Apical Ballooning Syndrome During Diagnostic Coronary Angiography

Dores, Hélder; Raposo, Luís; Ferreira, Jorge; Andrade, Maria João; Almeida, Manuel; Mendes, Miguel

doi:10.5935/abc.20130082

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…Hyper stimulation of the sympathetic nervous system may also trigger coronary vasospasm, that has been implicated as one of the possible pathophysiological mechanisms in TCM [7,8]. Although it is not possible to definitively exclude that in our report anxiety somatization with massive neurotransmitter discharge caused vasomotricity disturbance, pime pime pime pime p pi im me e EDITRICE Case Report we maintain it isn't the principal mechanism of this TCM case.…”

Section: Discussionmentioning

confidence: 54%

An unexpected complication of a percutaneous coronary angioplasty

Monzo

Cocco²,

Calò³

2018

Monaldi Arch Chest Dis

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Takotsubo cardiomyopathy (TCM) is characterized by transient ventricular dysfunction, classically in its apical and mid segments, in the absence of coronary lesions, and is often observed after intense stressful events and occasionally associated to an acute medical illness. We describe a case of TCM associated with coronary artery disease and triggered by a percutaneous coronary angioplasty. This case highlights the concept that a medical procedure can lead, in certain conditions, to TCM and provides new interesting insights on the pathophysiology of coronary syndromes.

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Section: Discussionmentioning

confidence: 54%

An unexpected complication of a percutaneous coronary angioplasty

Monzo

Cocco²,

Calò³

2018

Monaldi Arch Chest Dis

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“…Possible pathophysiological mechanisms have been discussed including coronary microvascular dysfunction, coronary artery spasm [5] and abnormalities in cardiac fatty acid metabolism, but catecholamine-induced cardiotoxicity is currently the most supported explanation [2] . Increased beta-2-adrenoreceptor stimulation has been proposed as a possible cause of this entity [6] and the task force on TS of the Heart Failure Association of the European Society of Cardiology proposed a classification as secondary TS [3] as a substantial proportion of cases occur in patients already hospitalized for another medical condition, and are a complication of the primary condition or its treatment [3] .…”

Section: Discussionmentioning

confidence: 99%

Inverted Variant of Takotsubo Syndrome Caused by Inhaled Adrenergic Beta-2 Agonists

Sousa

Casado

Marques

et al. 2018

European Journal of Case Reports in Internal Medicine

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Takotsubo syndrome (TS) is an acute and reversible clinical syndrome characterized by transient hypokinesis of the left ventricular (LV) apex. Variant forms of LV dysfunction have been reported, including inverted Takotsubo syndrome (ITS), which represents only 5% of cases and has previously been linked to excessive use of inhaled adrenergic beta-2 agonists. The authors describe the case of a 60-year-old female patient who was diagnosed with ITS after the excessive use of inhaled adrenergic beta-2 agonists. This case highlights an uncommon variant of this syndrome that may not be obvious and must be suspected in this particular context. LEARNING POINTS• Takotsubo syndrome (TS) was initially described with a classic pattern of LV apical akinesis and accounts for around 75-80% of cases.Variants including inverted Takotsubo (also known as basal variant) can affect other areas of the myocardium.• Several physiopathological mechanisms have been implicated. Catecholamine-induced cardiotoxicity is one of the most supported theories, while other triggers, including excessive use of inhaled beta-2 agonists, have also been described. • Treatment of TS is mainly symptomatic and conservative and frequently leads to rapid resolution and LV function recovery. KEYWORDS Takotsubo syndrome, catecholamines, adrenergic beta-2 agonists CASE REPORT We report the case of a 60-year-old woman with a history of chronic obstructive pulmonary disease (COPD), hypereosinophilic syndrome, hypothyroidism, rheumatoid arthritis, depression and arterial hypertension, whose treatment included fluticasone/salmeterol 50 μg/250 μg two puffs twice a day. The patient presented to the emergency room (ER) with a depressed level of consciousness after experiencing dyspnoea, cough and fever for 2 days at home. At home the patient had already overused her bronchodilator, but at the ER she received continuous nebulized salbutamol, furosemide and intravenous hydrocortisone, with no clinical improvement and a worsening of respiratory acidosis. The patient was promptly transferred to the ICU for intubation and mechanical ventilation under ketamine sedation, due to severe bronchospasm. Blood tests revealed an elevated CRP (13.17 mg/dl) and elevated NT-proBNP (11695 pg/ml), while the initial set of cardiac

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Apical Ballooning Syndrome During Diagnostic Coronary Angiography

Cited by 2 publications

References 10 publications

An unexpected complication of a percutaneous coronary angioplasty

An unexpected complication of a percutaneous coronary angioplasty

Inverted Variant of Takotsubo Syndrome Caused by Inhaled Adrenergic Beta-2 Agonists

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