Dobutamine stress echo-induced apical ballooning (Takotsubo) syndrome

Margey, Ronan; Diamond, Pauline; McCann, Hugh A.; Sugrue, D.

doi:10.1093/ejechocard/jen292

Cited by 56 publications

(44 citation statements)

References 11 publications

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“…Adverse effects are reported to occur in up to 75% of cases which include ST segment changes on ECG (in up to 50% cases), chest pain, palpitations and significant supraventricular and ventricular arrhythmias. Various case reports published in literature show occurrence of broken heart syndrome (Takotsubo syndrome) [1][2][3] prolonged left ventricular dysfunction [4], transient global amnesia [5], cardiac rupture [6] and papillary muscle rupture [7]. We describe a case of spinal subdural haematoma occurring as adverse effects of dobutamine stress test, which to our knowledge, has not been reported in the literature so far.…”

Section: Introductionmentioning

confidence: 92%

Spinal Subdural Haematoma in A Patient After Dobutamine Stress Test: An Unusual Occurrence

Hashmi

2012

J Med Cases

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Spinal subdural haematoma is a rare entity and commonly due to spinal pathology. Its occurrence in patients with impaired coagulation has been reported. We report a case of spinal haematoma occurring after dobutamine stress test. Prompt diagnosis of such cases is required which can be done with MRI spine. Early intervention with surgery and removal of clot causing compression can prevent permanent disability. Our patient developed excruciating back pain and paraplegia after dobutamine stress test. Initially treated with antibiotics and fluids for suspected urinary tract infection, neuroimaging later revealed spinal haematoma. Though surgical evacuation resulted in some improvement in neurology, she was left with a significant disability. It can be concluded that spinal haematoma should be suspected in any patient who complains of severe back pain with neurological symptoms. It needs prompt diagnosis and treatment to prevent disability.

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Section: Introductionmentioning

confidence: 92%

Spinal Subdural Haematoma in A Patient After Dobutamine Stress Test: An Unusual Occurrence

Hashmi

2012

J Med Cases

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“…Chest pain often occurs and presentation may mimic acute myocardial infarction [16]. LVABS has been strongly associated with catecholamine release and indeed catecholamine induced focal myocarditis and cardiomyopathy are well described [17][18][19][20].…”

Section: Myocarditis and Left Ventricular Apical Ballooningmentioning

confidence: 99%

“…Catecholamine myocarditis has been detected in patients abusing beta agonists, and implicated as a mechanism in patients in whom cardiomyopathy and panic disorder coincide [28,29]. Others have also associated LVABS and catecholamine surges and LVABS post dobutamine stress echo has been described [17,30]. In one recently published series, the authors elicited a history of profound psychological or physical stress in the 24 hours preceding onset of chest pain in each of their patients with LVABS [3].…”

Section: Catecholamine Myocarditis and Cardiomyopathymentioning

confidence: 99%

Gadolinium enhanced MRI in patients with left ventricular apical ballooning syndrome implicates myocarditis as an etiology

Maree¹,

Witzke²,

Holmvang³

et al. 2013

WJCD

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Aims: Left ventricular apical ballooning syndrome (LVABS) is a clinical condition of unknown etiology, characterized by acute onset of atypical apical wall motion and absence of coronary artery disease. Gadolinium-enhanced cardiac magnetic resonance imaging (Gd-MRI) may be used to identify patients with myocarditis. Using cardiac MRI, we evaluated whether acute myocarditis may be an etiology that underlies LVABS. Methods and Results: Consecutive patients who presented with LVABS during a three-year period were included. Demographic data was recorded and echocardiography, coronary angiography, and hemodynamic assessment performed. Gd-MRI was performed in all patients. The study was deemed consistent with myocarditis when global myocardial to skeletal muscle enhancement ratio was ≥3.5. Regional Gd-MRI analysis was also performed. Patients (n = 11) were female (100%) and of mean age 72 years (72 ± 11). Preceding febrile illness occurred in 4 (36.3%) and leukocytosis in 6 (54.4%) patients. Initial mean left ventricular ejection fraction (41% ± 12%) improved (70.2% ± 8%) upon follow-up (39 ± 43 days). Global MRI analysis was positive in 5/11 (45.5%) (mean relative enhancement ratio 4.8 ± 1.4). Regional MRI analysis was positive in 4/6 further patients (overall: 9/11 (82%)). Conclusions: Gadolinium enhanced MRI imaging in LVABS implicates myocarditis as a possible etiology. Regional MRI analysis adds sensitivity to global cardiac MRI evaluation.

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“…In the last few decades, TLVAB has been discovered in association with a variety of additional physiological stressors. Anecdotal evidence supports an association between TLVAB with sepsis, malignancy, cerebrovascular accidents, asthma, pulmonary disease, respiratory distress, chronic liver disease, general anxiety disorder, alcoholism, epilepsy, subarachnoid or intracranial hemorrhage, hyperthyroidism, pheochromocytoma, recent noncardiac surgery, and dobutamine administration during stress echocardiography [8][9][10][11][12][13][14][15][16][17][18][19] …”

Section: Definition and Epidemiologymentioning

confidence: 99%

Transient Left Ventricular Apical Ballooning in a Postmenopausal Woman with Chronic Liver Disease, Malignancy, and Recent Ischemic Stroke: A Case Report and Review of the Literature

Covell¹,

Clendenen

2012

ISRN Vascular Medicine

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Transient left ventricular apical ballooning (TLVAB), or Takotsubo cardiomyopathy, is a poorly understood phenomenon that is thought to be related to a surge of catecholamines under stress conditions that causes microvascular dysfunction and a unique pattern of myocardial stunning. TLVAB occurs in two distinct patient populations: (i) community presentation similar to acute coronary syndrome and (ii) the critically ill. Understanding the differences in presentation, prognosis and management between these two groups may improve the outcome. We present a case of TLVAB developing in a Caucasian postmenopausal female who developed TLVAB suddenly on a background of chronic liver disease, malignancy, and recent ischemic stroke. The patient presented with hemodynamic collapse and was treated with inotropes, vasopressors, and supportive care until cardiac function improved. Additionally, we review the current literature describing the risk factors, pathophysiology, and treatment of TLVAB. Case ReportA 58-year-old postmenopausal woman presented to the emergency department with a sudden onset of weakness associated with dyspnea, peripheral cyanosis, and bilateral lower extremity edema that progressed over one to two hours to include a decreased level of consciousness. In the emergency department, she was noted to be hypotensive and hypoxic. She was emergently intubated and admitted to the critical care unit. She has no significant medical history, but she reported a 25-pack-year history of smoking and drinks approximately 50 to 60 units of alcohol per week. Laboratory investigations revealed leukocytosis, thrombocytopenia, and evidence of chronic liver disease. Toxicology screen was negative for cocaine. EKG on admission was significant only for sinus tachycardia and QT prolongation. During the course of two days, the patient developed mild ST segment elevation in V 1 and T-wave inversions in leads avL, I, and V 1 . No pathological Q waves were noted. Imaging revealed no acute intracranial hemorrhage; however, changes consistent with recent ischemic stroke were present. Additional imaging demonstrated the presence of abdominal ascites, anasarca, and a right sided pleural effusion with left upper lobe mass suspicious for malignancy. Transthoracic echocardiography demonstrated akinetic apex, hypokinetic mid-left ventricular, and hyperkinetic basal left ventricular segments (Figure 1). Left ventricular ejection fraction was 20-25% and moderate mitral regurgitation with concomitant left atrial enlargement was noted. Cardiac enzyme peak levels were measured with a troponin of 4.92 and CK-MB of 18 (17.5% of total CPK). Biopsy of the lung masses revealed malignancy. During the acute phase of her presentation, the patient received norepinephrine and dobutamine to augment cardiac output until her TLVAB resolved. Definition and EpidemiologyTakotsubo cardiomyopathy was originally described by Dote et al. in the early 1990s [1]. Takotsubo cardiomyopathy

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Dobutamine stress echo-induced apical ballooning (Takotsubo) syndrome

Abstract: Dobutamine stress echocardiography is a widely performed diagnostic test, however, it can rarely result in presumed catecholamine-induced transient apical ballooning syndrome.

Cited by 56 publications

References 11 publications

Spinal Subdural Haematoma in A Patient After Dobutamine Stress Test: An Unusual Occurrence

Spinal Subdural Haematoma in A Patient After Dobutamine Stress Test: An Unusual Occurrence

Gadolinium enhanced MRI in patients with left ventricular apical ballooning syndrome implicates myocarditis as an etiology

Transient Left Ventricular Apical Ballooning in a Postmenopausal Woman with Chronic Liver Disease, Malignancy, and Recent Ischemic Stroke: A Case Report and Review of the Literature

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