Catastrophic ruptured Takotsubo cardiomyopathy
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King's College Hospital, London, UK Correspondence to Dr Refai Showkathali, MBBS, MRCP, (UK), Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK Tel: +20 3299 9000; e-mail: [email protected] Received 6 July, 2013 Revised 20 August, 2013 Accepted 06 October, 2013Keywords:
Interventional cardiology
Background: Takotsubo cardiomyopathy is a form of non-ischemic cardiomyopathy that may be acutely precipitated by stress. A number of neurologic conditions have been implicated in precipitating this disease such as subarachnoid hemorrhage, stroke, and seizures. Its association with status migrainosus, however, has never been described before. Case: We report a case of a 25-year-old female presenting with status migrainosus followed by takotsubo cardiomyopathy. Supportive management was instituted in this patient and she made an excellent recovery. Conclusion: The intense pain associated with migraine may have acted as a stressor, thereby precipitating takotsubo cardiomyopathy. To our knowledge, this is the first reported case demonstrating a relationship between status migrainosus and takotsubo cardiomyopathy.
Stressor
Stroke
Emotional stress
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Although the most frequent presentation of the novel Coronavirus disease-2019 (COVID-19) is a respiratory syndrome, cardiac involvement is being increasingly recognized. One such entity is takotsubo cardiomyopathy. We sought to review the various cases of takotsubo cardiomyopathy reported during the COVID-19 pandemic and consolidate the information available on its clinical features, evaluation and treatment. We performed a PubMed search using the MeSH terms “Takotsubo Cardiomyopathy” or “Stress Cardiomyopathy” and “COVID-19”, and identified 16 case reports, two case series, and one retrospective cohort study. There was a total of 24 reported patients with COVID-19 infection, who developed takotsubo cardiomyopathy, and two patients without COVID-19 who developed takotsubo cardiomyopathy due to the emotional stress associated with the global pandemic. The mean age of the patients was 67.19 years (SD 15.83) and 16(59.3%) were women. Chest pain was reported in only ten patients (38.46 %) and ST-elevation was seen in 11 patients (42.3%). While most patients had typical takotsubo cardiomyopathy, four patients had inverted(reverse) takotsubo cardiomyopathy, two had bi-ventricular involvement, one had median takotsubo and another had global takotsubo with apical sparing variant. Most patients had a positive outcome with complete or near-complete reversal of cardiac dysfunction at the time of discharge. Five deaths (19.23%) were reported. Takotsubo cardiomyopathy is a rare, but increasingly reported reversible cardiomyopathy that can be seen in patients with COVID-19 infection and the diagnosis must be actively sought for in these patients.
Presentation (obstetrics)
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In Scandinavia transplantations are performed at special units at certain university hospitals, which coordinate donor and recipient operations. Today there is a 24-hour organ retrieval service in the Nordic countries. Transplantation centres exist at Rigshospitalet, Copenhagen, Kommunehospitalet, Arhus and Odense University Hospital in Denmark, at Helsinki University Hospital in Finland, at Rigshospitalet, Oslo in Norway, and at Huddinge University Hospital, Uppsala University Hospital, Sahlgrenska Hospital, Gothenburg, and Malmö General Hospital in Sweden.
Regional hospital
West germany
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Concerns about ionizing radiation during interventional cardiology have been increased in recent years as a result of rapid growth in interventional procedure volumes and the high radiation doses associated with some procedures. Noncancer radiation risks to cardiologists and medical staff in terms of radiation-induced cataracts and skin injuries for patients appear clear potential consequences of interventional cardiology procedures, while radiation-induced potential risk of developing cardiovascular effects remains less clear. This paper provides an overview of the evidence-based reviews of concerns about noncancer risks of radiation exposure in interventional cardiology. Strategies commonly undertaken to reduce radiation doses to both medical staff and patients during interventional cardiology procedures are discussed; optimisation of interventional cardiology procedures is highlighted.
Interventional cardiology
Interventional radiology
Medical radiation
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Takotsubo cardiomyopathy was first reported by Sato et al at Hiroshima City Hospital in 1990 and has become increasingly recognized worldwide. In the clinical setting, takotsubo cardiomyopathy is an important disease that must be differentiated from AMI promptly for the appropriate management. Prognosis of takotsubo cardiomyopathy is generally favorable, but serious complications can occur, especially in the early stage. In this review, we summarize the current knowledge on the clinical management of takotsubo cardiomyopathy. (Circ J 2014; 78: 1559–1566)
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Takotsubo cardiomyopathy ("broken heart") exhibits a highly possible link between acute emotional stress and the onset of left ventricular dysfunction. This article describes a case report of takotsubo cardiomyopathy in an 89-year-old female; the patient is significantly older than the median age for this condition, which ranges from 63 to 76 years of age. The exact mechanism of this condition is unclear and there are several hypotheses under investigation. Several studies have shown a link between takotsubo cardiomyopathy and elevated catecholamines. Similarly, other studies have documented emotional and physical stress to be the underlying pathophysiology of this condition. Another case study has proposed a novel hypothesis of a link between septal thickening in cases of takotsubo cardiomyopathy. This article is an interesting case report of an elderly patient with takotsubo cardiomyopathy.
Pathophysiology
Takotsubo Syndrome
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Takotsubo cardiomyopathy is a reversible cardiomyopathy with a unique morphological feature of the left ventricle characterized by an apical ballooning appearance known for approximately known 25 years. Catecholamine drive plays an essential role in the pathogenesis and pathophysiology of Takotsubo cardiomyopathy; hence, it is also called stress cardiomyopathy. Physical stress could also have an impact and leads to a greater variety of characteristics in Takotsubo cardiomyopathy. Supportive and symptomatic medication remains the mainstay therapy with priority to improving the function of the left ventricle for several days and full recovery in 3-4 weeks. Due to its similarity with myocardial infarction, Takotsubo cardiomyopathy requires careful diagnosis and management for the best possible outcome.
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Takotsubo cardiomyopathy (TTC) is a non-ischemic cardiomyopathy precipitated by stress. Various infections are reported to precipitate this form of cardiomyopathy. We report a patient presenting with TTC secondary to influenza. In this article, we also discuss the various infections reported to precipitate this form of reversible cardiomyopathy in literature. We have also included the recent reports of TTC among patients with COVID-19.
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