Transient Left Ventricular Basal Dysfunction without Coronary Stenosis in Acute Cerebral Disorders: A Novel Heart Syndrome (Inverted Takotsubo)

Ennezat, Pierre Vladimir; Pesenti-Rossi, David; Aubert, J; Rachenne, V.; Bauchart, Jean Jacques; Auffray, Jean Luc; Logeart, Damien; Cohen-Solal, A; Asseman, Philippe

doi:10.1111/j.1540-8175.2005.40046.x

Cited by 100 publications

(67 citation statements)

References 5 publications

(9 reference statements)

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“…The ''second type'' is the reverse type with hyperdynamic apex and akinesia of left ventricular basal segments (reverse TakoTsubo or reverse apical ballooning type). This type is only rarely described in the literature [7][8][9][10][11]. The ''third type'' involves the mid left ventricular wall, sparing the base and the apex; it is also called ''mid ventricular type'' [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

An atypical case of inverted Tako-Tsubo syndrome: case report and review of the literature

et al. 2010

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A 69-yearold Caucasian woman was admitted to our emergency department (ED) for an acute and initial episode of substernal chest pain radiating to the left arm, which had lasted about 1 h, associated with dyspnea and diaphoresis. She had a past medical history of depression and first stage primary biliary cirrhosis. She was taking chronic low-dose sotalol therapy (80 mg PO bid) for a prior episode of supraventricular tachycardia. She had an otherwise normal heart, and was without cardiovascular risk factors.At admission, she denied any recent emotional or stressful event. The first EKG recorded 10 min after the ED admission showed mild ST-segment depression in the precordial leads V5 and V6 ( Fig. 1), without significant changes in the inferior, posterior and right precordial leads.The first blood sample analysis exhibited normal values of Troponin-I (cTn-I: 0.10 lg/L, normal range: 0-0.15 lg/L) and CK-MB (1.1 ng/ml, normal range: 0.5-3.6 ng/ml).The patient, fully asymptomatic, was admitted to our intensive observation unit.Based on our protocol, a second blood chemistry control was performed 6 h after the initial results. An elevated cTn-I value of 3.31 lg/L with normal CK-MB value (1.0 ng/ml) was observed. The EKG registered at the same time as the laboratory blood tests showed T-wave inversion in the precordial leads from V1 to V4 (Fig. 2), not present in the first tracing,and a small QT dispersion with a QT interval a bit longer than previous EKG. Trans-thoracic echocardiography showed normal left ventricular internal dimensions; the segmental wall motion analysis revealed akinesis of the basal anterior wall and the entire interventricular septum associated with hypokinesis of the inferior wall basal segments. Posterolateral basal segments and all mid-ventricular and apical segments appeared hyperkinetic. Preliminary diagnosisDr. Zanobetti, Dr. Conti, Dr. Pini: Based on the initial presentation, EKG abnormalities and a positive marker of myocardial necrosis, an acute coronary syndrome, myocarditis, or an atypical presentation of Tako-Tsubo syndrome were considered.None of the serial EKGs exhibited abnormalities characteristic of an acute coronary syndrome, and there was a mismatch between the limited extension of EKG abnormalities and the diffuse wall motion abnormalities in the echocardiographic examination. This mismatch can support the diagnosis of myocarditid, especially in the presence of limited abnormalities of myocardial specific enzymes. However, all indices of inflammation (C-Reactive Protein, leucocytes, erythrocyte sedimentation rate)

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Section: Discussionmentioning

confidence: 99%

An atypical case of inverted Tako-Tsubo syndrome: case report and review of the literature

et al. 2010

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“…The "inverted Takotsubo," pattern with basal akinesia and ballooning has been reported less frequently in the literature than midventricular akinesia [11]. Inverted Takotsubo cardiomyopathies have been reported in patients who have experienced acute cerebrovascular accidents [12], pheocromocytoma [13], paragliomas [14], acute pancreatitis [15], amphetamine use [16] and shoulder surgery [17]. Of these inciting events, cerebrovascular accidents and pheocromocytoma were the most common.…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Intraoperative “Broken Heart” Cardiomyopathy with an “Inverted” Takotsubu Pattern

Ruisi¹,

Lee²,

Rachko³

2011

J Clinic Experiment Cardiol

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Takotsubo cardiomyopathy is a reversible form of acute heart failure first described in Japan, believed to be triggered by major stressful events in a patient's life. The patient's clinical presentation in conjunction with ECG analysis, echocardiography, and angiography depicts an ischemic event leading to LV dysfunction with no evidence of an acute coronary syndrome. Classically, the cardiomyopathy manifests itself as apical akinesis and ballooning on echocardiography mimicking the likeness of an octopus trap. Less commonly there have been reports of an inverted pattern type of Takotsubo cardiomyopathy with preserved apical wall function. We present the case of a 43 year old female who developed a transient inverted variant of Takotsubu cardiomyopathy during an elective herniorrhaphy. A postoperative transthoracic echocardiogram revealed severely reduced LV function with akinesis of the basal and posterior walls with severe mitral regurgitation. Cardiac catheterization failed to reveal significant lesions, and an intra-aortic balloon pump was placed for cardiac support. Over the next 5 days the patient's clinical picture improved markedly with complete normalization of LV function.

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“…Our report to some extent reaffirms this finding because the intravenous injection of atropine was almost immediately followed by the onset of chest pain and dyspnea, which culminated in APO. An ultrasound evaluation performed immediately after the symptom started depicted an uncommon type of TCM known as inverted TCM, (5,6,8,9) in which there was akinesis of the mid-basal segments of the LV with a hyperdynamic apex [Video 1 in Supplementary Materials]. The clear temporal link between atropine administration and the beginning of symptoms suggests that surgery by itself cannot have precipitated this acute heart condition, and nor could it have been related to the noncardiac etiologies of pulmonary edema seen in the postpartum period such as amniotic fluid or air embolism, aspiration of gastric contents, or sepsis.…”

Section: Discussionmentioning

confidence: 99%

Postpartum Inverted Takotsubo Cardiomyopathy After Intravenous Atropine Administration

Díaz-Navarro¹,

Nihoyannopoulos²

2017

Arch Cardiovasc Imaging

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Postpartum Takotsubo cardiomyopathy is mainly induced by drugs that enhance sympathetic nervous activity. We report a novel case of postpartum inverted Takotsubo cardiomyopathy triggered by intravenous atropine administration resulting in acute pulmonary edema. Cardiac troponin I and beta-type natriuretic peptide were elevated. Transthoracic color Doppler echocardiography demonstrated a nondilated left ventricle with mid-basal akinesis, a hyperdynamic apex, and moderate-to-severe mitral regurgitation likely linked to papillary muscle dysfunction. Coronary computed tomography angiography revealed normal coronary arteries. Atropine inhibits the parasympathetic nervous system, alters the autonomic system balance, and, thus, leads to increased sympathetic nervous activity, which seems to have been the cause of Takotsubo cardiomyopathy in this patient. Atropine should be listed among the drugs triggering Takotsubo cardiomyopathy.

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Transient Left Ventricular Basal Dysfunction without Coronary Stenosis in Acute Cerebral Disorders: A Novel Heart Syndrome (Inverted Takotsubo)

Cited by 100 publications

References 5 publications

An atypical case of inverted Tako-Tsubo syndrome: case report and review of the literature

An atypical case of inverted Tako-Tsubo syndrome: case report and review of the literature

Intraoperative “Broken Heart” Cardiomyopathy with an “Inverted” Takotsubu Pattern

Postpartum Inverted Takotsubo Cardiomyopathy After Intravenous Atropine Administration

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