Takotsubo syndrome – ABC CARDIOL

ABC

Research Letter

Takotsubo Syndrome, Complete Heart Block, and Cardiac Arrest: A Clinical Challenge

Ana Abrantes et al. Catarina Gregório Miguel Raposo Nelson Cunha … Dulce Brito Fausto J. Pinto

Abstract

Complete atrioventricular block may be associated with Takotsubo syndrome, and the decision of device implantation in such patients is challenging. We present a case of a 76-year-old woman admitted after out-of-hospital cardiac arrest that was reverted after defibrillation treatment. Post-resuscitation electrocardiogram documented complete atrioventricular block, and echocardiogram revealed severe left ventricular dysfunction with apical ballooning. Coronary angiography excluded coronary artery disease, and Takotsubo syndrome was diagnosed based on clinical and imaging features. Atrioventricular block persisted despite normalization of left ventricular function; therefore, cardiac arrest was considered secondary to a ventricular arrhythmia induced by atrioventricular block, and a pacemaker, rather than an implantable cardioverter-defibrillator, was implanted. During follow-up, complete atrioventricular block persisted, with 99% of ventricular pacing observed upon device interrogation. This case supports that the stress of atrioventricular block may trigger Takotsubo syndrome, which is reinforced by the persistence of conduction abnormalities despite reversal of ventricular defects. Therefore, early implantation of a cardiac device should be carefully considered on a case-by-case basis.

Read Full Article

ABC

Letter to the Editor

Recurrent Takotsubo Cardiomyopathy: A Puzzle Yet to be Solved

Kenan Yalta et al. Caglar Kaya

Reply

First, we thank the authors for the comments regarding our recent article in Arquivos Brasileiros de Cardiologia entitled “Factors Associated with Recurrence in Takotsubo Syndrome: A Systematic Review”. In the letter, the authors made some interesting additional comments regarding the mechanisms of Takotsubo recurrence related to mechanical triggers related to mid-ventricular gradient that may be related to associated hypertrophic cardiomyopathy (HCM) and a second mechanism related to severe adrenergic discharge.

One question they posed was related to the incidence of HCM and hypertensive heart disease in the data we analyzed. Actually, in the original papers that were revised, the authors did not mention HCM or hypertensive heart disease incidence. Some patients with Takotsubo Syndrome (TS) may present with systolic anterior motion of the mitral valve and ventricular obstruction; it is sometimes difficult to determine whether these features are related to TS or associated to HCM or even their combination and the clinic, electrocardiographic and image follow-up may reveal the diagnosis.^, About the impact of the surgical reconstruction on recurrence, in a brief review of literature we found one article describing a case of ventricular reconstruction in a female who remained with apical aneurism and recurrent embolic events. Therefore, in the case of permanent ventricular outflow obstruction in HCM who has TS, one may consider the indication of the HCM guidelines for surgical intervention.

[…]

Read Full Article

ABC

Review Article

Coronavirus Disease 2019 and the Myocardium

José Albuquerque de Figueiredo Neto et al. Fabiana G. Marcondes-Braga Lidia Zytinski Moura André Melo e Silva de Figueiredo … Viviane Melo e Silva de Figueiredo Ricardo Mourilhe-Rocha Evandro Tinoco Mesquita

Abstract

Infection with the coronavirus known as COVID-19 has promoted growing interest on the part of cardiologists, emergency care specialists, intensive care specialists, and researchers, due to the study of myocardial involvement based on different clinical forms resulting from immunoinflammatory and neurohumoral demodulation.Myocardial involvement may be minimal and identifiable only by electrocardiographic changes, mainly increased cardiac troponins, or, on the other side of the spectrum, by forms of fulminant myocarditis and takotsubo syndrome.The description of probable acute myocarditis has been widely supported by the observation of increased troponin in association with dysfunction. Classical definition of myocarditis, supported by endomyocardial biopsy of inflammatory infiltrate, is rare; it has been observed in only one case report to date, and the virus has not been identified inside cardiomyocytes.Thus, the phenomenon that has been documented is acute myocardial injury, making it necessary to rule our obstructive coronary disease based on increased markers of myocardial necrosis, whether or not they are associated with ventricular dysfunction, likely associated with cytokine storms and other factors that may synergistically promote myocardial injury, such as sympathetic hyperactivation, hypoxemia, arterial hypotension, and microvascular thrombotic phenomena.Systemic inflammatory and myocardial phenomena following viral infection have been well documented, and they may progress to cardiac remodeling and myocardial dysfunction. Cardiac monitoring of these patients is, therefore, important in order to monitor the development of the phenotype of dilated myocardiopathy.This review presents the main etiological and physiopathological findings, a description of the taxonomy of these types of cardiac involvement, and their correlation with the main clinical forms of the myocardial component present in patients in the acute phase of COVID-19.

Read Full Article

ABC

Original Article

Factors Associated with Recurrence in Takotsubo Syndrome: A Systematic Review

Felipe Alverenga Duarte Campos et al. Luiz Eduardo Fonteles Ritt João Paulo Soares Costa Constança Margarida Cruz … Gilson Soares Feitosa-Filho Queila Borges de Oliveira Eduardo Sahade Darzé

Abstract

Background:

Takotsubo syndrome (TTS) is characterized by a temporary systolic dysfunction of the left ventricle (LV) related to a stressful event. However, the factors associated with its recurrence are still not well established.

Objective:

To analyze the main factors associated with TTS recurrence.

Methods:

A systematic review was performed using the PRISMA model. Observational studies, published between January 2008 and October 2017, which presented a recurrence rate of at least 3% and/or 5 or more patients with recurrence, and who met at least 80% of the STROBE criteria were included.

Results:

six articles reached the criteria to compose this systematic review. The recurrence rate ranged from 1 to 3.5% per year (global recurrence rate 3.8%). One study associated higher recurrence rate with the female gender, four reported the time between the first and second episodes, one study associated body mass index (BMI) and hypercontractility of the LV middle anterior wall to a higher recurrence rate. No association between recurrence and electrocardiographic changes were determined. Beta-blockers use was not associated with recurrence rates.

Conclusions:

Female gender, time from the first episode of the syndrome, low BMI and midventricular obstruction were reported as potential predictors of TTS recurrence.

Read Full Article

ABC

Case Report

Dobutamine stress echocardiography-induced broken heart syndrome (Takotsubo Syndrome)

Francisco Juarez Cruz de Vasconcelos Filho et al. Cezario Antonio Martins Gomes Oscar Aires de Queiroz José Erirtonio Façanha Barreto

We report a case of dobutamine stress echocardiography-induced Takotsubo syndrome in a 76-year-old hypertensive patient with clinical complaints of chest pain in an elective visit to the cardiologist. Dobutamine-stress-echocardiography was requested to rule out chest pain of coronary origin. During the test, at peak exercise, echocardiogram showed apical akinesia and electrocardiogram showed ST-segment elevation in D1, AVL, and V2. The patient was hospitalized and underwent coronary angiography, which showed normal coronary arteries and left ventricular apical ballooning. During follow-up, the patient’s condition remained stable, with regression of the manifestations 21 days after the initial presentation.

Read Full Article

ABC

Case Report

Broken-heart syndrome (Takotsubo syndrome)

Alessandra Edna Teófilo Lemos et al. Antonio Luiz Junior Araújo Michely Teófilo Lemos Lucia de Souza Belém … Francisco Juarez C. Vasconcelos Filho Raimundo Barbosa Barros

Stress-induced cardiomyopathy, also know as reversible left ventricular apical ballooning, ” Broken-Heart” syndrome, and in Japan, Takotsubo, is characterized by the presence of a transient left ventricular dyskinetic movement of the anterior wall of with hypercontraction of the ventricular basilar segments precipitated by emotional stress. The clinical course of Takotsubo cardiomyopathy is similar to that of an acute myocardial infarct with typical chest pain and electrocardiographic changes, and during the acute phase, coronary angiography is used to distinguish between the two conditions.

Read Full Article

ABC

Case Report

A rare association of systemic lupus erythematosus, morbid obesity and Takotsubo Syndrome

João Gaspar Corrêa Meyer Neto et al. Claudio Buarque Benchimol Guilherme Loures Penna Luiz Antônio Ferreira Carvalho Maria Carolina Pessoa

The authors report a 68-year-old white female with long-term systemic lupus erythematosus as well as morbid obesity, characterized by very elevated body mass index, who presented a classical picture of acute coronary failure ascribed to Takotsubo syndrome.

Read Full Article