Isolated Left Ventricular Basal Ballooning Phenotype of Transient Cardiomyopathy in Young Women

Reuss, Christina S.; Lester, Steven J.; Hurst, R. Todd; Askew, J. Wells; Nager, Paul; Lusk, Joan L.; Altemose, Gregory T.; Tajik, A. Jamil

doi:10.1016/j.amjcard.2006.12.078

Cited by 82 publications

(44 citation statements)

References 12 publications

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“…The majority of patients have the well-described ''apical ballooning'' pattern in which there is akinesis or dense hypokinesis of the apical and midventricular segments with sparing of the base. More recently, variants of this syndrome have been reported in which the apex is not affected (Hurst et al 2006;Reuss et al 2007). Patients with ''basal'' and ''midventricular'' ballooning patterns tend to be younger and have less heart failure, but otherwise have many of the same clinical features as patients with apical involvement (Hahn et al 2007).…”

Section: Qt Interval Prolongation (Usually Maximal By 24-48 H)mentioning

confidence: 94%

“…We prefer the name stress cardiomyopathy because it emphasizes the importance of acute stress, whether emotional or physiologic, in the pathogenesis of this disorder. Further, it is now clear that the left ventricle in some patients with SCM can assume morphologic appearances that spare the apex (Hurst et al 2006;Reuss et al 2007), making the names takotsubo and transient left ventricular apical ballooning syndrome both confusing and somewhat inaccurate for these subgroups. Until a clear and consistent nomenclature is agreed upon, physicians should be aware that all four names are used interchangeably in the literature to refer to the same clinical condition.…”

Section: Nomenclaturementioning

confidence: 96%

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Stress Cardiomyopathy: A Syndrome of Catecholamine-Mediated Myocardial Stunning?

2012

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During the past few years, a novel syndrome of heart failure and transient left ventricular systolic dysfunction precipitated by acute emotional or physical stress has been described. While patients with "stress cardiomyopathy"(SCM) typically present with signs and symptoms that resemble an acute coronary syndrome, it has become clear that this syndrome has unique clinical features that can readily be distinguished from acute infarction.In particular, in contrast to the irreversible myocardial injury seen with infarction, the myocardial dysfunction of SCM is completely reversible and occurs in the absence of plaque rupture and coronary thrombosis. There is increasing evidence that exaggerated sympathetic stimulation may play a pathogenic role in the development of SCM. Plasma catecholamine levels have been found to be markedly elevated in some patients with SCM, and the syndrome has been observed in other clinical states of catecholamine excess such as central neurologic injury and pheochromocytoma.Further, intravenous catecholamines can precipitate SCM in humans and can reproduce the syndrome in animal models. The precise mechanism in which excessive sympathetic stimulation may result in transient left ventricular dysfunction remains controversial. Abnormal myocardial blood flow due to sympathetically mediated microvascular dysfunction has been suggested and is supported by decreased coronary flow reserve during the acute phase of this syndrome. An alternative explanation is the direct effect of catecholamines on cardiac myocytes, possibly through cyclic AMP-mediated calcium overload. This manuscript will review the clinical and diagnostic features of SCM and will summarize the evidence supporting a sympathetically mediated pathogenesis. Clinical risk factors that appear to increase susceptibility to SCM, possibly by modulating myocyte and microvascular sensitivity to catecholamines, will also be highlighted.

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Section: Qt Interval Prolongation (Usually Maximal By 24-48 H)mentioning

confidence: 94%

Section: Nomenclaturementioning

confidence: 96%

Stress Cardiomyopathy: A Syndrome of Catecholamine-Mediated Myocardial Stunning?

2012

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“…The LVG of this cardiomyopathy demonstrates midventricular dilatation and akinesis with a hypercontractile apex and base. 14,15 Recurrent ampulla cardiomyopathy is infrequent, with one study reporting a recurrence rate of 11.4% over 4 years after initial presentation. 16 Both emotional stress and physical stress cause recurrent ampulla cardiomyopathy and the time-to-recurrence ranges from 3 months to 13 years after initial presentation.…”

Section: Discussionmentioning

confidence: 99%

Morphologically Unique Feature of Recurrent Ampulla (Takotsubo) Cardiomyopathy

Ikeda

Hisamatsu

Kijima

et al. 2009

Circ J

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mpulla (takotsubo) cardiomyopathy is a novel heart syndrome characterized by transient left ventricular (LV) dysfunction, mimicking acute myocardial infarction. 1,2 Guidelines for the diagnosis of ampulla cardiomyopathy were recently established in Japan. 3 We report 2 rare cases of recurrent ampulla cardiomyopathy. Both patients experienced typical ampulla cardiomyopathy at the initial admission and atypical ampulla cardiomyopathy at the second admission. We diagnosed the transient LV apical ballooning as typical ampulla cardiomyopathy and the other types of transient LV ballooning as atypical ampulla cardiomyopathy in accordance with the guidelines. Case Reports Case 1A 55-year-old woman with a history of rhabdomyolysis was admitted to the Department of Internal Medicine because of severe general fatigue, vomiting and weakness of the extremities related to recurrent rhabdomyolysis. She did not have chest oppression or dyspnea at the initial admission. At that time, her pulse rate was 127 beats/min, blood pressure 130/79 mmHg, and temperature 36.4°C. The leukocyte count was elevated at 11,800/ μl. The serum levels of aspartate aminotransferase (AST) (208 IU/L), lactate dehydrogenase (LDH) (840 IU/L), creatine kinase (CK) (7,972 IU/L), CK-MB (68 IU/L) and C-reactive protein (CRP) (6.2 mg/dl) were also elevated. Electrocardiogram (ECG) revealed sinus rhythm and T-wave inversion in leads II, III, aVF and V3-6 with prolongation of the QT interval (QTc 0.52 ms) (Fig 1B). Transthoracic echocardiography on admission revealed akinesis of the left ventricle, except in the basal region (ejection fraction 41%) (Fig 2A). She recovered 4 weeks later and was discharged because her general condition had improved with treatment for rhabdomyolysis and repeat echocardiography showed normalization of LV wall motion. The T wave inversion and the QT interval also normalized before discharge.One month later, she again experienced general fatigue, vomiting, weakness of the extremities again because of recurrent rhabdomyolysis, but she also had chest oppression and dyspnea. The leukocyte count was elevated (21,600/ μl), as were the serum levels of AST (166 IU/L), LDH (709 IU/L), CK (2,713 IU/L), CK-MB (108 IU/L), CRP (5.9 mg/dl) and noradrenalin (NA) (1,492 pg/ml). ECG on admission revealed sinus rhythm and T-wave inversion in leads V1-3 with prolongation of the QT interval (QTc 0.50 ms) (Fig 1C). Transthoracic echocardiography on admission revealed a hypercontractile LV apex with an akinetic basal-to mid-LV (ejection fraction 43%) (Fig 2B). Urgent coronary angiography (CAG) did not reveal a significant stenotic lesion. Computed tomography of the abdomen and iodine-131-metaiodobenzylguanidine (MIBG) scintigraphy did not show pheochromocytoma. Her acute heart failure was medically treated, she recovered and was discharged. Case 2A 75-year-old man with a history of bronchial asthma was admitted to a nearby hospital because of worsening cough and dyspnea. He was treated with intravenous the- (Received December 2, 2007; revised manuscript...

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“…[6][7][8] In this case, the patient visited the hospital due to decreased mentality but not chest pain; she was experiencing physical stress, e.g., panhypopituitarism and severe diarrhea, resulting in electrolyte imbalance and renal failure. Initial echocardiogram showed typical findings of atypical SICM.…”

Section: A B C D E Fmentioning

confidence: 99%

Acute Coronary Syndrome Mimicking Atypical Stress-Induced Cardiomyopathy in a Patient with Panhypopituitarism

Park

Yun

Kim

et al. 2010

J Cardiovasc Ultrasound

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Stress-induced cardiomyopathy is frequently confused with acute coronary syndromes. We encountered a 64-year old female patient with panhypopituitarism initially suspected as atypical stress-induced cardiomyopathy due to her history and initial echocardiographic findings. She was finally diagnosed as non ST-segment elevation myocardial infarction based on the findings of coronary angiogram, intravascular ultrasound and subsequent echocardiogram.

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Isolated Left Ventricular Basal Ballooning Phenotype of Transient Cardiomyopathy in Young Women

Cited by 82 publications

References 12 publications

Stress Cardiomyopathy: A Syndrome of Catecholamine-Mediated Myocardial Stunning?

Stress Cardiomyopathy: A Syndrome of Catecholamine-Mediated Myocardial Stunning?

Morphologically Unique Feature of Recurrent Ampulla (Takotsubo) Cardiomyopathy

Acute Coronary Syndrome Mimicking Atypical Stress-Induced Cardiomyopathy in a Patient with Panhypopituitarism

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