Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2023; 15(1): 33-44
Published online Jan 26, 2023. doi: 10.4330/wjc.v15.i1.33
Takotsubo cardiomyopathy following envenomation: An updated review
Ajay K Mishra, Anu A George, Kevin John John, Pramukh Arun Kumar, Mahati Dasari, Mohammed Afraz Pasha, Michelle Hadley
Ajay K Mishra, Michelle Hadley, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
Anu A George, Pramukh Arun Kumar, Mahati Dasari, Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Kevin John John, Department of Medicine, Tufts Medical Center, Boston, MA 02111, United States
Mohammed Afraz Pasha, Department of Medicine, North Alabama Medical Center, Florence, AL 35630, United States
Author contributions: Mishra AK, George AA, Hadley M planned and formulated the study; GeorgeAA, John KJ, ArunKumar P, Dasari M, Pasha MA collected and analyzed the data; Mishra AK, George AA completed the manuscript; Mishra AK, Hadley M reviewed the manuscript and Hadley M approved the manuscript; All authors reviewed and agreed with the final content of the article.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: All the authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ajay K Mishra, MBBS, MD, Academic Fellow, Division of Cardiology, Saint Vincent Hospital, No. 123 Summer Street, Worcester, MA 01608, United States. ajay.mishra@stvincenthospital.com
Received: September 11, 2022
Peer-review started: September 11, 2022
First decision: November 2, 2022
Revised: November 15, 2022
Accepted: November 15, 2022
Article in press: November 15, 2022
Published online: January 26, 2023
Processing time: 122 Days and 4.7 Hours
Abstract
BACKGROUND

Takotsubo cardiomyopathy (TTC) can be diagnosed in patients presenting with clinical features of acute coronary syndrome (ACS) by using Mayo clinic criteria. Multiple precipitators have been attributed to causing TTC. Rarely it has been reported to occur following an acute envenomation.

AIM

This review describes the various patterns, mechanisms, and outcomes of envenomation induced TTC.

METHODS

In this review, we included all studies on “TTC” and “envenomation “published in the various databases before June 2022. To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation

RESULTS

A total of 20 patients with envenomation induced TTC were identified. Most episodes of envenomation induced TTC were reported following a bee sting, scorpion sting, and snake envenomation. Fear and anxiety related to the sting, direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients. 95% of these patients presented with a clinical picture of ACS. Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC. Echocardiographic evidence of Apical TTC was noted in 72% of patients. 94% of these patients had clinical improvement following optimal management and 35% of these patients were treated with guideline directed medications for heart failure.

CONCLUSION

Envenomation following multiple insect stings and reptile bites can precipitate TTC. Most reported envenomation related TTC has been due to bee stings and scorpion bites. Common mechanisms causing TTC were fear, anxiety, and stress of envenomation. Most of these patients present with clinical presentation of ACS, ST elevation, and elevated troponin. The most common type of TTC in these patients is Apical, which improved following medical management.

Keywords: Takotsubo cardiomyopathy; Envenomation; Mechanism; Outcome

Core Tip: Multiple envenomations following insect stings and reptile bites can cause Takotsubo cardiomyopathy. Bee stings, wasp stings, scorpion stings, snake bites, spider bites, and jellyfish stings are the commonly reported precipitators of this cardiomyopathy. Multiple mechanisms have been postulated to cause this of which fear, anxiety, and stress of envenomation are the predominant ones. Patients usually present with clinical presentation of acute coronary syndrome, ST elevation, and elevated troponin. Echocardiography commonly shows an apical pattern of cardiomyopathy. This cardiomyopathy improves with medical management.