Mid-Ventricular Variant Takotsubo Cardiomyopathy in the Setting of Midodrine Use

Matevosyan, Adelaida; Duchene, B.; Patel, Shivraj; Mirabella, Steven; Ayala, Tomas

doi:10.1016/j.chest.2017.08.115

Cited by 3 publications

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“…The development of takotsubo cardiomyopathy following the institution of midodrine therapy has been described in prior cases, but our patient had a normal transthoracic echocardiogram during her inpatient stay, thus excluding this possibility. [9,10] In contrast, myocardial infarction has been associated with clonidine in a case of a woman who was administered a subcutaneous overdose of clonidine (12.24 mg) and hydromorphone (48.3 mg) to refill an implanted epidural infusion pump. [11] Although she responded to naloxone after deterioration in her conscious state, she subsequently developed an anteroseptal myocardial infarction in association with a hypertensive crisis, and subsequent cardiac catheterization did not show any stenosis or occlusion of her coronary circulation.…”

Section: Discussionmentioning

confidence: 99%

Treatment of prolonged clonidine-induced autonomic instability with midodrine: a case report about a new approach or a cautionary tale?

Malouf

Henry

Pemberton

et al. 2022

Emerg Crit Care Med

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BackgroundClonidine is a centrally acting α2 adrenergic and imidazoline-1 receptor agonist that can cause somnolence, bradycardia, and hypotension within several hours of ingestion. Less well-described but observed by us locally is the observation that patients presenting after large overdoses including clonidine can have prolonged autonomic instability. As a result, they may require many days in hospital before recovery. We have previously used midodrine as an indirect antagonist with good effect; however, there are no previous reports of its use for this indication.Case presentationWe present the case of a young female patient who developed prolonged autonomic instability following a large overdose of clonidine (coingested with smaller doses of escitalopram + lisdexamfetamine) that was treated with midodrine but complicated by a type 2 non-ST segment elevated myocardial infarction.ConclusionMidodrine seems to ameliorate this protracted instability and may provide a means to decrease hospital length of stay in appropriate individuals.

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Section: Discussionmentioning

confidence: 99%

Treatment of prolonged clonidine-induced autonomic instability with midodrine: a case report about a new approach or a cautionary tale?

Malouf

Henry

Pemberton

et al. 2022

Emerg Crit Care Med

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“…In addition to ACS, other medical conditions like hypoglycemia, GI bleed, acute asthma, and pneumothorax triggering TC have also been reported [13]. Sympathomimetic medications like beta2 agonist nebulization, and alpha agonist medications like midodrine, have also reportedly precipitated recurrent TC events in a few patients [13,31].…”

Section: Discussionmentioning

confidence: 99%

Forme Fruste in Recurring Mid-Ventricular Variant of Takotsubo Cardiomyopathy

et al. 2019

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Patient: Female, 69 Final Diagnosis: Mid ventricular type of Takotsubo cardiomyopathy Symptoms: Chest discomfort Medication: — Clinical Procedure: Angiography • 2D echocardiogram Specialty: Cardiology Objective: Unusual clinical course Background: Takotsubo cardiomyopathy (TC) is characterized as acute left ventricular dysfunction precipitated by intense emotional or physiological stress. The mid-ventricular variant of TC usually has akinesis, with or without ballooning of the mid-ventricular segment, and a hyperdynamic base and apex. Recurrence of the typical and atypical (reversed and mid-ventricular type) forms has been reported in only a very small number of cases. We report a forme fruste presentation of mid-ventricular variant of TC. Case Report: A 69-year-old woman with a prior history of stress-induced cardiomyopathy presented with complaint of moderate intensity, persistent, sub-sternal chest discomfort. She reported that her symptoms were similar to those she had during a previous hospitalization in 2015, and this time cited the death of her mother as an inciting stressor. No significant obstructive flow-limiting coronary artery disease was found on cardiac catheterization. However, the left ventriculogram was suggestive of mid-ventricular pattern of TC. Her first symptomatic episode of apparent TC did not reveal completion of the mid-ventricular pattern of the TC variant. The subsequent episode, during this hospitalization, manifested as a completed version of her initial apparent forme fruste of mid-ventricular variant of TC. Conclusions: TC may present in a myriad of clinical forms that must be considered in the evaluation of patients with suspected acute coronary syndromes or cardiomyopathy. Treatment is mainly supportive, and recurrence rates range from 7.7% to 11.4%. To the best of our knowledge, this forme fruste presentation has not been previously reported in recurrent variants of TC.

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Midodrine

2017

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Mid-Ventricular Variant Takotsubo Cardiomyopathy in the Setting of Midodrine Use

Cited by 3 publications

References 0 publications

Treatment of prolonged clonidine-induced autonomic instability with midodrine: a case report about a new approach or a cautionary tale?

Treatment of prolonged clonidine-induced autonomic instability with midodrine: a case report about a new approach or a cautionary tale?

Forme Fruste in Recurring Mid-Ventricular Variant of Takotsubo Cardiomyopathy

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