Transient Left Ventricular Apical Ballooning After Cocaine Use: Is Catecholamine Cardiotoxicity the Pathologic Link?

Arora, Sandeep; Alfayoumi, Fadi; Srinivasan, Venkatraman

doi:10.4065/81.6.829

Cited by 93 publications

(61 citation statements)

References 16 publications

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“…Other substances could have similar effects and cocaine use has been associated with TTS in a recent observation [21]. Systemic effects of cocaine are mediated by the inhibition of norepinephrine, epinephrine, dopamine, and serotonine amine uptake in the presynaptic neurons.…”

Section: Discussionmentioning

confidence: 99%

Tako-tsubo syndrome following nortriptyline overdose

Roock

Beauloye

Bauwer

et al. 2008

Clinical Toxicology

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Background. Tako-tsubo syndrome (TTS) refers to the apical ballooning of the left ventricle observed when angiographic ventriculography is performed in patients presenting with electrocardiographic changes suggestive of acute coronary syndrome (new transient ST-segment deviation (>0.05 mV) or T-wave inversion (>0.2 mV)), mild elevation of cardiac markers, but normal coronary arteries at the angiogram. Case report. A 54-year-old woman developed the characteristic features of TTS 44 hours following nortriptyline overdose. The admission ECG showed increased QRS duration rapidly reversible after sodium bicarbonate infusion. There was a minimal increase in troponin I level. The ECG performed at the time of chest pain revealed deeply negative T waves in leads I, II, III, aVF, V1 to V6 and remained abnormal at 5 weeks follow-up. In contrast, a complete recovery of left ventricular function was observed within one week. Discussion. The pathophysiology of TTS, a variant of myocardial stunning, is still incompletely understood but could be related to sympathetic overstimulation. The possibility of TTS following toxic exposure is discussed.

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Section: Discussionmentioning

confidence: 99%

Tako-tsubo syndrome following nortriptyline overdose

Roock

Beauloye

Bauwer

et al. 2008

Clinical Toxicology

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“…Reports of TTC associated with opiate withdrawal [14] or cocaine use [15], acute respiratory failure [16], following pulmonary resection [17], after cholecystectomy [18], related to motor vehicle accidents [19] or associated with pheochromocytoma [20] have recently been published. TTC may be precipitated by eclampsia during pregnancy [21].…”

Section: Discussionmentioning

confidence: 99%

Ivabradine in Takotsubo cardiomyopathy

Saïd¹

2017

IJCC

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Abstract:AIM: The aim of this review is to present a case report of Takotsubo cardiomyopathy and to review the current literature. The second aim is to describe the role of ivabradine in the management of Takotsubo cardiomyopathy when intolerance for beta blockers occurs. MATERIALS: Case report and literature review of Takotsubo cardiomyopathy. RESULTS: A 52-year-old Caucasian female presented with Takotsubo cardiomyopathy triggered by severe emotional stress. Dmission electrocardiogram mimicked acute ST-segment elevation myocardial infarction , coronary angiography excluded significant coronary stenosis and left ventriculogram showed a typical Takotsubo cardiomyopathy apical ballooning appearance. Due to beta blocker intolerance, "off-label" treatment with ivabradine was initiated because of symptomatic sinus tachycardia. Echocardiography revealed normalization of the ejection fraction at outpatient follow-up. In the recent literature, ivabradine has been used in the management of different entities such as stable angina pectoris, congestive heart failure, inappropriate sinus tachycardia syndrome, postural tachycardia syndrome and Takotsubo cardiomyopathy. CONCLUSION: Takotsubo cardiomyopathy may be induced by witnessing a robbery. The patient was intolerant for beta blockers and had a favorable response to treatment with ivabradine. Ivabradine may be an alternative choice in cases where there is an intolerance of beta blockers. We present an exceedingly rare case of Takotsubo cardiomyopathy induced by uncommon severe emotional stress, catching her colleague stealing money from the cash register, which was associated with sinus tachycardia in a female patient with intolerance for beta blockers. The patient responded well to treatment with oral ivabradine. The literature is briefly reviewed

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“…Among other pharmacological actions, cocaine inhibits NET function (37). Cocaine abuse can induce cardiomyopathies (4).…”

Section: Net Dysfunction and Chronic Heart Diseasementioning

confidence: 99%