Possible predictive factors for recovery of left ventricular systolic function in Takotsubo cardiomyopathy

Shaikh, Nasreen; Sardar, Muhammad; Jacob, Aasems; Alagusundaramoorthy, Sayee Sundar; Eng, Margaret; Checton, John; Shah, Ajay

doi:10.5582/irdr.2018.01042

Cited by 12 publications

(13 citation statements)

References 18 publications

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“…Although not performed until SCM was considered as a potential etiology of her ECG abnormalities, our patient's ventricular function was normal on day 11 by bedside cardiac ultrasound. This is consistent with a study by Shaikh et al that showed that the median time to left ventricular dysfunction is 7 days [8]. Due to the delayed diagnosis of SCM, we were unable to confirm the classic apical left ventricular dysfunction, but in hindsight, this patient's clinical, biochemical, and ECG findings are more suggestive of an SCM caused by the generalized seizure.…”

Section: Discussionsupporting

confidence: 90%

Diffuse Deep T-Wave Inversions Following a Generalized Seizure

Prosperi-Porta

Oleynick

2019

Am J Case Rep

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Patient: Female, 44Final Diagnosis: Stress induced cardiomyopathySymptoms: SeizureMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Mistake in diagnosisBackground:Stress cardiomyopathy (SCM) is a transient dysfunction of the left ventricle due to physical or emotional triggers that produces a range of electrocardiogram (ECG) changes. While ST-segment elevation or depression often leads to more urgent investigation and diagnosis, T-wave inversions can result in delayed diagnosis.Case Report:A 44-year-old woman with a prior left middle cerebral artery septic embolic stroke from endocarditis resulting in residual dense right sided hemiparesis and aphasia was admitted to the hospital for treatment of Staphylococcus aureus bacteremia. While hospitalized, she experienced a generalized seizure that was aborted with lorazepam and then loaded with phenytoin. Her ECG following the seizure showed a prolonged QT interval, for which her methadone that she was stabilized on during hospitalization was held. Her ECG to follow-up on her QT interval 25 h following the seizure showed new diffuse symmetric deep T-wave inversions. While initially believed to be due to the either the discontinuation of methadone or initiation of phenytoin, retrospective analysis revealed that these changes were more suggestive of a missed SCM.Conclusions:We report a patient who experienced a generalized seizure resulting in diffuse, symmetric, deep T-wave inversions that were incorrectly attributed to medication effects before identifying the likely diagnosis of SCM. Fortunately for this patient, there were no consequences of the delayed diagnosis, but this case emphasises the importance of considering SCM following a generalized seizure in any patient with ECG abnormalities.

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Section: Discussionsupporting

confidence: 90%

Diffuse Deep T-Wave Inversions Following a Generalized Seizure

Prosperi-Porta

Oleynick

2019

Am J Case Rep

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“…Demographic and clinical factors were compared between the groups. Generalized anxiety disorder was seen more commonly in the group with early recovery [48]. Thus long-term complications seem no to be affected by pre-existing psychiatric disorders [47,48].…”

Section: Recurrence and Complicationsmentioning

confidence: 84%

Role of Depression and Anxiety Disorders in Takotsubo Syndrome: The Psychiatric Side of Broken Heart

Oliveri¹,

Goud²,

Mohammed³

et al. 2020

Cureus

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Takotsubo syndrome (TTS), also called broken heart syndrome, is an acute and transient cardiac wall motion abnormality of the left ventricle. The patient prototype is a postmenopausal woman with myocardial infarction-like symptoms (angina pectoris, breathlessness, palpitations, etc.) who has experienced sudden emotional or physical stress. Although prognosis is generally considered relatively benign, both complications and recurrence rates are not insignificant. Pathophysiological mechanisms underlying TTS are not entirely understood, but the sympathetic system over-activity has a leading role. Moreover, since emotional stress frequently triggers TTS and since precedent diagnosis of psychiatric disorders sometimes coexists, the psychological response to stress could be another potential therapeutic target. Indeed, this article aims to explore the association between underlying depression and anxiety disorders and TTS, as well as to find ideal therapeutic options useful to treat and prevent TTS. Thus in our review, we considered case reports, case-control studies, and review articles from PubMed. Papers dealing with Takotsubo syndrome and anxiety disorder or depression were selected. We included papers published since 2010 and whose abstract was in English. We concluded that anxiety disorders, but not depression, are associated with a higher occurrence of TTS. There is a link between anxiety, TTS, and inflammation leading to increased sympathetic activity. Nevertheless, patients with pre-admission psychiatric disorders have a higher risk of recurrent TTS. Importantly, the use of selective serotonin reuptake inhibitors (SSRIs) could be a potential therapeutic aid in preventing TTS's recurrence in selected patients.

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“…Our study makes an important contribution to the literature because it quantitates the reliability of ICD codes to identify patients with SCM. This finding is important because multiple studies have used this code to study trends in the incidence of this disease, [1][2][3][4][5][6][7][8] and futures studies will almost certainly continue to do so. Our results also showed similar demographics and trends in the incidence of SCM compared with those of prior studies [1][2][3]11 but additionally revealed that these codes also have some important limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, all currently proposed diagnostic criteria require resolution of typical regional wall motion abnormalities before finalizing a research-grade diagnosis of SCM (Table 2). 12,13 However, because the median time to recovery of ejection fraction in SCM is between three and four weeks after hospital discharge (with some recovery extending much longer), 6 it is almost impossible to make a research-grade diagnosis of SCM after a threeto four-day hospitalization. Moreover, 33% of our patients did not undergo cardiac catheterization, 8.5% did not undergo echocardiography, and it is our experience that testing for pheochromocytoma and myocarditis is rarely done.…”

Section: Discussionmentioning

confidence: 99%

“…In 2006, SCM gained an International Classification of Diseases code at the 9 th Clinical Modification (ICD‐9 CM). Subsequently, several epidemiological studies have used ICD codes to evaluate trends in the diagnosis of SCM; 1‐8 however, to our knowledge, no previous studies have validated ICD‐9 or ‐10 codes using chart review. We aimed to determine the positive predictive value (PPV) and the limitations of these ICD codes among hospitalized patients.…”

mentioning

confidence: 99%

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Utility of ICD Codes for Stress Cardiomyopathy in Hospital Administrative Databases: What Do They Signify?

Bhat

White

Gobeil

et al. 2019

Journal of Hospital Medicine

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Prior studies of stress cardiomyopathy (SCM) have used International Classification of Diseases (ICD) codes to identify patients in administrative databases without evaluating the validity of these codes. Between 2010 and 2016, we identified 592 patients discharged with a first known principal or secondary ICD code for SCM in our medical system. On chart review, 580 charts had a diagnosis of SCM (positive predictive value 98%; 95% CI: 96.4-98.8), although 38 (6.4%) did not have active clinical manifestations of SCM during the hospitalization. Moreover, only 66.8% underwent cardiac catheterization and 91.5% underwent echocardiography. These findings suggest that, although all but a few hospitalized patients with an ICD code for SCM had a diagnosis of SCM, some of these were chronic cases, and numerous patients with a new diagnosis of SCM did not undergo a complete diagnostic workup. Researchers should be mindful of these limitations in future studies involving administrative databases.

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Possible predictive factors for recovery of left ventricular systolic function in Takotsubo cardiomyopathy

Cited by 12 publications

References 18 publications

Diffuse Deep T-Wave Inversions Following a Generalized Seizure

Diffuse Deep T-Wave Inversions Following a Generalized Seizure

Role of Depression and Anxiety Disorders in Takotsubo Syndrome: The Psychiatric Side of Broken Heart

Utility of ICD Codes for Stress Cardiomyopathy in Hospital Administrative Databases: What Do They Signify?

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