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Pillitteri M, Brogi E, Piagnani C, Bozzetti G, Forfori F. Perioperative management of Takotsubo cardiomyopathy: an overview. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:45. [PMID: 39010210 PMCID: PMC11247845 DOI: 10.1186/s44158-024-00178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
Resembling the morphology of Japanese polyp vessels, the classic form of Takotsubo cardiomyopathy is characterized by the presence of systolic dysfunction of the mid-apical portion of the left ventricle associated with basal hyperkinesia. It is believed that this may be due to a higher density of β-adrenergic receptors in the context of the apical myocardium, which could explain the greater sensitivity of the apex to fluctuations in catecholamine levels.The syndrome is precipitated by significant emotional stress or acute severe pathologies, and it is increasingly diagnosed during the perioperative period. Indeed, surgery, induction of general anaesthesia and critical illness represent potential harmful trigger of stress cardiomyopathy. No universally accepted guidelines are currently available, and, generally, the treatment of TTS relies on health care personal experience and/or local practice. In our daily practice, anaesthesiologists can be asked to manage patients with the diagnosis of new-onset Takotsubo before elective surgery or an emergent surgery in a patient with a concomitant stress cardiomyopathy. Even more, stress cardiomyopathy can arise as a complication during the operation.In this paper, we aim to provide an overview of Takotsubo syndrome and to discuss how to manage Takotsubo during surgery and in anaesthesiologic special settings.
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Affiliation(s)
- Marta Pillitteri
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Etrusca Brogi
- Neuroscience Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Chiara Piagnani
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Giuseppe Bozzetti
- Department of Anaesthesia, Peri Operative Medicine and Critical Care, NHS Golden Jubilee, Glasgow, UK
| | - Francesco Forfori
- Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy
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Eter A, Yamamoto T, Koutrouvelis A, Yamamoto S. The Association Between the Location of Subarachnoid Hemorrhage and the Occurrence of Takotsubo Cardiomyopathy: A Systematic Review and Meta-analysis. Cureus 2024; 16:e62533. [PMID: 39022462 PMCID: PMC11253893 DOI: 10.7759/cureus.62533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a syndrome characterized by transient regional cardiac dysfunction of the left ventricle. The goal of this review is to better understand the relationship between the anatomic locations of subarachnoid hemorrhages (SAHs) and the development of TCM as identified through a review of cohort studies. From inception to December 2023, we systematically explored major electronic medical information sources to identify cases of TCM that developed after SAHs. The six selected studies included in the meta-analysis suggest a modest but statistically significant increase in the odds of the events in the posterior circulation group compared to the anterior circulation group, with a combined odds ratio (OR) estimate of around 1.45-1.46. The fixed effect model gives an overall OR of 1.45 with a 95% confidence interval (CI) of 1.01 to 2.10, z = 2.01, p = 0.0442, while the random effects model yields a slightly higher OR of 1.46 with the same 95% CI, z = 2.03, p = 0.0425. There is a tendency for SAH occurrence in the posterior cerebral circulation to cause SAH-related TCM more frequently than in the anterior cerebral circulation.
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Affiliation(s)
- Asia Eter
- School of Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | | | | | - Satoshi Yamamoto
- Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, USA
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Dev D, El-Din M, Vijayakumar S, Mitrakrishnan RN. Takotsubo cardiomyopathy following pacemaker insertion complicated with polymorphic ventricular tachycardia: a case report. J Med Case Rep 2024; 18:238. [PMID: 38705996 PMCID: PMC11071207 DOI: 10.1186/s13256-024-04565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/14/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy is a novel form of rapidly reversible heart failure occurring secondary to a stressor that mimics an acute coronary event. The underlying etiology of the stressor is highly variable and can include medical procedures. Pacemaker insertion is an infrequent cause of Takotsubo cardiomyopathy. CASE PRESENTATION An 86-year-old Caucasian woman underwent an uncomplicated pacemaker insertion for symptomatic complete heart block in the background of slow atrial fibrillation. A transient episode of polymorphic ventricular tachycardia was noted on day 1 following the procedure; however, her pacemaker was checked and, as she remained stable, she was discharged home. She presented again 5 days later with symptomatic heart failure. Chest X-ray confirmed pulmonary edema. Echocardiography confirmed new onset severe left ventricle dysfunction. Pacemaker checks were normal and lead placement was confirmed. Though her troponin I was elevated, her coronary angiogram was normal. Contrast enhanced echocardiography suggested apical ballooning favoring Takotsubo cardiomyopathy. She was treated for heart failure and made a good recovery. Her follow-up echocardiography a month later showed significant improvement in left ventricle function. CONCLUSIONS Takotsubo cardiomyopathy is mediated by a neuro-cardiogenic mechanism due to hypothalamic-pituitary-adrenal axis activation. It generally has a good prognosis. Complications though uncommon, can occur and include arrhythmias. Pacemaker insertion as a precipitant stressor is an infrequent cause of Takotsubo cardiomyopathy. As pacemaker insertions are more frequent in the elderly age group, this phenomenon should be recognized as a potential complication.
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Affiliation(s)
- Damanpreet Dev
- Department of Cardiology, Kettering General Hospital, NHS, Kettering, UK.
| | - Mohammed El-Din
- Department of Cardiology, Kettering General Hospital, NHS, Kettering, UK
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Rathod DK, Sharma A, Sharma N, Kaushik A, Karmakar S. Takotsubo cardiomyopathy following head and neck surgery: Can the fear of disfigurement be blamed? Saudi J Anaesth 2023; 17:419-422. [PMID: 37601518 PMCID: PMC10435813 DOI: 10.4103/sja.sja_906_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/07/2023] [Accepted: 01/07/2023] [Indexed: 08/22/2023] Open
Abstract
Takotsubo cardiomyopathy is accompanied by transitory left ventricular dysfunction without substantial coronary artery disease. A history of acute physical or mental stress typically precedes such a presentation. We want to highlight a case of Takotsubo cardiomyopathy in the early postoperative period in a young female patient who underwent extensive surgery for buccal mucosal carcinoma. The onset of this cardiomyopathy can be ascribed to a fear of disfigurement and prolonged surgical stress.
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Affiliation(s)
| | - Ankur Sharma
- Department of Trauma and Emergency (Anesthesiology), AIIMS, Jodhpur, Rajasthan, India
| | - Nivedita Sharma
- Department of Surgical Oncology, AIIMS, Jodhpur, Rajasthan, India
| | - Atul Kaushik
- Department of Cardiology, AIIMS, Jodhpur, Rajasthan, India
| | - Shilpi Karmakar
- Department of Burns and Plastic Surgery, AIIMS, Jodhpur, Rajasthan, India
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Yazdi F, Blackmon M, Kattubadi A, Krishnan P. Seizure-Induced Cardiomyopathy: A Case of Takotsubo Cardiomyopathy Following an Epileptic Event. Cureus 2023; 15:e39288. [PMID: 37346223 PMCID: PMC10281001 DOI: 10.7759/cureus.39288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/23/2023] Open
Abstract
We present a case, written with the assistance of the Chat Generative Pre-training Transformer (ChatGPT) Artificial Intelligence (AI), of a 75-year-old female with a history of hypertension, epilepsy, coronary artery disease, and alcohol use disorder. She presented with a tonic-clonic seizure, tachycardia, and a cyanotic right hand. Diagnostic tests revealed stress-induced cardiomyopathy, patent bilateral subclavian and axillary arteries with heavy calcification of bilateral upper extremity arteries, and a small filling defect in the segmental branch of the left lower lobe. The patient was started on antiepileptic medication, thiamine/folate, and heparin drip for limb ischemia. Despite treatment with multiple anti-arrhythmic agents, the patient developed cardiogenic shock and underwent left heart catheterization with Impella placement. The Impella was removed 72 hours after placement, and the patient was started on low-dose Milrinone and Levophed for hemodynamic support. The patient eventually recovered and was discharged to long-term acute care.
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Affiliation(s)
- Fereshteh Yazdi
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Melodie Blackmon
- Critical Care Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Ayeesha Kattubadi
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Prathik Krishnan
- Pulmonary Critical Care, Louisiana State University Health Sciences Center, Shreveport, USA
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(A rare complication of Tako-tsubo cardiomyopathy). COR ET VASA 2022. [DOI: 10.33678/cor.2022.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Xu Y, Li Y, He J, Li J, Liu M, Zhang H. Anesthetic management of epilepsy surgery in a patient previously diagnosed with Takotsubo cardiomyopathy: A case report. Medicine (Baltimore) 2022; 101:e31229. [PMID: 36281085 PMCID: PMC9592447 DOI: 10.1097/md.0000000000031229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RATIONALE Takotsubo cardiomyopathy (TC), also known as stress cardiomyopathy, apical ballooning syndrome, octopus pot cardiomyopathy and broken heart syndrome, is characterized by wall motion abnormalities of the left ventricle. PATIENT CONCERNS Here, we reported a 73-year-old woman diagnosed with TC induced by epilepsy before 3 months presented to the authors' hospital with generalized tonic-clonic seizure. She was scheduled for intracranial tumor resection to cure the epilepsy. DIAGNOSIS She was diagnosed with epilepsy and TC. Interventions: Anesthesia management plays an important role in patients with a past history of TC. OUTCOMES At the 1-week follow-up, she had fully recovered without obvious abnormalities. LESSONS SUBSECTIONS We emphasize the importance of individualized anesthesia management in patients with a past history of TC.
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Affiliation(s)
- Yue Xu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Yi Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Jinhua He
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
- * Correspondence: Jianli Li, Department of Anesthesiology, Hebei General Hospital, Shijiazhuang 050051, China (e-mail: )
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
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Shang Z, Zhao M, Cai J, Wu C, Xu Y, Zeng L, Cai H, Xu M, Fan Y, Li Y, Gao W, Xu W, Zu L. Peri-operative Takotsubo syndrome after non-cardiac surgery: a retrospective nested case-control study. ESC Heart Fail 2022; 9:3149-3159. [PMID: 35757924 DOI: 10.1002/ehf2.14015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/09/2022] [Accepted: 06/03/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Takotsubo syndrome (TTS) is an acute reversible cardiac dysfunction that may occur during the peri-operative period and among patients with serious illness. We aimed to evaluate the clinical characteristics, peri-operative management, and prognosis of peri-operative TTS (pTTS) and explore the factors associated with pTTS. METHODS We conducted a retrospective nested case-control study using the database of patients who underwent in-hospital non-cardiac surgeries between January 2017 and December 2020 in Peking University Third hospital. Cases were adult patients diagnosed TTS at discharge who were matched with four controls based on operative types. Multivariable conditional logistic regression was used to identified the factors associated with pTTS. The area under the curve (AUC) was used to evaluate the diagnostic efficacy. RESULTS Among the 128 536 patients underwent non-cardiac surgery, 20 patients with pTTS and 80 patients without were enrolled in this study. The incidence of pTTS was about 0.016% in our centre. The median age of patients with pTTS was 52.5 (38.25, 76.25) years, although 90% of them were female. Fifty per cent (9 cases) of female patients were pre-menopausal. Caesarean section has the highest proportion of pTTS (30% of the pTTS cases) with the incidence of caesarean section-related pTTS of 0.06% in our centre. A high prevalence of non-apical ballooning pattern of regional wall motion abnormality (seven cases, 35%) and a high mortality (two cases, 10%) were observed. Left ventricular ejection fraction (LVEF) of patients with pTTS was significantly decreased (41.7 ± 8.8%). In the acute phase, supportive treatments aiming to reduce life-threatening complications were main treatment strategies. After receiving systematic treatment, significant improvements were observed in LVEF (63.1 ± 13.5%), with median recovery time of LVEF of 7.48 days. Leucocyte count [odds ratio (OR): 4.59; 95% confidence interval (CI): 1.10-19.15], haemoglobin (HGB) (OR: 10.52; 95% CI: 1.04-106.36), and the revised cardiac risk index (RCRI) score (OR: 6.30; 95% CI: 1.05-37.88) were the factors significantly associated with pTTS. The RCRI score performed poorly in the prediction of pTTS (AUC: 0.630; 95% CI: 0.525-0.735). After adding leucocyte count and HGB into the RCRI score, the AUC was significantly improved (AUC: 0.768; 95% CI: 0.671-0.865; P = 0.001). CONCLUSIONS Patients with pTTS have some differences compared with common TTS, including higher proportion of pre-menopausal female, higher prevalence during caesarean section, higher prevalence of non-apical ballooning pattern of regional wall motion abnormality, and higher mortality. The RCRI score performed poorly in the evaluation of pTTS. Adding HGB and leucocyte count into the RCRI score could significantly improve its predictive performance.
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Affiliation(s)
- Zhi Shang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Menglin Zhao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Jiageng Cai
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Cencen Wu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yuan Xu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Hong Cai
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Mao Xu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yuanyuan Fan
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yanguang Li
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Wei Gao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Weixian Xu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Lingyun Zu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
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Xu Y, Liu M, Li J, Rong J. Takotsubo cardiomyopathy as an overlooked cause of cardiac arrest in a patient undergoing ureteral stenting: a case report and literature review. J Int Med Res 2022; 50:3000605221099255. [PMID: 35579194 PMCID: PMC9128059 DOI: 10.1177/03000605221099255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Takotsubo cardiomyopathy (TC) is a rare disease with unclear etiology that is characterized by wall motion abnormalities of the left ventricle. We report a 64-year-old woman who presented with cardiac arrest 6 hours after ureteral stenting, with no history of heart disease. Notably, she had a urinary tract infection preoperatively. TC was diagnosed with characteristic apical ballooning on the left ventriculogram. The hemodynamics and cardiac function recovered quickly within 1 day after conservative treatment and controlling the infection. TC should be considered when a patient presents with decreased cardiac function after ureteral stenting, especially in patients with potential concurrent infection. A review of the literature documenting cases of TC related to urological surgery in the past decade was conducted using PubMed. The results were summarized in a table.
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Affiliation(s)
- Yue Xu
- Department of Anesthesiology, 117872Hebei General Hospital, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Meinv Liu
- Department of Anesthesiology, 117872Hebei General Hospital, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Jianli Li
- Department of Anesthesiology, 117872Hebei General Hospital, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Junfang Rong
- Department of Anesthesiology, 117872Hebei General Hospital, Hebei General Hospital, Shijiazhuang, 050051, China
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Li P, Wang Y, Liang J, Zuo X, Li Q, Sherif AA, Zhang J, Xu Y, Huang Z, Dong M, Teng C, Pan S, Dixon RAF, Wei X, Wu L, Jin C, Cai P, Dai Q, Ma J, Liu Q. Takotsubo syndrome and respiratory diseases: a systematic review. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac009. [PMID: 35919117 PMCID: PMC9242042 DOI: 10.1093/ehjopen/oeac009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/02/2022] [Accepted: 02/23/2022] [Indexed: 06/15/2023]
Abstract
Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction and a presentation resembling that of acute myocardial infarction. An increasing number of studies has shown the association of respiratory diseases with TTS. Here, we comprehensively reviewed the literature and examined the available evidence for this association. After searching PubMed, EMBASE, and Cochrane Library databases, two investigators independently reviewed 3117 studies published through May 2021. Of these studies, 99 met the inclusion criteria (n = 108 patients). In patients with coexisting respiratory disease and TTS, the most common TTS symptom was dyspnoea (70.48%), followed by chest pain (24.76%) and syncope (2.86%). The most common type of TTS was apical, accounting for 81.13% of cases, followed by the midventricular (8.49%), basal (8.49%), and biventricular (1.89%) types. Among the TTS cases, 39.82% were associated with obstructive lung disease and 38.89% were associated with pneumonia. Coronavirus disease 2019 (COVID-19), which has been increasingly reported in patients with TTS, was identified in 29 of 42 (69.05%) patients with pneumonia. The overall mortality rate for patients admitted for respiratory disease complicated by TTS was 12.50%. Obstructive lung disease and pneumonia are the most frequently identified respiratory triggers of TTS. Medications and invasive procedures utilized in managing respiratory diseases may also contribute to the development of TTS. Furthermore, the diagnosis of TTS triggered by these conditions can be challenging due to its atypical presentation. Future prospective studies are needed to establish appropriate guidelines for managing respiratory disease with concurrent TTS.
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Affiliation(s)
- Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Yanxuan Wang
- Xinxiang Medical University, Xinxiang, Henan, China
| | - Jing Liang
- Xinxiang Medical University, Xinxiang, Henan, China
| | - Xinyu Zuo
- Xinxiang Medical University, Xinxiang, Henan, China
| | - Qiuyue Li
- Xinxiang Medical University, Xinxiang, Henan, China
| | - Akil Adrian Sherif
- Department of Medicine, Divison of Cardiology, Saint Vincent Hospital, Worcester, MA, USA
| | - Jingyi Zhang
- Xinxiang Medical University, Xinxiang, Henan, China
| | - Yidan Xu
- Xinxiang Medical University, Xinxiang, Henan, China
| | - Zirui Huang
- Xinxiang Medical University, Xinxiang, Henan, China
| | - Man Dong
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Catherine Teng
- Division of Cardiology, Department of Medicine, University of Texas at San Antonio, San Antonio, TX, USA
| | - Su Pan
- Wafic Said Molecular Cardiology Research Laboratory, Texas Heart Institute, 6770 Bertner Avenue, MC 2-255, Houston, TX 77030, USA
| | - Richard A F Dixon
- Wafic Said Molecular Cardiology Research Laboratory, Texas Heart Institute, 6770 Bertner Avenue, MC 2-255, Houston, TX 77030, USA
| | - Xin Wei
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Lingling Wu
- Division of Cardiovascular Disease, University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Chengyue Jin
- Department of Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Qiying Dai
- Department of Medicine, Divison of Cardiology, Saint Vincent Hospital, Worcester, MA, USA
| | - Jianjun Ma
- Xinxiang Medical University, Xinxiang, Henan, China
| | - Qi Liu
- Wafic Said Molecular Cardiology Research Laboratory, Texas Heart Institute, 6770 Bertner Avenue, MC 2-255, Houston, TX 77030, USA
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Odierna I, Pagano T, Erra A, Oliveri L, Pasquale M, Muoio R, Petrosino M, Albano F, Pepe L. Pheochromocytoma-induced "inverted" takotsubo cardiomyopathy and cardiogenic shock: case report. Anaesthesiol Intensive Ther 2022; 54:341-343. [PMID: 36458670 PMCID: PMC10156569 DOI: 10.5114/ait.2022.121100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
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Shining a light on perioperative Takotsubo syndrome. Can J Anaesth 2021; 68:1738-1743. [PMID: 34580833 DOI: 10.1007/s12630-021-02108-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 02/01/2023] Open
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Anesthetic implications of perioperative Takotsubo syndrome: a retrospective cohort study. Can J Anaesth 2021; 68:1747-1755. [PMID: 34570351 DOI: 10.1007/s12630-021-02109-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Takotsubo syndrome is a reversible cardiomyopathy triggered by emotional or physical stressors. Although surgeries could be physical triggers, this has been scantily investigated. We aimed to describe the baseline characteristics, surgical/anesthesia-related triggering events, clinical presentation, and in-hospital outcomes of a cohort of patients diagnosed with perioperative Takotsubo syndrome. METHODS In this retrospective study, we included all consecutive adult patients who were admitted to Hospital Italiano de Buenos Aires between 1 June 2008 and 30 November 2017 and diagnosed with Takotsubo syndrome according to the revised criteria of the European Society of Cardiology during hospitalization. RESULTS We diagnosed 21 patients with perioperative Takotsubo syndrome out of 305,906 patients undergoing procedures with anesthesia care. The median (interquartile range [IQR]) patient age was 75 (55-82) yr, and 16 (76%) were women. The median (IQR) left ventricular ejection fraction was 35 (35-42)% at diagnosis and 55 (46-55)% at discharge. Fifteen patients (71%) required inotropic/vasopressor support; however, this is a controversial treatment considering the physiopathology of the syndrome. Severe complications such as unexplained syncope/cardiac arrest, cardiogenic shock, and ventricular thrombus formation occurred in seven (33%) patients, and two (10%) patients died. These results were compared with 31 patients who experienced non-perioperative Takotsubo syndrome during the same period of time. CONCLUSION Perioperative Takotsubo syndrome is a reversible cardiomyopathy. Nevertheless, it seems to be associated with severe complications, the need for aggressive treatment, and non-negligible mortality.
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Scuotto F, Albertini CMDM, Lemos SGD, Staico R, Assad RS, Cirenza C. Author's Reply-Left bundle branch pacing as cause for takotsubo cardiomyopathy? HeartRhythm Case Rep 2021; 7:575. [PMID: 34434713 PMCID: PMC8377264 DOI: 10.1016/j.hrcr.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Frederico Scuotto
- Hospital Samaritano Higienópolis, United Health Group, São Paulo, Brazil
| | | | | | - Rodolfo Staico
- Hospital Samaritano Higienópolis, United Health Group, São Paulo, Brazil
| | - Renato Samy Assad
- Hospital Samaritano Higienópolis, United Health Group, São Paulo, Brazil
| | - Claudio Cirenza
- Hospital Samaritano Higienópolis, United Health Group, São Paulo, Brazil
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Yamamoto W, Nishihara T, Nakanishi K, Abe N, Hamada T, Takeuchi M, Yorozuya T. Takotsubo Cardiomyopathy Induced by Very Low-Dose Epinephrine Contained in Local Anesthetics: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932028. [PMID: 34174047 PMCID: PMC8244375 DOI: 10.12659/ajcr.932028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Takotsubo cardiomyopathy is a reversible left ventricular dysfunction triggered by emotional or physical stress. Perioperatively, takotsubo cardiomyopathy is sometimes induced by various psychological factors, such as stress from surgery, and non-psychological factors, such as epinephrine misinjection. This report describes a case of takotsubo cardiomyopathy induced by the administration of very low-dose epinephrine contained in a local anesthetic. CASE REPORT A 78-year-old woman with mycosis in the maxillary sinus was scheduled to undergo endoscopic sinus surgery. After the submucosal injection of 3 mL of local anesthetic (lidocaine, 0.5%; epinephrine, 1: 200 000) immediately before the incision, her heart rate and blood pressure reached 135 beats per min and 254/185 mmHg, respectively, inducing ventricular tachycardia. After receiving 50 mg of lidocaine, her cardiac rhythm resumed a normal sinus rhythm, without cardioversion. As her hemodynamics stabilized, the surgical procedure began as planned. Postoperative electrocardiography, echocardiography, and coronary arteriography demonstrated takotsubo cardiomyopathy. Subsequently, her cardiac movement gradually improved, and she was discharged from the hospital on postoperative day 9. CONCLUSIONS To the best of our knowledge, this is the first reported case in which a very small amount of epinephrine (0.015 mg) induced takotsubo cardiomyopathy. Therefore, epinephrine should be used cautiously, especially in the nasal mucosa, vaginal mucosa, and uterus, where blood flow is relatively high. If unexpected hemodynamic alterations and ST-segment abnormalities occur after epinephrine administration, asymptomatic takotsubo cardiomyopathy should be considered.
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Affiliation(s)
- Waichi Yamamoto
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Tasuku Nishihara
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan,Corresponding Author: Tasuku Nishihara, e-mail:
| | - Kazuo Nakanishi
- Department of Anesthesiology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Naoki Abe
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Taisuke Hamada
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Mikiko Takeuchi
- Department of Anesthesiology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Toshihiro Yorozuya
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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16
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Wu HY, Cheng G, Liang L, Cao YW. Recurrent Takotsubo cardiomyopathy triggered by emotionally stressful events: A case report. World J Clin Cases 2021; 9:677-684. [PMID: 33553408 PMCID: PMC7829724 DOI: 10.12998/wjcc.v9.i3.677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction triggered by emotional or physical stress. Only 1%-2% of patients with acute coronary syndrome are diagnosed with TCM. Although obstructive coronary artery disease is frequently considered to be the cause of chest pain, TCM should be considered in some clinical settings. In this case, clinicians did not make a timely and accurate diagnosis for TCM due to a lack of knowledge until the third hospitalization with a left ventriculogram.
CASE SUMMARY A 55-year-old postmenopausal woman had intermittent chest pain following emotionally stressful events three times in the past 3 years. Cardiac troponin levels increased after each instance of symptom onset. A transthoracic echocardiogram showed reversible left ventricular dysfunction. The patient underwent three coronary angiograms without evidence of coronary artery disease. A left ventriculogram was first performed at the third hospitalization and revealed apical akinesia with ballooning of the apical region and consistent hypercontractile basal segments. The diagnosis of TCM was confirmed. The patient was treated with an angiotensin-converting-enzyme inhibitor (perindopril) and a β-blocker (metoprolol). No complications occurred during the patient’s hospitalization. The patient was told to avoid stressful events. During the 9-mo follow-up visit, the patient was asymptomatic with an ejection fraction of 55%.
CONCLUSION Clinicians should be conscious of the possibility of TCM, especially in postmenopausal women presenting with clinical manifestations similar to acute coronary syndrome without coronary occlusion.
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Affiliation(s)
- Hao-Yu Wu
- Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
| | - Gong Cheng
- Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
| | - Lei Liang
- Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
| | - Yi-Wei Cao
- Department of Electrocardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
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17
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Alfarih M, Moon JC, Fontana M, Knight D, Captur G. An unusual cause of polymorphic ventricular tachycardia: Acquired long QT syndrome from atypical variant of stress-induced cardiomyopathy. SAGE Open Med Case Rep 2020; 8:2050313X20944307. [PMID: 32922792 PMCID: PMC7457639 DOI: 10.1177/2050313x20944307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022] Open
Abstract
A 55-year-old woman with a recent history of surgically and radioiodine treated thyroid cancer experienced a run of polymorphic ventricular tachycardia with hemodynamic perturbation during anaesthetic induction with propofol, fentanyl and rocuronium for elective surgical excision of right hip metastasis. Electrocardiography showed new T-wave inversion and QT prolongation that subsequently resolved. Cardiac enzymes were elevated but invasive coronary angiography showed unobstructed epicardial coronary arteries. Cardiovascular magnetic resonance showed not only normal biventricular size and systolic function but also a striking pattern of patchy myocardial oedema involving the basal-to-mid anterior, septal and inferior walls and some associated hypertrophy in the anteroseptum (representing focal myocardial swelling from the oedema) but no focal or diffuse myocardial fibrosis. All these abnormalities resolved on subsequent convalescent imaging. A diagnosis of multifactorial acquired long QT syndrome secondary to atypical variant stress-induced cardiomyopathy was made with the likely provoking factors in this case having been the female sex, understandable pre-operative anxiety, anaesthetic drugs, supraglottic airway placement and thyroid dysfunction. An implantable loop recorder during follow-up detected no further significant arrhythmias and she remains well and asymptomatic to date on a low dose of beta-blocker.
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Affiliation(s)
- Mashael Alfarih
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiac Technology, College of Applied Medial Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - James C Moon
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Magnetic Resonance, Royal Free London NHS Foundation Trust, London, UK
| | - Dan Knight
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Magnetic Resonance, Royal Free London NHS Foundation Trust, London, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, UK.,MRC Unit for Lifelong Health and Ageing at UCL, London, UK.,Inherited Heart Muscle Conditions Unit, Department of Cardiology, Royal Free London NHS Foundation Trust, London, UK
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Ashcroft AJ, McKinlay J, Sira J. Takotsubo cardiomyopathy following resection of a fourth ventricle tumour. Anaesth Rep 2019; 7:100-103. [PMID: 32051962 DOI: 10.1002/anr3.12028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2019] [Indexed: 12/22/2022] Open
Abstract
Takotsubo cardiomyopathy is a rare disorder associated with catecholamine discharge in response to episodes of stress. We present the case of a 39-year-old patient with no other significant medical history who suffered acute ECG changes, left ventricular dysfunction with regional wall motion abnormalities and raised cardiac enzymes following a period of severe and sustained hypertension and tachycardia associated with resection of tumour from the floor of the fourth ventricle. We believe this to be only the second case of a takotsubo cardiomyopathy related to intracranial surgery. It demonstrates the need for consideration, recognition and diagnosis of takotsubo cardiomyopathy following periods of severe peri-operative stress.
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Affiliation(s)
- A J Ashcroft
- Anaesthetic and Intensive Care Trainee Leeds General Infirmary Leeds UK
| | - J McKinlay
- Anaesthetic and Intensive Care Consultant Leeds General Infirmary Leeds UK
| | - J Sira
- Anaesthetic and Intensive Care Consultant Leeds General Infirmary Leeds UK
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