Stress-induced cardiomyopathy associated with ipratropium bromide therapy in a patient with chronic obstructive pulmonary disease

Melão, Filipa; Nunes, José Pedro L.; Vasconcelos, Mariana; Dias, Paula; Almeida, Pedro; Rodrigues, Rui; Pinho, Teresa; Madureira, António J.; Maciel, Maria Júlia

doi:10.1016/j.repc.2013.10.012

Cited by 10 publications

(5 citation statements)

References 9 publications

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“…The medical records reveal that the patient had been inhaling high doses of salbutamol and ipratropium prior to hospitalization. Remarkably, ipratropium has also been proposed as an inducer in “bronchogenic TTS” [26]. Still, the use of ipratropium may mainly have favorable effects in “bronchogenic TTS” since it may reduce the need of beta-2-agonist administration.…”

Section: Discussionmentioning

confidence: 99%

Frequently Recurrent Takotsubo Syndrome in COPD

Vaz

Berggren

Eriksson

2019

Case Reports in Cardiology

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Cardiovascular disease is common among patients with chronic obstructive pulmonary disease (COPD). Takotsubo syndrome (TTS) is a transient cardiac disorder that, in its typical form, involves left ventricular dysfunction with apical ballooning and mimics acute coronary syndrome (ACS). “Bronchogenic TTS” has been proposed as a specific form of TTS (during severe acute dyspnea in asthma or COPD) with atypical presentation. Recurrent TTS in COPD seems to be exceptionally rare since only a handful of clinical cases have previously been reported in the literature. Here, we present a unique case of a frequently recurrent TTS during COPD exacerbation in a 70-year-old woman, with at least 4 different episodes of TTS within 5 years. This case report exemplifies the difficulties of the diagnosis of TTS at the onset of acute COPD exacerbation. Potential pathophysiological mechanisms and therapeutic strategies are also briefly discussed.

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Section: Discussionmentioning

confidence: 99%

Frequently Recurrent Takotsubo Syndrome in COPD

Vaz

Berggren

Eriksson

2019

Case Reports in Cardiology

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“…Rat models demonstrated elevated markers of oxidative stress in TC, which were reduced with alpha and beta adrenergic blockers [1]. Density of adrenoceptors in left ventricular myocardium in animals are higher in the apex and lower in the base, which may explain propensity of apical ballooning caused by TC [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…High sensitivity troponins are often found to be elevated in patients presenting with COPD exacerbation and is associated with higher mortality. Another component of TC in a patient with COPD, is that the treatment itself may potentiate this condition [6][7][8][9][10]. The mainstay of treatment for COPD is bronchodilator therapy, including beta-2 adrenergic agonists and anticholinergics.…”

Section: Discussionmentioning

confidence: 99%

A rare case of chronic obstructive pulmonary disease induced Takotsubo cardiomyopathy in a male

Khan¹,

Biren²,

Qaqa³

et al. 2018

Int J Case Rep Images

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Introduction: Takotsubo cardiomyopathy (TC) is a transient nonischemic cardiomyopathy causing wall motion abnormalities of a particular region of the heart, most commonly the apex. The classic presentation is of a postmenopausal female presenting with chest pain and congestive heart failure in response to an emotional stressor, but physical stressors may cause it as well. Uncommonly, men may present with this condition. We present a rare case of TC in a male, triggered by a COPD exacerbation. Case Report: A 62-year-old African American Male with a past medical history of COPD presented with shortness of breath, wheezing and chest tightness. The patient had increased his use of his albuterol inhaler to four times a day, which did not relieve his symptoms. His electrocardiogram showed right bundle branch block and nonspecific T wave changes and his troponins progressively increased to 2.47 ng/mL within 6 hours. Echocardiogram showed apical akinesis with a newly reduced ejection fraction of 30-35% Cardiac catheterization revealed nonobstructive coronary artery disease and apical ballooning

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“…87 Phentermine is an amphetamine derivative used as an appetite suppressant, which is thought to be a sympathomimetic amines that stimulate the release of norepinephrine and dopamine from the storage sites in the presynaptic nerve terminals. 119 Other catecholamine-related causes included indirect adrenergic effects, including parasympathetic block (2 cases), 117,122 sudden withdrawal of b-blockers (3 cases), 76,77 anaphylactic reactions (5 cases), [81][82][83][84]118 withdrawal of opioids (5 cases), 69,70,75,78,79 or alcohol (2 cases). 71,125 Opioid withdrawal is known to cause hyperadrenergic state that leads to catecholamine surge and increased b-receptor sensitivity and subsequently myocardial stunning.…”

Section: Discussionmentioning

confidence: 99%