Recurrent takotsubo cardiomyopathy can appear as transient midventricular ballooning syndrome

Yamamoto, Yoshiyuki; Watari, Yuichiro; Kobayashi, Kengo; Tanaka, Kōichi

doi:10.1016/j.jccase.2009.11.004

Cited by 5 publications

(4 citation statements)

References 5 publications

(8 reference statements)

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“…25 Conversely, provoked coronary spasm cases in patients with TTC have been reported and their variants from the early era of discovering this syndrome to the present. 1,6,[33][34][35][36][37][38][39][40] This discrepancy in the relationship between TTC and spasm may be due to the sensitivity of the ACh provocation test. Sueda et al reported that intracoronary injection of ACh is less sensitive for diagnosis in young patients with rest angina and recommend performing sequential spasm provocation tests of ACh and ergonovine.…”

Section: Discussionmentioning

confidence: 99%

Serial changes of myocardial perfusion imaging in takotsubo and reverse takotsubo cardiomyopathy

Miyajima

Tawarahara

Saito³

2022

Journal of Nuclear Cardiology

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Background Takotsubo cardiomyopathy (TTC) shows reversible hypokinesis in the left ventricular (LV) apical-half segment and hyperkinesis in the LV basal-half segment. However, the precise pathophysiological mechanism of TTC is unclear. Therefore, this study sought to clarify the nuclear characteristics, degree of myocardial damage, and serial change of TTC and rTTC using myocardial perfusion imaging. Methods We performed myocardial perfusion scintigraphy in 28 patients (TTC: 20, rTTC: 8) using Tc-99m sestamibi and assessed minimum percentage uptake (min-%-uptake), extent score (ES) and summed rest score (SRS) at acute and chronic phases. Results Min-%-uptake improved from the acute to the chronic phase (TTC: 54 [48-59]% vs 87 [81-90]%, P < 0.01; rTTC: 60 [55-64]% vs 77 [71-79]%, P < 0.01), as did the ES (TTC: 32 [26-41]% vs 0.0 [0.0-6.0]%, P < 0.01; rTTC: 16 [12-34]% vs 0.0 [0.0-0.0]%, P = 0.02) and SRS (TTC: 4.5 [3.9-5.3] vs 0.0 [0.0-0.2], P < 0.01; rTTC: 3.6 [3.3-3.8] vs 0.0 [0.0-0.0], P = 0.01). Conclusion Tc-99m sestamibi uptake was reduced in hypokinetic regions in the acute phase and improved in the chronic phase. TTC and rTTC may involve a reversible disorder of the myocardial cell membrane, mitochondria, and microcirculation.

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Section: Discussionmentioning

confidence: 99%

Serial changes of myocardial perfusion imaging in takotsubo and reverse takotsubo cardiomyopathy

Miyajima

Tawarahara

Saito³

2022

Journal of Nuclear Cardiology

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“…Our patient is unique in that she had a recurrence of this syndrome within seven months of her initial presentation, and both episodes were preceded by transient neurological complaints. Recurrence of TTC, once thought to be rare, has been increasingly recognized in the literature, with a recurrence rate of 5% to 10% worldwide [ 2 , 4 , 5 ]. Additionally, the development of TTC in the setting of fleeting neurological symptoms such as aphasia and ataxia without structural brain disease has never been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Typically, LV function returns to normal within six to eight weeks. Recurrence, which is increasingly being reported in the literature [ 2 , 4 , 5 ], can be related to neurological pathology [ 6 , 7 ]. We present a case of a woman with recurrent TTC whose presenting symptoms on both occasions were of neurological origin.…”

Section: Introductionmentioning

confidence: 99%

Recurrent takotsubo cardiomyopathy in the setting of transient neurological symptoms: a case report

et al. 2011

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IntroductionFirst described in Japan, takotsubo cardiomyopathy is increasingly becoming recognized worldwide as a cause of sudden and reversible diminished left ventricular function characterized by left apical ballooning and hyperkinesis of the basal segments, often with symptoms mimicking a myocardial infarction. Associated with physical or emotional stress, its exact pathogenesis has not been established, though evidence supports a neurohumoral etiology. Additionally, recurrence of this condition is rare. In this report, we present a rare case of recurrent takotsubo cardiomyopathy in a post-menopausal woman who presented with transient neurological complaints on both occasions.Case presentationWe present a rare case of a 76-year-old Caucasian woman with no history of congestive heart failure who presented to our emergency department twice with transient neurological complaints. On the first occasion, she was found to have transient aphasia which resolved within 24 hours, yet during that period she also developed symptoms of congestive heart failure and was noted to have a new, significantly depressed ejection fraction with apical akinesis and possible apical thrombus. One month after her presentation a repeat echocardiogram revealed complete resolution of all wall motion abnormalities and a return to baseline status. Seven months later she presented with ataxia, was diagnosed with vertebrobasilar insufficiency, and again developed symptoms and echocardiography findings similar to those of her first presentation. Once again, at her one-month follow-up examination, all wall motion abnormalities had completely resolved and her ejection fraction had returned to normal.ConclusionThough the exact etiology of takotsubo cardiomyopathy is unclear, a neurohumoral mechanism has been proposed. Recurrence of this disorder is rare, though it has been reported in patients with structural brain abnormalities. This report is the first to describe recurrent takotsubo cardiomyopathy in a patient with transient neurological symptoms. In our patient, as expected in patients with this condition, complete resolution of all left ventricular abnormalities occurred within a short period of time. It is important for clinicians to be aware of this increasingly recognized syndrome, including its association with recurrence, especially in the clinical setting of neurologic dysfunction.

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“…However, several variants of TC have been described. The midventricular type is characterized by akinesis with or without ballooning of the midventricular segment and a hyperdynamic pattern of base and apex [3]. The exact pathophysiology of TC is still unclear, although several hypotheses, such as multivessel coronary spasm, microvascular impairment and direct catecholamine-mediated myocardial stunning, have been proposed [4].…”

Section: Introductionmentioning

confidence: 99%

An Uncommon Case of Recurrent Midventricular Takotsubo Cardiomiopathy

Duarte

2019

OJCRR

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Recurrent takotsubo cardiomyopathy can appear as transient midventricular ballooning syndrome

Cited by 5 publications

References 5 publications

Serial changes of myocardial perfusion imaging in takotsubo and reverse takotsubo cardiomyopathy

Serial changes of myocardial perfusion imaging in takotsubo and reverse takotsubo cardiomyopathy

Recurrent takotsubo cardiomyopathy in the setting of transient neurological symptoms: a case report

An Uncommon Case of Recurrent Midventricular Takotsubo Cardiomiopathy

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