Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo-like left ventricular dysfunction

Kurisu, Satoshi; Inoue, Ichiro; Kawagoe, Takuji; Ishihara, Masaharu; Sakai, Yuji; Nishioka, Kenji; Umemura, Takashi; Nakamura, Suji; Yoshida, Masashi; Sato, Hajime

doi:10.1016/s0735-1097(02)02924-8

Cited by 278 publications

(235 citation statements)

References 19 publications

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“…Despite the spasm of the anterior interventricular artery has been initially conjectured 6,7 , it was not confirmed in more judicious analyses performed afterwards, as the presence of coronary spasm in those cases was more sporadic than uniform 7,12,13 . The decrease of flow reserve and the increase in time of coronary flow are always present.…”

Section: Case Reportmentioning

confidence: 96%

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Cardiomiopatia de Takotsubo: uma causa rara de choque cardiogênico simulando infarto agudo do miocárdio

Vasconcelos¹,

Martins²,

Sousa³

et al. 2005

Arq. Bras. Cardiol.

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We report a case of cardiogenic shock caused by an acute left ventricular aneurysm, similar to Takotsubo or Dumbbell, in a patient without obstructive coronary lesion. The case fulfills all criteria for Takotsubo cardiomiopathy, a pathology most frequent in Japan and that can simulate acute myocardial infarction. Case ReportA 70-year-old, female patient, with precordial discomfort under constriction for 6 hours, without irradiation, followed by difficulty to breathe, with stressed worsening in the last 3 hours. In the morning before the beginning of the symptoms, the family informed and intense emotion motivated by family discussion. There was no report of morbid history or use of medications.A patient showing stressed respiratory discomfort, pale, with abounding sudoresis. Tachycardic rhythmic sounds without other noises, bullous rales of medium and thin bubbles up to pulmonary apexes. Blood pressure was 90x60 mmHg, heart rate was 135 b.p.m, respiratory rate was 35 i.p.m., axillary temperature was 37°C. During the exam in the emergency room, the patient showed stressed worsening of respiratory discomfort, needing an urgent orotracheal intubation and mechanical ventilation. Dopamine IV was started. Electrocardiogram (ECG) of 12 derivations showed sinus tachycardia with non-specific changes of ventricular repolarization. Dosage of CKMB -mass collected at the admission was 22 u.The patient was transferred to this service with the diagnostic hypothesis of non-Q infarction and cardiogenic shock.She was under mechanical ventilation, tachycardic with rhythmic sounds, heart rate of 145 b.p.m, bullous rales up to the upper third of both pulmonary fields, blood pressure was 80x50 mmHg. The thoracic radiography showed right pneumothorax, of moderate size and signs of pulmonary congestion ( fig. 1). The ECG showed changes in ventricular repolarization and sinus tachycardia ( fig. 2). The CKMB-mass was 29 u, creatinine of 1,2 mg% and glycemia 140 mg%. The pneumothorax was immediately drained. An echocardiogram performed by the bed, showed left ventricular aneurysm of anterior wall, compromising the middle and apical regions ( fig. 3). After a fast hemodynamic stabilization with careful infusion of fluids, guided by the echocardiogram, institution of dobutamine at 12 mcg/kg/min and noradrenaline at 8 mcg/min, the patient was sent to hemodynamics laboratory, where the coronary angiography showed coronary arteries without obstructive lesions ( fig. 4) and the left ventriculography showed anterior wall aneurysm in a shape similar to Takotsubo or Dumbbell (fig. 5). The patient was kept under mechanical ventilation, with vasoactive drugs. Successive measurements of CKMB revealed a peak of 45 u in approximately 40 hours of evolution. After 48 hours there was an improvement of the features, with possibility of removal of mechanical ventilation and progressive discontinuity of vasoactive drugs. A new echocardiogram, by the bed, performed 72 hours after admission, did not show abnormalities of segmental contraction ( fig. 6). The pat...

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Section: Case Reportmentioning

confidence: 96%

“…Recently, concomitant analyses with thallium 201 and with a positron emission tomography (SPECT), using pentadecaenoic acid marked with iodine 123 (I-BMIPP), showed a defect of fatty acid metabolism in an area greater than that associated to the defect of perfusion, which suggested a more extensive metabolic disorder 13 .…”

Section: Case Reportmentioning

confidence: 99%

Cardiomiopatia de Takotsubo: uma causa rara de choque cardiogênico simulando infarto agudo do miocárdio

Vasconcelos¹,

Martins²,

Sousa³

et al. 2005

Arq. Bras. Cardiol.

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“…This syndrome is characterized by several electrocardiographic changes mimicking those of acute myocardial infarction (AMI) such as ST-segment elevation, T-wave inversion and QT-interval prolongation (1)(2)(3)(4)(5)(6)(7). We report a case of tako-tsubo cardiomyopathy presenting transient QRS prolongation during the early phase.…”

Section: Introductionmentioning

confidence: 99%

Tako-tsubo Cardiomyopathy Complicated by QRS Prolongation

et al. 2012

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A 68-year-old woman was admitted to our hospital due to sudden onset of dyspnea. On admission, electrocardiogram (ECG) showed T-wave inversion and QRS prolongation (120 msec) that were not found in her previous ECG. Chest X-ray showed pulmonary edema and cardiac enlargement. Left ventriculogram showed akinesis of the left ventricle except in the basal region. No significant coronary stenosis was found on angiogram. She was diagnosed as having tako-tsubo cardiomyopathy complicated by QRS prolongation. Intraaortic balloon pumping (IABP) was subsequently initiated for the treatment of acute heart failure. QRS prolongation was resolved immediately after the initiation of IABP, and left ventricular dysfunction was resolved within 9 days. She was discharged 14 days later.

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“…Takotsubo syndrome is characterized by transient left ventricular apical wall motion abnormality with electrocardiographic changes and minimal myocardial enzymatic release mimicking acute myocardial infarction, but without significant coronary artery disease (1)(2)(3)(4)(5)(6)(7)(8)(9). To date, we have reported several early angiographic characteristics of takotsubo syndrome such as left ventricular outflow tract obstruction (2), mitral regurgitation (2), apical thrombus formation (3) or reduced coronary blood flow (2).…”

Section: Introductionmentioning

confidence: 99%

“…To date, we have reported several early angiographic characteristics of takotsubo syndrome such as left ventricular outflow tract obstruction (2), mitral regurgitation (2), apical thrombus formation (3) or reduced coronary blood flow (2). Also, other Japanese groups have recently reported malignant arrhythmia (8) or cardiac rupture (9) as complications of takotsubo syndrome.…”

Section: Introductionmentioning

confidence: 99%