of beta-adrenergic stimulators inducing sympathetic activation has been suggested as the main pathophysiologic mechanism.…”

Section: Introductionmentioning

confidence: 99%

Recurrent Stress Cardiomyopathy During COPD Exacerbation: Are Beta-adrenergic Agonists Only to Blame?

Katsa

Christia

Massera

et al. 2017

Cureus

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Takotsubo cardiomyopathy (TCM) is a variant of stress-induced cardiomyopathy, characterized by transient left ventricular dysfunction that may be associated with emotional or physical triggers. We present the case of a 51-year-old Caucasian female with severe chronic obstructive pulmonary disease (COPD) who presented with syncope and was found to have her second lifetime episode of stress-induced cardiomyopathy. Eight months prior, she had been admitted with a COPD exacerbation and was found to have left ventricular (LV) dysfunction with ejection fraction (EF) of 22% attributed to TCM with subsequent normalization of her left ventricular function. Recurrence of stress-induced cardiomyopathy associated with COPD is a rare phenomenon and its presentation raises the possibility of a common underlying mechanism.

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Cardiomiopatia de takotsubo desencadeada pelo uso de agonista β2: adrenérgico

Cited by 11 publications

References 8 publications

Combined spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS): a case series

Combined spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS): a case series

A case of apical ballooning syndrome in a male with status asthmaticus; highlighting the role of B2 agonists in the pathophysiology of a reversible cardiomyopathy

Recurrent Stress Cardiomyopathy During COPD Exacerbation: Are Beta-adrenergic Agonists Only to Blame?

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