Takotsubo cardiomyopathy in the setting of complete heart block

Afzal, Aasim; Watson, John T.; Choi, James W.; Schussler, Jeffrey M.; Assar, Manish D.

doi:10.1080/08998280.2018.1499314

Cited by 5 publications

(9 citation statements)

References 14 publications

(19 reference statements)

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“…Cardiogenic shock occurs in 7% of cases in TTC and the patients could be managed by intra-aortic balloon pumping and by administering vasopressors [4]. Few case of complete heart block have been described and management by temporary pacing [8]. According to the International Registry of Takotsubo cardiomyopathy, 103 patients over 2098 developed cardiac arrest or asystole/pulseless electrical activity during TTC [9].…”

Section: Discussionmentioning

confidence: 99%

Interventional Cardiology Management of a Cardiogenic Shock Induced by Takotsubo Cardiomyopathy at the Hospital Center of Montlucon: A Case Report

Chanséaume¹,

Temgoua²,

Camus³

et al. 2021

WJCD

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Background: Takotsubo cardiomyopathy is frequently considered as a benign disorder. We present an atypical form with cardiogenic shock that was managed by interventional cardiology measures. Case presentation: A 58 years old female patient with a past history of hypertension, obesity and multiple sclerosis was admitted at the Hospital Center of Montlucon for septic shock of urinary origin. During hospitalization in intensive care unit, the patient presented a markedly increasing of troponin levels with a diffused ST-segment elevation. Transthoracic Echocardiography showed an altered left ventricular ejection fraction at 35% with hypokinesia of apex and lateral ventricular segments in conjunction with compensatory hyperkinesis of the base; these findings were strongly suggestive of a diagnosis of Takotsubo cardiomyopathy. Despite concomitant anemia, renal failure and sepsis, all adequately treated with complete remission, the patient developed frequent episodes of ventricular tachycardia that prompted an emergency coronarography. During this procedure, the patient presented a cardiogenic shock and bradyasystole that were successfully managed by intra-aortic balloon pumping and temporary transvenous pacing. Finally, there were no coronary lesions and ventriculography confirmed a Takotsubo cardiomyopathy. Given the unstable hemodynamic status of this patient, she was addressed to the University Teaching Hospital of Clermont-Ferrand for more specialized care.

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Section: Discussionmentioning

confidence: 99%

Interventional Cardiology Management of a Cardiogenic Shock Induced by Takotsubo Cardiomyopathy at the Hospital Center of Montlucon: A Case Report

Chanséaume¹,

Temgoua²,

Camus³

et al. 2021

WJCD

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“…β-blockers or other drugs causing bradycardia should not be administered, or if they have been started, they should be promptly discontinued [ 19 ]. Atropine should also be used in patients with mild atrioventricular (AV) blocks, but advanced or complete heart block (CHB) should be managed with a temporary pacemaker, to be followed by permanent pacemaker (PPM) implantation decided on an individual basis [ 22 , 47 , 48 , 49 ] ( Figure 2 ). Not all patients with TTS and CHB require PPM implantation, but some patients who have suffered TTS, triggered by CHB, certainly need to have a PPM implanted without exception [ 47 , 50 ].…”

Section: Current Therapy Of Acute Ttsmentioning

confidence: 99%

“…Reproduced and modified from Ref. [ 49 ], with the permission of the Baylor University, Medical Center.…”

Section: Figurementioning

confidence: 99%

Takotsubo Cardiomyopathy: Current Treatment

Madias

2021

JCM

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Management of takotsubo syndrome (TTS) is currently empirical and supportive, via extrapolation of therapeutic principles worked out for other cardiovascular pathologies. Although it has been emphasized that such non-specific therapies for TTS are consequent to its still elusive pathophysiology, one wonders whether it does not necessarily follow that the absence of knowledge of TTS’ pathophysiological underpinnings should prevent us for searching, designing, or even finding, therapies efficacious for its management. Additionally, it is conceivable that therapy for TTS may be in response to pathophysiological/pathoanatomic/pathohistological consequences (e.g., “myocardial stunning/reperfusion injury”), common to both TTS and coronary artery disease, or other cardiovascular disorders). The present review outlines the whole range of management principles of TTS during its acute phase and at follow-up, including considerations pertaining to the recurrence of TTS, and commences with the idea that occasionally management of TTS should consist of mere observation along the “first do no harm” principle, while self-healing is under way. Finally, some new therapeutic hypotheses (i.e., large doses of insulin infusions in association with the employment of intravenous short- and ultrashort-acting β-blockers) are being entertained, based on previous extensive animal work and limited application in patients with neurogenic cardiomyopathy and TTS.

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Section: Introductionmentioning

confidence: 99%

“…Takotsubo cardiomyopathy (TC) is an increasingly diagnosed clinical entity that usually mimics an acute coronary syndrome [1][2][3]. The diagnosis requires the presence of temporary left ventricular apical ballooning induced by stress, in the absence of significant coronary heart stenosis [1][2][3]. Although the overall prognosis is often favorable, in rarer cases, it can be associated with life-threatening complications, such as cardiac arrhythmias [2].…”

Section: Introductionmentioning

confidence: 99%

“Blocked broken heart syndrome”: an unusual case of a complete atrioventricular block complicating a Takotsubo cardiomyopathy

et al. 2022

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Background Complete heart block is considered a unique and rare complication of Takotsubo cardiomyopathy, an otherwise self-resolving disease. When this occurs, there is a double clinical dilemma: first to find out which triggered the other and second, to decide whether or not to implant a permanent pacemaker. Case presentation We present a case of a 77 years-old female patient, with previous medical history of arterial hypertension, diabetes mellitus, dyslipidemia and bifascicular block known since 2013. She came to the emergency department after recurrent syncopal episodes. At admission a complete heart block was diagnosed, and it was implanted a single chamber temporary pacemaker. The patient remained in disproportional acute decompensated heart failure despite pacemaker implantation. She denied chest pain although referring an episode of self-limiting chest pain 2 days before, after an argument with the family. Blood analysis showed an important rise in NTproBNP and troponin levels. Transthoracic echocardiogram showed a dilated left ventricle with akinesia of apical and mid segments, hyperkinesia of basal segments and severely depressed left ventricle ejection fraction. Coronary angiography showed no significant lesions and the diagnosis of Takotsubo cardiomyopathy was suspected. During the following days, she recovered her own intrinsic rhythm. Electrocardiogram evolved with deep T-wave inversion and prolonged QT interval and transthoracic echocardiogram showed resolution of the previous alterations. Despite complete reversion of rhythm alteration, it was decided to implant a permanent pacemaker. Conclusions We describe a rare, life-threatening and often underdiagnosed complication of the stress cardiomyopathy. Furthermore, we performed a literature revision of this rare complication and discussed the therapeutic challenge encountered in such patients.

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Takotsubo cardiomyopathy in the setting of complete heart block

Cited by 5 publications

References 14 publications

Interventional Cardiology Management of a Cardiogenic Shock Induced by Takotsubo Cardiomyopathy at the Hospital Center of Montlucon: A Case Report

Interventional Cardiology Management of a Cardiogenic Shock Induced by Takotsubo Cardiomyopathy at the Hospital Center of Montlucon: A Case Report

Takotsubo Cardiomyopathy: Current Treatment

“Blocked broken heart syndrome”: an unusual case of a complete atrioventricular block complicating a Takotsubo cardiomyopathy

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