Can aldosterone break your heart? Takotsubo cardiomyopathy in a patient with newly diagnosed primary aldosteronism

Zoltowska, Dominika; Agrawal, Yashwant; Kalavakunta, Jagadeesh K

doi:10.1136/bcr-2017-223472

Cited by 3 publications

(3 citation statements)

References 18 publications

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“… 9 , 10 , 11 As TCM is reportedly caused by myocardial damage via activation of MRs that lead to sympathetic nerve activation, we believe that an apparent activation of MRs caused by the inhibition of 11βHSD2 in pseudoaldosteronism may be associated with the onset of TCM. 12 As the patient had no history of emotional stress before admission in this case, these findings led us to speculate that TCM might be triggered by an activation of MRs or physical stress caused by licorice‐induced pseudoaldosteronism. Although several cases demonstrating a potential association between pseudoaldosteronism and reversible secondary cardiomyopathy have been reported, to the best of our knowledge, this is the first case showing a potential association between licorice‐induced pseudoaldosteronism and TCM onset.…”

Section: Discussionmentioning

confidence: 73%

“…Moreover, the accumulation of activated cortisol subsequently triggers the activation of mineralocorticoid receptors (MRs) and glucocorticoid receptors, potentially leading to cardiovascular events even in patients with normal or low serum aldosterone levels 9–11 . As TCM is reportedly caused by myocardial damage via activation of MRs that lead to sympathetic nerve activation, we believe that an apparent activation of MRs caused by the inhibition of 11βHSD2 in pseudoaldosteronism may be associated with the onset of TCM 12 . As the patient had no history of emotional stress before admission in this case, these findings led us to speculate that TCM might be triggered by an activation of MRs or physical stress caused by licorice‐induced pseudoaldosteronism.…”

Section: Discussionmentioning

confidence: 99%

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Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Yoshida

Yamamoto

Inoue

et al. 2022

Clinical Case Reports

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Takotsubo cardiomyopathy (TCM) is an acute reversible ventricular dysfunction that often causes QT interval prolongation, which can lead to a fatal arrhythmia. 1 Glycyrrhiza uralensis (licorice in English; kanzo in Japanese) is one of the components of Kampo drugs, which are often used for the treatment of various diseases in older patients (Figure 1A-1C). Long-term use of licorice can initiate pseudoaldosteronism, mainly manifesting as severe hypokalemia leading to QT interval prolongation. 2 Yokukansan (TJ-54), which consists of seven dried herbs, including licorice, is reportedly effective for dementia, insomnia, and schizophrenia (Figure 1D). 3,4 Moreover, polypharmacy, an unresolved issue in the aging population, is associated with drug side effects, including fatal arrhythmia due to QT interval prolongation. 5 We herein report a cautionary case of licorice-induced pseudoaldosteronism that precipitated the onset of TCM and subsequent fatal arrhythmia in an octogenarian patient on polypharmacy. | CASE REPORTAn 84-year-old woman with a history of old cerebral infarction and Alzheimer-type dementia was brought to our emergency department because of anorexia and body weakness that persisted for 1 week, progressively worsening dyspnea at rest, and subsequent somnolence. The patient had a history of long-term use of several medications for her comorbidities: aspirin (100 mg/day) for old

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Yoshida

Yamamoto

Inoue

et al. 2022

Clinical Case Reports

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“…TTS development is known to be associated with some neurologic disorders and pheochromocytoma, but TTS complicated by PA is rare. 15,16) Chronic excessive aldosterone induces left ventricular hypertrophy and vascular fibrosis, contributing to atrial stiffness and remodeling, resulting in microcirculation impairment, which are consequently associated with cardiac disease including AF. 17,18) These cardiovascular disorders may increase the potential risk of TTS.…”

Section: Discussionmentioning

confidence: 99%

Tako-Tsubo Syndrome Following Pulmonary Vein Isolation for Atrial Fibrillation in a Patient with Primary Aldosteronism

et al. 2023

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Tako-tsubo syndrome (TTS) can be triggered by emotional or physical stress and is characterized by transient left ventricular dysfunction with apical ballooning. Some neurologic disorders and pheochromocytoma serve as triggers for TTS, however, its association with primary aldosteronism (PA) is not well known. Pulmonary vein isolation (PVI) with catheter ablation for atrial fibrillation (AF) has been performed worldwide, and TTS following PVI has been reported as a rare complication. Sympathetic stimulation can play an important role in TTS development, however, its mechanism and risk factors are not yet understood.We describe a 72-year-old woman with PA who developed TTS after PVI with radiofrequency catheter ablation (RFCA) for symptomatic paroxysmal AF. Complete isolation of the pulmonary vein was carried out without any complications, however, she complained of epigastric discomfort 7 hours after the procedure. An electrocardiogram showed recurrent AF with a new negative-T wave and prolonged QT interval. Transthoracic echocardiography revealed apical ballooning and basal hypercontraction, characteristic of TTS, and coronary angiography showed no significant stenosis. She was diagnosed with TTS following RFCA for AF and managed well with conservative therapy.The present case suggests that TTS should be recognized as a complication associated with AF ablation. Moreover, PA may be involved in TTS development by increasing sympathetic activity. Further studies on the mechanism and characteristics of TTS are required.

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Takotsubo Cardiomyopathy Complicating Diabetic Ketoacidosis, Hypothermia and Hypernatremia in a Comatose Patient

AlShehabi,

Hallak,

Battistin

et al. 2024

Cureus

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Takotsubo cardiomyopathy (TCM) is a transient wall motion abnormality of the left ventricular apex associated with emotional or physical stress. In the setting of diabetic ketoacidosis (DKA), it is thought to be caused by the compound effect of a catecholamine surge and the noxious effect of acidosis and ketones leading to myocardial stunning. In this report, the first of its kind in the Middle East, we describe the case of a 71-year-old comatose patient, who was being treated for DKA and hypernatremia and was incidentally diagnosed with TCM. We also review 15 case reports of DKA-induced TCM published to date in the literature, many of which had an atypical presentation and good outcomes. Furthermore, we discuss possible risk factors for TCM in our case and supporting literature. It is recommended to maintain increased vigilance and attempt early identification of such conditions in acutely ill patients to prevent life-threatening complications.

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Can aldosterone break your heart? Takotsubo cardiomyopathy in a patient with newly diagnosed primary aldosteronism

Cited by 3 publications

References 18 publications

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice‐induced pseudoaldosteronism: A case report

Tako-Tsubo Syndrome Following Pulmonary Vein Isolation for Atrial Fibrillation in a Patient with Primary Aldosteronism

Takotsubo Cardiomyopathy Complicating Diabetic Ketoacidosis, Hypothermia and Hypernatremia in a Comatose Patient

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