McConnell's sign — An insight into the pathogenesis of Takotsubo syndrome?

Shao, Yangzhen; Redfors, Björn; Ali, Anwar; Bossone, Eduardo; Lyon, Alexander R.; Ömerovic, Elmir

doi:10.1016/j.ijcard.2014.10.143

Cited by 11 publications

(10 citation statements)

References 23 publications

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Section: Sympathoexcitation-induced Takotsubo Cardiomyopathymentioning

confidence: 99%

“…They have suggested that a catecholamine-induced increase in LV afterload produces changes in the LV similar to those described in acute pulmonary embolism; that is, akinesis of the RV mid-free wall with the apex retaining its systolic function (also known as McConnell's sign). 68 Additionally, there have been numerous reports linking this entity to certain medications and toxins such as albuterol, 69 high-dose intravenous cytarabin, 70 5-fluorouracil, 71 entacapone, 72 and allopurinol 73 as well as the inhalation of hypochlorite gel exhalations. 74 Furthermore, a case has been reported on a possible link to cocaine abuse.…”

Section: Sympathoexcitation-induced Takotsubo Cardiomyopathymentioning

confidence: 99%

See 1 more Smart Citation

Reversible Cardiomyopathies

Patel

Madanieh

Kosmas

et al. 2015

Clin Med Insights Cardiol

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Cardiomyopathies (CMs) have many etiological factors that can result in severe structural and functional dysregulation. Fortunately, there are several potentially reversible CMs that are known to improve when the root etiological factor is addressed. In this article, we discuss several of these reversible CMs, including tachycardia-induced, peripartum, inflammatory, hyperthyroidism, Takotsubo, and chronic illness–induced CMs. Our discussion also includes a review on their respective pathophysiology, as well as possible management solutions.

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Section: Sympathoexcitation-induced Takotsubo Cardiomyopathymentioning

confidence: 99%

Section: Sympathoexcitation-induced Takotsubo Cardiomyopathymentioning

confidence: 99%

Reversible Cardiomyopathies

Patel

Madanieh

Kosmas

et al. 2015

Clin Med Insights Cardiol

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“…We propose that the delay in recovery of RV function, may be due to increased RV afterload secondary to PAH due to pre-existing lung disease. Shao et al , 4 based on animal experiments, proposed the differential wall stress hypothesis, in the development of different phenotypes of TC. He suggested that the presentation of TC would depend on afterload related wall stress of myocytes.…”

Section: Discussionmentioning

confidence: 99%

A case report: biventricular takotsubo cardiomyopathy with sequential ventricular recovery due to pulmonary hypertension

Agarwal

Kardos

2021

European Heart Journal - Case Reports

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Background Biventricular Takotsubo cardiomyopathy (BTC) is estimated to occur in 25–42% of those with Takotsubo cardiomyopathy (TC). Little is known about which subset of patients are predisposed to having concomitant right ventricular (RV) involvement, or the pattern of recovery in BTC. Case summary We describe a 69-year-old woman who presented with dyspnoea and was subsequently diagnosed with BTC. We propose that this was triggered by an exacerbation of chronic obstructive pulmonary disease on a background of multiple predisposing factors including recent bereavement, previous excessive alcohol use, status as a current smoker, and anxiety. During her admission, she required non-invasive ventilation and inotropic support to manage her type two respiratory failure and acute heart failure. Serial echocardiograms during the admission allowed us to capture and present the sequential recovery of ventricular systolic function, with the left ventricular (LV) recovery preceding the right ventricle. Discussion Our patient fulfils the International Takotsubo Diagnostic criteria of transient LV dysfunction, emotional and physical triggers, electrocardiogram abnormalities, raised troponin and brain natriuretic peptide and no occlusive coronary artery disease. We hypothesize that pulmonary hypertension-related strain on the right ventricle due to lung disease, may have led to the observed delay in the recovery of RV function, despite the full recovery of LV function.

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“…Although the exact etiology of takotsubo syndrome is unknown, it is characteristically identified as being triggered by severe emotional or physical stress, and studies suggest that increased sympathetic hyperactivity leads to myocardial stunning and contractile dysfunction in these patients 9 . Similarities have often been drawn between McConnell's syndrome and inverted takotsubo syndrome in the literature, 10 but the connection between the two has not been completely elucidated. Given the near identical RV findings seen on echocardiography in our patient to takotsubo syndrome of the right ventricle, this strengthens the argument that there may be similarities between these two disease processes.…”

Section: Discussionmentioning

confidence: 99%