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Paolo Angelini Jorge Monge Leo Simpson 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2013,40(3):312-315
In recent years, our understanding of the physiologic mechanisms of transient takotsubo cardiomyopathy has improved because of the growing use of emergent heart catheterization in patients who present with severe ischemic syndromes. However, even this procedure has revealed only that, in most patients with takotsubo syndrome, the sudden onset of ventricular dysfunction is not due to fixed coronary artery occlusions. We present a case of transient takotsubo cardiomyopathy with an exceptional feature—uneven impairment of both right and left ventricular function, or biventricular takotsubo—and we discuss a novel, comprehensive theory that we have devised to explain the pathophysiology of this syndrome''s many manifestations.Key words: Acetylcholine/diagnostic use, angina pectoris, variant, coronary endothelial dysfunction, coronary vasospasm/physiopathology, takotsubo cardiomyopathy/classification/diagnosis/physiopathology, ventricular dysfunction, left/etiology/diagnosis, ventricular dysfunction, right/etiology/diagnosisOnly during the last 2 decades have Japanese authors1,2 specifically categorized transient takotsubo cardiomyopathy (TTC) as an entity in itself. Before that time, TTC was often called “acute myocardial infarction with normal coronary arteries.”3 Its prevalence is probably as low today as in the remote past. However, acute coronary artery syndromes are now studied aggressively with emergent heart catheterization, which documents better than any previous means the transience of the myopathy and the presence of apparently normal coronary arteries. These circumstances have stimulated the quest to generate a pathophysiologic concept broad enough to encompass the full clinical spectrum of TCC.Apical ballooning (resulting in a systolic takotsubo or “octopus trap”) is the most frequent and emblematic feature of TTC. The use of this term has successfully promoted awareness of the disease in the cardiology community at large, but it has also impeded clinicians'' understanding of the breadth of this entity''s clinical manifestations. Our persistently inadequate knowledge of the nature and spectrum of TTC seems to warrant an update on the subject.Here, we present a case of right ventricular (in union with left ventricular) TTC. In addition, we discuss a pathophysiologic theory that our group has recently proposed, which might explain the newly discovered and broad spectrum of TTC clinical manifestations. 相似文献
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Paolo Angelini Carlo Uribe Jonathan M. Tobis 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2021,48(3)
Takotsubo cardiomyopathy (TTC), a persistently obscure dysfunctional condition of the left ventricle, is uniquely transient but nevertheless dangerous. It features variable ventricular patterns and is predominant in women. For 30 years, pathophysiologic investigations have progressed only slowly and with inadequate focus.It was initially proposed that sudden-onset spastic obliteration of coronary flow induced myocardial ischemia with residual stunning and thus TTC. Later, it was generally accepted without proof that, in the presence of pain or emotional stress, the dominant mechanism for TTC onset was a catecholamine surge that had a direct, toxic myocardial effect.We think that the manifestations of TTC are more dynamic and complex than can be assumed from catecholamine effects alone. In addition, after reviewing the recent medical literature and considering our own clinical observations, especially on spasm, we theorize that atherosclerotic coronary artery disease modulates and physically opposes obstruction during spasm. This phenomenon may explain the midventricular variant of TTC and the lower incidence of TTC in men. We continue to recommend and perform acetylcholine testing to reproduce TTC and to confirm our theory that coronary spasm is its initial pathophysiologic factor. An improved understanding of TTC is especially important because of the condition''s markedly increased incidence during the ongoing COVID-19 pandemic. 相似文献
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Ramy Abdelmaseih Anamarys Blanco Randa Abdelmasih Krutika Desai Joshua Pothen Jay Patel Rama Balaraman 《Current problems in cardiology》2021,46(8):100854
Capecitabine has been more recognized for its cardiotoxicity with an incidence that varies widely. It demonstrates its toxicity in the forms of acute coronary syndrome, arrhythmias and, to a lesser extent, cardiomyopathy. There are several proposed theories including coronary vasospasm, endothelial injury, and oxidative stress. We present a case of capecitabine-induced cardiomyopathy in a patient with pancreatic cancer and mild coronary artery disease, and shed light on other cardio-toxic agents, their proposed mechanism of cardiotoxicity, and on cardiomyopathy in general. 相似文献
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Stephen Kim MD Anthony Yu MD Lea A. Filippone BA Daniel M. Kolansky MD Amresh Raina MD 《Clinical cardiology》2010,33(4):200-205
Takotsubo cardiomyopathy is an increasingly recognized clinical syndrome of transient left ventricular dysfunction, commonly with apical ballooning, in the context of physical or emotional stress. Recently, an inverted‐Takotsubo contractile pattern has been described with hypokinesis of the basal and mid‐ventricular segments and sparing of the apex. We report a case of a 30‐year‐old man presenting with transient left ventricular dysfunction in an inverted‐Takotsubo contractile pattern, associated with a newly discovered pheochromocytoma, and present a literature review of the inverted‐Takotsubo contractile pattern cardiomyopathy. Copyright © 2010 Wiley Periodicals, Inc. 相似文献
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Takotsubo cardiomyopathy, also known as apical ballooning syndrome or stress-induced cardiomyopathy, is characterized by reversible
left ventricular segmental dysfunction. The incidence is disproportionately increased in elderly women and is precipitated
by a stressful event. Pathophysiology is uncertain, but increased incidence in postmenopausal elderly women has implicated
endocrine and hormonal mechanisms, including catecholamine excess, as the most favored explanations. The patients typically
present with chest pain, ST segment changes on electrocardiogram, and increased cardiac biomarkers. Angiography is usually
the first diagnostic test with evidence of apical ballooning or mid-ventricular dyskinesia/akinesia without significant epicardial
coronary disease. Treatment is supportive and prognosis is good, especially in elderly female patients presenting with underlying
emotional stressor as the inciting event. A subset of patients presenting with idiopathic or physiologic stress may be at
increased risk of hemodynamic compromise requiring intensive hemodynamic support and monitoring. The jury is still out on
disease pathogenesis, management, primary prevention, and long-term outcomes. 相似文献
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《The American journal of medicine》2022,135(10):e387-e388
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Takotsubo Cardiomyopathy in an Elderly Woman with Alzheimer's Disease: A Rare Association. Case Report and Mini‐Review of the Literature
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Marco Zuin MD Pierluigi Dal Santo MD Claudio Picariello MD Luca Conte MD Giovanni Zuliani MD Katia D'Elia MD Loris Roncon MD 《Journal of the American Geriatrics Society》2016,64(4):916-917
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BackgroundAthletes use androgenic-anabolic steroids to increase strength and muscle mass. Several case reports suggest that it may lead to dilated cardiomyopathy.Methods and ResultsWe report a case of a 41-year-old bodybuilder with severe systolic dysfunction and Class IV heart failure despite maximal medical therapy. He used anabolic steroids and insulin growth factor, and did not have any other risk factors for cardiomyopathy. We briefly review the literature and summarize other reported cases with similar scenarios. In most of them cardiomyopathy was at least partially reversible after discontinuation of anabolics.ConclusionsAbuse of anabolic steroids may be an uncommon cause of cardiomyopathy in young and otherwise healthy individuals. 相似文献
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Lucien Marchand Bérénice Segrestin Marion Lapoirie Véronique Favrel Julie Dementhon Emmanuel Jouanneau Gérald Raverot 《Medicine》2015,94(46)
Cardiovascular impairments are frequent in Cushing''s syndrome and the hypercortisolism can result in cardiac structural and functional changes that lead in rare cases to dilated cardiomyopathy (DCM). Such cardiac impairment may be reversible in response to a eucortisolaemic state.A 43-year-old man with a medical past of hypertension and history of smoking presented to the emergency department with global heart failure. Coronary angiography showed a significant stenosis of a marginal branch and cardiac MRI revealed a nonischemic DCM. The left ventricular ejection fraction (LVEF) was estimated as 28% to 30%. Clinicobiological features and pituitary imaging pointed toward Cushing''s disease and administration of adrenolytic drugs (metyrapone and ketoconazole) was initiated. Despite the normalization of cortisol which had been achieved 2 months later, the patient presented an acute heart failure. A massive mitral regurgitation secondary to posterior papillary muscle rupture was diagnosed as a complication of the occlusion of the marginal branch. After 6 months of optimal pharmacological treatment for systolic heart failure, as well as treatment with inhibitors of steroidogenesis, there was no improvement of LVEF. The percutaneous mitral valve was therefore repaired and a defibrillator implanted. The severity of heart failure contraindicated pituitary surgery and the patient was instead treated by stereotaxic radiotherapy.This is the first case reporting a Cushing''s syndrome DCM without improvement of LVEF despite normalization of serum cortisol levels. 相似文献
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We report a previously asymptomatic HIV patient with high CD4 lymphocyte count and low HIV1 viral load who developed cardiac and renal disease. Management with ACE inhibitor, diuretics and triple antiretroviral combination therapy yielded a rapid clinical response. An understanding of the spectrum of renal and cardiac derangements is essential for clinicians in managing patients with HIV disease. 相似文献
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Giuseppina Novo Patrizia Carità Laura Ajello Pasquale Assennato 《Journal of Cardiovascular Echography》2014,24(3):83-85
Takotsubo cardiomyopathy (TC) is characterized by transient systolic dysfunction of the apical and middle segments of the left ventricle, accompanied by electrocardiographic abnormalities and mild elevation of cardiac biomarker levels in the absence of obstructive coronary artery disease. The following case is of a woman suffering from chronic emotional stress with a very early recurrence. An acute trigger event was not detectable in both cases. It is possible to suppose that, in predisposed subjects, chronic stress by increasing sympathetic activity may be considered not only a trigger for TC, but also a negative prognostic factor for early recurrence. 相似文献
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Acromegaly is characterized by a high prevalence of cardiovascular complications that account for increased morbidity and mortality. Several studies emphasized the role of GH and IGF-1 excess in cardiac dysfunction. Coexisting factors such as hypertension, glucose tolerance abnormalities and coronary artery disease have a potential role in the progression of the acromegalic cardiomyopathy. Herein, we review the most relevant pathophysiological, functional and morphological findings in this specific disease. 相似文献
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