Takotsubo cardiomyopathy in a patient with postural tachycardia syndrome

A patient with postural tachycardia syndrome (POTS) developed takotsubo cardiomyopathy while undergoing elective surgery. Based on experimental data, we hypothesize that POTS may have predisposed our patient to this disorder and suggest possible modifications in management.     

Seizure-associated Takotsubo cardiomyopathy

Takotsubo cardiomyopathy is characterized by chest pain, dyspnea, electrocardiographic changes resembling an acute coronary syndrome, and transient wall-motion abnormalities without identifiable coronary culprit lesion explaining the wall-motion abnormality. Takotsubo cardiomyopathy occurs frequently after emotional or physical stress. Seizures have been reported as triggers of takotsubo cardiomyopathy. It is unknown if seizure-associated takotsubo cardiomyopathy differs from takotsubo cardiomyopathy associated with other triggers. Seizure-associated takotsubo cardiomyopathy cases from the literature were compared with takotsubo cardiomyopathy series comprising 30 or more patients. Thirty-six seizure-associated takotsubo cardiomyopathy cases (6 male, mean-age 61.5 years) were found. Seizure-type were tonic-clonic (n = 13), generalized (n = 5), status epilepticus (n = 6), grand mal (n = 2), or not reported (n = 13). Twelve patients had a history of epilepsy, in 15 patients takotsubo cardiomyopathy-associated seizure was the first or the information was not given (n = 9). In 17 patients takotsubo cardiomyopathy occurred immediately after the seizure, in 9 patients 1-72 h postictally, and in 10 patients, the interval was not reported. In 20 patients neurologic disorders were reported and in 14 psychiatric disorders were reported. There were medical comorbidities in 17 patients, arterial hypertension (n = 11), hyponatremia (n = 2), and cancer (n = 2). Compared with 974 patients reported in takotsubo cardiomyopathy -series, patients with seizure-associated takotsubo cardiomyopathy were younger (61.5 vs. 68.5 years, p < 0.0001), more frequently males (17 vs. 9%, p = 0.004), had less frequent chest pain (6 vs.76%, p < 0.005), more frequent cardiogenic shock (25 vs. 8%, p = 0.003), and more frequent recurrency (14 vs. 3%, p = 0.004). Seizure-associated takotsubo cardiomyopathy manifests frequently as sudden hemodynamic deterioration, which could result in death in the absence of adequate help. Probably some cases of sudden unexpected death in epilepsy are attributable to takotsubo cardiomyopathy.     

Takotsubo cardiomyopathy associated with top of the basilar artery syndrome

Journal of Neurology -     

颅内动脉瘤性蛛网膜下隙出血并发Takotsubo心肌病

目的探讨颅内动脉瘤性蛛网膜下隙出血并发Takotsubo心肌病临床特点。方法回顾分析14例颅内动脉瘤性蛛网膜下隙出血并发Takotsubo心肌病患者的临床资料、血清心肌酶谱[包括肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、氨基末端B型利尿钠肽前体(NT-pro BNP)]水平、心电图和超声心动图表现。结果 14例患者入院时(初次检查)血清心肌酶谱[CK(591.93±248.78)IU/L、CK-MB(27.07±7.66)IU/L、NT-pro BNP(8685.36±3963.44)IU/L]水平即升高,2周复查时下降[CK(137.79±29.93)IU/L、CK-MB(14.36±5.58)IU/L、NT-pro BNP(577.14±203.37)IU/L],治疗前后差异具有统计学意义(t=7.090,P=0.000;t=4.897,P=0.000;t=7.778,P=0.000)。入院时心电图表现为ST段抬高或压低、T波倒置、QT间期延长,超声心动图呈节段性左室壁运动异常,左心室射血分数(36.07±6.15)%,2周复查时升至(56.43±3.18)%(t=13.381,P=0.000),1个月后恢复正常。结论颅内动脉瘤性蛛网膜下隙出血可诱发Takotsubo心肌病,患病率约4.58%,患者预后良好。超声心动图对早期筛查至关重要,急性期可通过冠状动脉造影术明确诊断。     

Takotsubo cardiomyopathy after electroconvulsive therapy: a case report and review

Takotsubo cardiomyopathy (TCM) is a syndrome of reversible stress-induced cardiomyopathy associated with profound emotional stress and a variety of medical illnesses and procedures, including electroconvulsive therapy (ECT). We describe 1 case of ECT-induced TCM followed by a successful retrial of ECT. We further discuss the management of ECT-induced TCM and the decision to perform a second trial of ECT in patients with this complication. Given the current understanding of the pathogenesis of TCM, it is appropriate to discontinue ECT during the acute setting of TCM. After the resolution of the acute episode of TCM, a second trial of ECT may be warranted depending on the severity of psychiatric illness (ie, suicidal ideation, catatonia, psychotic symptoms). If a retrial of ECT is performed, oral and intravenous β-blockers should be used for cardioprotection, and patients should be monitored for signs and symptoms of an evolving cardiomyopathy. It is preferable to perform retrials of ECT-at least initially-in a general hospital setting, where immediate invasive monitoring and intensive treatments are available in the event of acute cardiac failure.     

COVID-19-related severe MS exacerbation with life-threatening Takotsubo cardiomyopathy in a previously stable patient and interference of MS therapy with long-term immunity against SARS-CoV-2

Journal of Neurology -     

Cardiac transplantation in a patient with muscular dystrophy and cardiomyopathy

A 17-year-old boy with muscular dystrophy developed a cardiomyopathy. His brother died of a cardiomyopathy, and muscle enzyme levels were elevated in asymptomatic family members. Examination revealed cardiomegaly, hepatomegaly, proximal muscle atrophy and weakness, and calf hypertrophy. Skeletal muscle and endomyocardial biopsy specimens were consistent with Becker's muscular dystrophy. Because of intractable heart failure, orthotopic cardiac transplantation was performed. Two years after transplantation, the patient has returned to work and regained previous exercise tolerance. Heart transplantation can be an acceptable treatment of patients who have muscular dystrophy, with preserved ambulation and favorable life expectancy, and also life-threatening cardiomyopathy refractory to medical management.     

Takotsubo cardiomyopathy in the setting of acute hydrocephalus secondary to neurocysticercosis

We report the case of a 45-year-old male who presented with transient neurogenic stunned myocardium, or takotsubo cardiomyopathy, secondary to acute hydrocephalus caused by obstruction of the third ventricle by neurocysticercosis.     

Impaired emotional processing in a patient with a left posterior insula-SII lesion

The present case-report investigated the influence of a lesion in the left posterior insula-SII cortices on the processing of emotions. MB and 16 normal controls explicitly rated the valence and the intensity of both facial expressions and emotional words. In addition, they had to perform a number comparison task and a lexical decision task without focusing their attention on emotional components of stimuli. MB identified the valence of emotional words as well as the control group. Nevertheless, she provided higher intensity scores for disgusted words and her responses in the lexical decision task were significantly delayed for these stimuli. In addition, MB’s response times were not differently influenced by the presence of irrelevant emotional faces. However, she explicitly identified fewer facial expressions of disgust and she assessed them as significantly less intense. This pattern of results contributes to highlight the psychological and behavioral disorders observed after a left posterior insular stroke.