Reversible left ventricular dysfunction "takotsubo" cardiomyopathy associated with pneumothorax

Akashi, Yoshihiro J.; Sakakibara, Masayoshi; Miyake, Fumihiko

doi:10.1136/heart.87.2.e1

Cited by 55 publications

(38 citation statements)

References 8 publications

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“…5) Takotsubo-shaped hypokinesis of the left ventricle has been documented in patients in Japan; it is characterized by an apical wall motion abnormality, sometimes in the absence of coronary artery disease. 6) Akashi, et al 7,8) reported takotsubo-shaped hypokinesis following an episode of polymorphic ventricular tachycardia especially with a short coupling interval, and following an episode of pneumothorax of the left lung. Our patient did not complain of palpitations, there were no signs of arrhythmia, and the chest X-ray findings were normal.…”

Section: Discussionmentioning

confidence: 99%

A Case of Takotsubo-Shaped Hypokinesis of the Left Ventricle Caused by a Lightning Strike

Hayashi¹,

Yamada²,

Agatsuma³

et al. 2005

Int. Heart J.

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SUMMARYA 62-year-old woman was struck by lightning while on a mountain and fortunately did not suffer burns or unconsciousness. She stayed at a mountain lodge overnight and was taken to our hospital by helicopter the next day. Upon admission, electrocardiography showed ST segment elevation indicating acute lateral myocardial infarction, and echocardiography showed takotsubo-shaped hypokinesis of the left ventricle indicating an apical aneurysm. Her serum escaped enzyme levels were increased, as is typical in cases of myocardial infarction, however, she did not complain of cardiac symptoms. Coronary arteriography performed 4 days after admission showed a normal coronary artery while left ventriculography showed apical akinesia. An echocardiogram obtained 2 days later showed resolution of the LV wall motion abnormality. This is the first reported case of takotsubo cardiomyopathy caused by lightning. Takotsubo-shaped hypokinesis is not described as a complication of lightning-induced cardiac injury and its pathogenesis remains controversial. (Int Heart J 2005; 46: 933-938) Key words: Takotsubo-shaped hypokinesis, Lightning, Catecholamine-induced cardiomyopathy CASE REPORTA 62-year-old woman was admitted to our hospital in July 2004 after being struck by lightning. Before the event, she had been healthy, and the results of electrocardiography (ECG) performed at her annual health examinations were normal. She was climbing Mt. Hakuba (2932 meters) with two other people when her walking-stick was struck by lightning. All three stayed at a mountain lodge that night, and the next day they were brought to our hospital by helicopter. Upon admission, the woman complained of a slight headache, but there were no cardiac symptoms. However, one of her companions had sustained second-degree burns From the

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Section: Discussionmentioning

confidence: 99%

A Case of Takotsubo-Shaped Hypokinesis of the Left Ventricle Caused by a Lightning Strike

Hayashi¹,

Yamada²,

Agatsuma³

et al. 2005

Int. Heart J.

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“…Despite the association with spontaneous pneumothorax has already been found 10 , there is a strong evidence in that report suggesting pneumothorax due to accident during central vain puncture, as pneumothorax was not seen in the first radiography. The patient was sent with thoracic draining, optimization of volemia and vaso- active drugs, for the stabilization of vital signs and fast sent to hemodynamics laboratory for a possible intervention.…”

Section: Case Reportmentioning

confidence: 78%

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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“…In 2002, Akashi, et al reported the second case. 10 It presents a transient and reversible left ventricular contractile dysfunction with an acute beginning of symptoms mimickings those of a myocardial infarction. 5,11 The name Takotsubo or apical ballooning derives from the distinctive morphology of the left ventricle during the endsystole resembling an octopus fishing vessel with round bottom and narrow neck (the "takotsubo" in Japanese).…”

Section: Discussionmentioning

confidence: 99%

Can a pneumothorax break your heart?

et al. 2015

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ABSTRAK ABSTRACTTakotsubo cardiomyopathy or apical ballooning is a condition characterized by transitory left ventricular dysfunction, affecting commonly postmenopausal females after foregoing acute emotional or physical stress. We report a case of a 63 year old female presenting with severe dyspnea and rightsided secondary spontaneous pneumothorax, initially treated with tube thoracostomy. Despite the fact that pneumothorax resolved, shortness of breath persisted and due to STsegment elevation and increased Troponin I levels, she was admitted to cardiac catheterization. A significant coronary stenosis was ruled out and the diagnosis of a Takotsubo cardiomyopathy was established. Electrocardiographic findings were normalized within three days and attributable to prolonged air leakage. A thoracoscopic apex resection followed by a partial parietal pleurectomy was performed. Although Takotsubo cardiomyopathy is a rare syndrome, it should always be considered as a potential cardiac complication of a pneumothorax.

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Reversible left ventricular dysfunction "takotsubo" cardiomyopathy associated with pneumothorax

Cited by 55 publications

References 8 publications

A Case of Takotsubo-Shaped Hypokinesis of the Left Ventricle Caused by a Lightning Strike

A Case of Takotsubo-Shaped Hypokinesis of the Left Ventricle Caused by a Lightning Strike

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

Can a pneumothorax break your heart?

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