Tako‐Tsubo‐like syndrome during anaphylactic reaction

Vultaggio, Alessandra; Matucci, Andrea; Pace, Stefano Del; Simonetti, Ignazio; Parronchi, Paola; Riggio, Oliviero; Maggi, Enrico; Gensini, Gianfranco; Romagnani, Sergio

doi:10.1016/j.ejheart.2006.05.011

Cited by 45 publications

(25 citation statements)

References 19 publications

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“…Severe emotional distress is the usual precipitant, however, LVBS has been described in anaphylaxis, pheochromocytoma, the immediate post-operative setting, and has similarities to the cardiac changes seen in sub-arachnoid hemorrhage [13,[15][16][17]. The clinical presentation of LVBS mimics acute ischemia [2].…”

Section: Discussionmentioning

confidence: 95%

“…Left ventricular ballooning syndrome is an increasingly recognized cause of transient left ventricular dysfunction [13,14]. Severe emotional distress is the usual precipitant, however, LVBS has been described in anaphylaxis, pheochromocytoma, the immediate post-operative setting, and has similarities to the cardiac changes seen in sub-arachnoid hemorrhage [13,[15][16][17].…”

Section: Discussionmentioning

confidence: 98%

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Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome

Joshi

Chao

Herzka

et al. 2009

Int J Cardiovasc Imaging

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Left ventricular ballooning syndrome (LVBS), also known as Takotsubo cardiomyopathy, is characterized by regional left ventricular dysfunction associated with severe psychological stress. T2 weighted cardiac magnetic resonance (CMR) can identify myocardial edema due to ischemia or other insults. A standard clinical CMR scan with double inversion recovery fast spin echo T2 weighted sequences was performed on consecutive patients with LVBS. T2 signal was compared in myocardial segments with normal and impaired function based on systolic wall thickening (SWT). Eight LVBS patients were identified, all female, with a median age of 61 years and median left ventricular ejection fraction of 52%. Four patients had apical ballooning and four had mid-wall or basal ballooning. In severely dysfunctional segments (those with SWT < 25%), the median percentage of high T2 signal was 85 compared with 35 in those with SWT > 25% (P < 0.001). When the segments were categorized into tertiles based on SWT, the percentage of high T2 signal was greatest in segments with the worst function (68% vs. 43% vs. 31%, P = 0.005). In the five patients who returned for follow up, there was a significant reduction in high T2 signal compared with baseline in those segments that were initially severely dysfunctional (85% vs. 35%, P < 0.001). In conclusion, we describe elevated T2 signal consistent with myocardial edema in patients with LVBS. The T2 signal is highest in myocardium with the most impaired function and resolves over time.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome

Joshi

Chao

Herzka

et al. 2009

Int J Cardiovasc Imaging

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“…Transient left ventricular apical ballooning syndrome is an acute, self-limited cardiac disease that was first described in Japan and it has subsequently been recognized in other countries as well [1][2][3][4][7][8][9][10][11][12]. Although there are many case reports of adult TLV-ABS, TLVABS is rare in children and so it is not well known to pediatricians.…”

Section: Discussionmentioning

confidence: 99%

A case of transient left ventricular apical ballooning syndrome in a child: clinical features and imaging findings

Lee

Choi

et al. 2010

Int J Cardiovasc Imaging

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Transient left ventricular apical ballooning syndrome (TLVABS) is an acute cardiac disease that is characterized by transient left ventricular systolic dysfunction involving the apical region. The symptoms and electrocardiographic changes of TLVABS mimic those observed in acute myocardial infarction while obstructive coronary arterial lesions are not seen in patients with TLVABS. TLVABS usually occurs in elderly women after physical or emotional stress. However, it is very rare in children and so it not well known to pediatricians. Accordingly, TLVABS in children can be misdiagnosed as myocarditis or cardiomyopathy. We report here on a case of child who showed the typical findings of TLVABS in association with pericarditis. He presented with dyspnea and pericardial effusion, which required pericardiocentesis. After pericardiocentesis, he showed the typical echocardiographic and electrocardiographic findings of TLVABS. The MRI findings at 14 days after the initial symptoms showed normal coronary arteries and normal left ventricular function without any wall motion abnormalities. In addition, no delayed hyper enhancement was found on delayed-enhanced (DE)-MRI. We also reviewed the other reported cases of TLVABS in patients who were under the age of 40.

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“…126 There are several reports in the literature of ABS following adrenaline therapy during anaphylaxis. [127][128][129][130][131][132][133][134] While it is the first-line therapy in anaphylaxis, its use in acute coronary syndromes is a slightly more challenging decision. It can cause serious side effects like arrhythmias (e.g.…”

Section: Acute Coronary Syndromesmentioning

confidence: 99%

Kounis syndrome: a narrative review

Fourie

2016

Southern African Journal of Anaesthesia and Analgesia

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Inflammatory mediators released from activated mast cells and basophils during hypersensitivity reactions have direct pathological effects on the myocardium and coronary vasculature. It was traditionally thought that cardiovascular signs and symptoms in anaphylaxis are largely due to peripheral vasodilation and increased vascular permeability. However, there is extensive evidence of primary cardiac involvement during hypersensitivity reactions, most notably coronary vasoconstriction as well as atherosclerotic plaque erosion and rupture, leading to angina pectoris and acute coronary syndromes. Furthermore, mast cells are well established as effector cells in atherosclerosis, through their effects on atherosclerotic plaque progression and destabilisation. It was noted over 30 years ago that cardiac patients have a markedly higher concentration of biologic amines (especially histamine) in their coronary vasculature, and, additionally, are hyper-reactive to the effects thereof. This is borne out by the disproportionate mortality rate of those with cardiac disease that suffer a hypersensitivity reaction. Kounis syndrome refers to angina pectoris or an acute coronary syndrome secondary to a hypersensitivity reaction, with the subtypes dependent on the underlying state of the coronaries and presence of a drug-eluting stent or not. This review will focus mainly on the aetiology, pathophysiology, diagnoses and treatment of this important syndrome.

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Tako‐Tsubo‐like syndrome during anaphylactic reaction

Cited by 45 publications

References 19 publications

Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome

Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome

A case of transient left ventricular apical ballooning syndrome in a child: clinical features and imaging findings

Kounis syndrome: a narrative review

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