Differentiation Between Patients With Takotsubo Cardiomyopathy and Those With Anterior Acute Myocardial Infarction

tandard 12-lead electrocardiography (ECG) is the simplest examination for diagnosing acute myocardial infarctions (AMI) because generally the infarct area and the segments with ST elevation correspond well with each other; that is, for AMI of the left anterior descending artery (LAD), right coronary artery (RCA) and left circumflex artery (LCX), the specificity of ST segment elevation is more than 90%. [1][2][3][4][5] Recording the ECG in AMI is very useful for making a prompt and precise diagnosis of the culprit artery, but for left main trunk (LMT) infarction, it is sometimes difficult to obtain the characteristic ECG findings because lethal arrhythmias, such as ventricular fibrillation, or atrioventricular block with hemodynamic compromise often occurs. These unstable hemodynamics can lead to cardiac arrest before the patient arrives at the hospital and thus a poor prognosis. Consequently, it is important to diagnose LMT infarction from the ECG on admission and institute coroCirculation Journal Vol.70, May 2006 nary interventions, such as mechanical assistance by an intra-aortic balloon pump, or surgical treatment without any delay.Some research has indicated that ST-segment elevation in lead aVR may indicate LMT infarction, 5-7 but to the best of our knowledge, the ECG features in LMT infarction have not been fully described. Methods Study PopulationThe records of 2,190 patients admitted to Gifu University Hospital and its referral hospitals with AMI from 1988 to 2004 were retrospectively collected from the data bank and 140 were enrolled and divided into 4 equal groups according to the location of the culprit artery: LMT, LAD, RCA (#3 and #4 AV) and LCX (#13 and #14). All patients immediately underwent coronary angiography and the extent of stenosis was evaluated according to American Heart Association classification. Exclusion criteria were (1) prior Q-wave myocardial infarction (MI), (2) prior coronary artery bypass graft operation, and (3) inability to identify the culprit lesion as a result of severe stenosis in 2 or 3 vessels. 2,3 A lesion was considered to be the culprit when it occluded or showed severe narrowing and ulceration with or without thrombus.Standard 12-lead surface ECG (paper speed: 25 mm/s, calibration: 1 mV =10 mm) was recorded as soon as possible after admission and various parameters (heart rate (HR),

Section: St Elevation In Avrmentioning

confidence: 50%

Clinical Features of Emergency Electrocardiography in Patients With Acute Myocardial Infarction Caused by Left Main Trunk Obstruction

Hirano

Tsuchiya

Nishigaki

et al. 2006

“…7 A unique form of acute cardiac attack called "takotsubo cardiomyopathy", or "transient left ventricular apical ballooning" similarly occurs predominantly in postmenopausal women in association with emotional or physical stress. [8][9][10][11][12][13][14] Although the etiology of this syndrome is yet to be clarified, an increase of serum norepinephrine, epinephrine and neuropeptide Y levels at the onset of takotsubo cardiomyopathy compared with acute myocardial infarction suggests that the exaggerated sympathoadrenal activation triggered by stress is the primary cause of this cardiomyopathy. 9,10 Immobilization stress (IMO) in the rat provides an excellent animal model of emotional stress, which activates the hypothalamic-pituitary-adrenocortical system and the sympathoadrenal system.…”

mentioning

confidence: 99%

Chronic Estrogen Supplementation Following Ovariectomy Improves the Emotional Stress-Induced Cardiovascular Responses by Indirect Action on the Nervous System and by Direct Action on the Heart

Umemura

Ishikura

Matsuda

et al. 2007

151

he incidence of cardiovascular diseases is low in pre-menopausal women, whereas it is increased in post-menopausal women. Estrogen supplementation therapy prevented the increase of cardiovascular diseases in post-menopausal women, 1 while recent metaanalysis of randomized trials showed no significant merits. 2 Effects of estrogen on cardiovascular diseases were attributed principally to the modification of serum lipid concentration and coagulation pathways, while direct actions of estrogen on the cardiovascular system contributed substantially to the cardiovascular protective effects of estrogen because estrogen receptors (ER and ER ) are expressed in the blood vessels and in the heart. 3,4 Both ER and ER are also widely expressed in the central nervous system. 5 Estrogen plays crucial roles in sexual behavior, learning and memory processes, protection against ischemic insults and modulation of autonomic nervous function. 6 In fact, a reduction of estrogen levels following menopause might increase the vulnerability of women to stress while estrogen supplementation attenuates the exaggerated response to stress or to increased sympathoadrenal activity. 7 A unique form of acute cardiac attack called "takotsubo cardiomyopathy", or "transient left ventricular apical ballooning" similarly occurs predominantly in postmenopausal women in association with emotional or physical stress. [8][9][10][11][12][13][14] Although the etiology of this syndrome is yet to be clarified, an increase of serum norepinephrine, epinephrine and neuropeptide Y levels at the onset of takotsubo cardiomyopathy compared with acute myocardial infarction suggests that the exaggerated sympathoadrenal activation triggered by stress is the primary cause of this cardiomyopathy. 9,10 Immobilization stress (IMO) in the rat provides an excellent animal model of emotional stress, which activates the hypothalamic-pituitary-adrenocortical system and the sympathoadrenal system. 15 We have succeeded in developing a model of this clinical condition in rats. [16][17][18][19][20] The characteristic changes such as elevation of Circ J 2007; 71: 565 -573 (Received September 19, 2006; revised manuscript received January 9, 2007; accepted January 23, 2007 Background Takotsubo cardiomyopathy is triggered by emotional or physical stress especially in postmenopausal women. A reduction in estrogen levels following menopause might underlie the high incidence of takotsubo cardiomyopathy. Methods and ResultsThe left ventricular contraction between ovariectomized rats (OVX) and OVX with estrogen supplementation (OVX + E) while subjected to immobilization stress (IMO) was compared. The IMO in combination with general anesthesia impaired the left ventricular contraction in both OVX and OVX + E. Estrogen supplementation tended to improve the IMO-induced cardiac dysfunction and significantly attenuated the increase of blood pressure and heart rate. To understand the protective mechanism of estrogen, the expression of c-fos mRNA, a marker of cellular activation was compared. ...

“…Among patients with anterior AMI, the presence of 23 However, other studies have proposed that the ECG findings in TC are heterogeneous; no ECG criterion allowed TC to be reliably differentiated from anterior AMI with enough certainty to preclude the need for cardiac catheterization. [24][25][26] However, the time elapsed from symptom onset to recording ECG varied widely among previous studies assessing the ECG common type of TC is the apical type, 16 and in this type of TC, ST-segment elevation occurs mainly in the precordial leads immediately after symptom onset.…”

Section: Anterior Ami Identification Of High-risk Patients With a Larmentioning

confidence: 99%

Implications of Using the Cabrera Sequence for Diagnosing Acute Coronary Syndrome

Kosuge

Kimura

2016

The 12-lead electrocardiogram (ECG) is the important, initial examination for diagnosing acute coronary syndrome (ACS). In the traditional 12-lead ECG display, the precordial leads are displayed in their anatomically contiguous order, which makes it easy to understand the positional relationships between the precordial leads and the heart, but the limb leads are not. The "Cabrera sequence" displays the limb leads in an anatomically contiguous manner, which facilitates understanding of the positional relations between the limb leads and the heart, resulting in more rapid, easy, and accurate ECG interpretation than the traditional limb leads display. This review explores the clinical advantages of the Cabrera sequence as compared with the traditional limb leads display for the diagnosis of ACS. (Circ J 2016; 80: 1087 -1096