Takotsubo cardiomyopathy: pathophysiology and treatment

Milinis, Kristijonas; Fisher, Michael

doi:10.1136/postgradmedj-2012-130761

Cited by 34 publications

(23 citation statements)

References 78 publications

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“…As mentioned earlier, the most common finding on the admission ECG was ST-segment elevation. In recent study, the classic ECG features included ST elevation (56%), T wave inversion (39%) and pathological Q waves (32%) [19]. Arrhythmia has been reported in 43.5% of cases with ventricular fibrillation, torsade des pointes, ventricular tachycardia and prolonged QTc being the most common and life-threatening arrhythmias occurring in up to 5.7%.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of patients with stress-induced cardiomyopathy associated with renal dysfunction: 7 case series in single center

et al. 2013

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BackgroundStress-induced cardiomyopathy (sCMP) is characterized by transient wall-motion abnormalities involving the left ventricular apex and mid-ventricle that are precipitated by emotional or physical stress. As the heart and kidney influence each other’s function through bidirectional pathways, sCMP can induce renal dysfunction or be induced by renal dysfunction. This study reviewed the clinical characteristics and outcomes of patients with confirmed sCMP associated with renal dysfunction.MethodsWe conducted a retrospective analysis of the medical records of all patients from our institution who were diagnosed with sCMP from March 2010 to April 2012. Each patient’s demographic characteristics, presenting symptoms, triggering events, electrocardiographic characteristics, laboratory data, echocardiographic study findings, cardiac catheterization data, and outcomes were reviewed.ResultsAmong 30 patients who were diagnosed with sCMP, 7 patients had associated renal dysfunction. Three patients were on maintenance hemodialysis (HD) and 4 patients had acute kidney injury (AKI). Their mean ejection fraction was 35.2% at initial echocardiography, and 57.2% at follow-up echocardiography. Pericardial effusion was detected in all HD patients initially; these patients were treated with intensive HD for suspected under-dialysis status. In patients with AKI, the mean peak serum creatinine was 4.17 mg/dL. Two patients were treated with continuous renal replacement therapy. One patient required maintenance HD, and 1 patient died. Two patients had full renal recovery to their baseline renal function at 7 and 14 days.ConclusionsPatients with renal dysfunction including those with AKI and those undergoing HD can develop sCMP, renal function must be closely monitored in patients with sCMP. Additionally, it should be considered that patients on HD who develop sCMP may be under-dialyzed.

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Section: Discussionmentioning

confidence: 99%

Clinical features of patients with stress-induced cardiomyopathy associated with renal dysfunction: 7 case series in single center

et al. 2013

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“…Angiography shows wall motion abnormalities in the absence of significant CAD to explain the distribution of the wall motion abnormalities. Of note, patients with TCM can have concurrent CAD, but not in the distribution of the akinesis, as many of the patients with TCM are post-menopausal women who also have risk factors for CAD [16]. Four of our patients had concurrent CAD, which were deemed as not to be responsible for the wall motion abnormalities that were noted.…”

Section: Discussionmentioning

confidence: 85%

Takotsubo Cardiomyopathy: Typical and Atypical Variants, A Two-Year Retrospective Cohort Study

et al. 2014

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BackgroundTypical or classical takotsubo cardiomyopathy (TCM) is associated with the characteristic abnormality of a ballooned left ventricular apex with basal segmental hyperkinesis. TCM may not present with the “classical” wall motion abnormalities but can have a variety of segmental wall motion abnormalities. The aim of our work was to assess for any unique identifying factors that can help distinguish typical and atypical variants of TCM.MethodsWe studied 11 consecutive patients between 2010 and 2012 admitted with chest pain, electrocardiographic and cardiac biomarker changes consistent with acute coronary syndrome (ACS) who underwent left heart angiography and were clinically diagnosed to have TCM.ResultsOur study found no specific features distinguishing typical and atypical variants of TCM. In our study, all patients were female and all had excellent outcome. One patient was in fourth decade of life, three patients in fifth and sixth decade of life, while remaining were older. One patient had diabetes mellitus, five had hypertension, four had concurrent coronary artery disease, but no patient had any family history of TCM. Nine of 11 patients had immediate clear-cut stressors. Three patients had normal ECG, two with ST segment elevation, with nine patients having only modest troponin elevations. One patient had an anomalous RCA take-off from the right coronary cusp, otherwise remaining patients had normal anatomy. One patient had only apical involvement, remaining had multiple wall motion abnormalities, and all patients had involvement of the anterior wall. Four patients had apical sparing. No inverted TCM pattern with basal akinesis with normal wall motion in the midventricular and apical regions was found among our patients.ConclusionsWe report that the classification of TCM as typical versus atypical is probably not clinically meaningful. The regional wall motion abnormalities are related to catecholamine excess and to the susceptibility of that particular region to excess catecholamine. We do not know why such differences in regional susceptibility exist, and agree with the other authors that sub-classification would only add to confusion, and a delay in understanding of the disease process.

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“…When this condition is recognized early, treatment is largely supportive without the need for aggressive resuscitation and antithrombotic therapy. Medical therapy with beta-blockers appears reasonable from the pathophysiological standpoint, although randomized trials that evaluate their role are lacking [8]. A few patients need more advanced support like an intra-aortic balloon pump and extracorporeal membrane oxygenation.…”

Section: Discussionmentioning

confidence: 99%

Reverse Takotsubo Cardiomyopathy: A Story of a Critically Ill Man with Transient Cardiac Dysfunction

Kakroo¹,

Chowdhury

Luni

et al. 2014

Cardiology

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Reverse Takotsubo cardiomyopathy (TCM) is a recently described variant of classic TCM. In contrast to classic TCM, the regional wall motion abnormalities are localized in the basal segments. The condition can be triggered by acute stressful events, including acute medical illnesses. The wall motion abnormalities and left ventricular dysfunction are usually completely reversible. We present a case of an 84-year-old man with a complicated postoperative course after laparoscopic cholecystectomy with multiple laparotomies and recurrent sepsis. Echocardiographic evaluation demonstrated left ventricular dysfunction and wall motion abnormalities in a pattern resembling reverse TCM. He had no significant coronary disease on angiography and follow-up echocardiography showed complete resolution of left ventricular systolic dysfunction and regional wall motion abnormalities.

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Takotsubo cardiomyopathy: pathophysiology and treatment

Cited by 34 publications

References 78 publications

Clinical features of patients with stress-induced cardiomyopathy associated with renal dysfunction: 7 case series in single center

Clinical features of patients with stress-induced cardiomyopathy associated with renal dysfunction: 7 case series in single center

Takotsubo Cardiomyopathy: Typical and Atypical Variants, A Two-Year Retrospective Cohort Study

Reverse Takotsubo Cardiomyopathy: A Story of a Critically Ill Man with Transient Cardiac Dysfunction

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