Academic literature on the topic 'Takotsubo Syndrome, acute coronary syndrome, catecholamines'
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Journal articles on the topic "Takotsubo Syndrome, acute coronary syndrome, catecholamines"
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Mencer, Nicholas, Larry Todd Justice, William Black, and Kayleigh Litton. "A Rare Case of Takotsubo Syndrome and Acute Coronary Syndrome of the Right Coronary Artery." Case Reports in Cardiology 2019 (June 9, 2019): 1–4. http://dx.doi.org/10.1155/2019/9128273.
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Takotsubo syndrome (TTS) is an increasingly recognized heart disease that was initially regarded as a benign condition, but since has proven to cause irreversible myocardial damage, resembling that of acute coronary syndrome (ACS). The etiology of TTS is still uncertain but may be associated with catecholamine elevations during times of emotional or physical stress. Catecholamines are also understood to have prothrombotic properties, which could lead to ACS. With these similarities, differentiating these two pathologies can be difficult, especially when TTS and ACS occur simultaneously.
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Ognjenović, Areta. "Nursing interventions in the treatment of syndrome Takotsubo // Zadaci kardiološke medicinske sestre u lečenju Takotsubo sindroma." SESTRINSKI ŽURNAL 5, no. 1 (November 28, 2018): 45. http://dx.doi.org/10.7251/sez0118045o.
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Takostube syndrome (TS; broken heart syndrome) is described as transient reversible cardiomyopathy that occurs in older women in most cases as a result of mental or psychological suffering. It is associated with various disorders and it is defined as Takotsubo Syndrome (TS). The clinical picture is similar to acute coronary syndrome, but it must differ from acute ischemic heart disease. Ethiopathological factors have not been fully clarified, but the main role in the development of TS by catecholamine-induced spiking myocardial capillaries or the direct toxicity of catecholamines themselves.There are no strict guidelines in the implementation of health care for patients with TS. Given the great similarity in the clinical picture between acute myocardial infarction and TS, the same procedures and tasks are used in practice as in patients with acute myocardial infarction with ST elevation, while coronarography does not prove to be the opposite. The patient under suspicion of diagnosis of TS is admitted to the coronary unit.Healthcare goals for the treatment of patients with TS are identical to those in acute coronary syndrome and include: pain relief, tension reduction - anxiety, preservation of myocardial function, and prevention and treatment of complications.
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Andronic, Gheorghe, Oana-Petronela Oancea, Alexandru-Dan Costache, Ovidiu Mitu, and Florin Mitu. "Takotsubo Syndrome." Internal Medicine 19, no. 3 (September 1, 2022): 61–67. http://dx.doi.org/10.2478/inmed-2022-0220.
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Abstract Takotsubo syndrome occurs in 1-2% of patients admitted in the emergency department with suspicion of ST-segment elevation myocardial infarction (STEMI), over 90% being postmenopause women. Psycho-emotional or physical stress is the main trigger that causes the release of catecholamines, with an important role in the pathophysiology of Takotsubo cardiomyopathy. In most cases, supportive and symptomatic treatment is sufficient, with a dynamic follow-up of the left ventricular (LV) function. Usually, a complete recovery occurs in 3-4 weeks. We are presenting the case of a 67-year-old patient with a severe angina attack which occuredafter a major psycho-emotional stress, with an electrocardiographic appearance of an anterior STEMI and echocardiographic apical ballooning, both compatible with Takotsubo syndrome. Coronary angiography showed a muscle bridge with a systolic compression of 75% on the anterior descending artery (ADA). The evolution was marked by the occurrence of cardiogenic shock remitted under treatment, with complete recovery of LV systolic function. The particularity of the case resides in an acute coronary syndrome (ACS) after a psycho-emotional stress associated with a muscular bridge, as well as the appearance of the cardiogenic shock.
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Demea, Anca Diana, Dan-Grigore Dunca, Roxana Adina Radu, and Lucia Agoșton-Coldea. "TAKOTSUBO SYNDROME INDUCED BY MALIGNANT PHEOCHROMOCYTOMA IN A PATIENT WITH TYPE 2 PAPILLARY RENAL CELL CARCINOMA – A CASE REPORT." Medicine and Pharmacy Reports 91, no. 2 (April 26, 2018): 242–44. http://dx.doi.org/10.15386/cjmed-920.
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The clinical presentation of the Takotsubo syndrome mimics an acute coronary syndrome with chest pain, ischemia-like ECG changes, mild to moderate myocardial enzyme elevation, and apical ballooning on echocardiography and ventriculography. On coronary angiography, epicardial coronary arteries are either normal or exhibit minimal atherosclerotic changes. Primary Takotsubo syndrome usually occurs in postmenopausal women in whom symptoms are triggered by emotional or physical stress, associated with catecholamine surges. Secondary Takotsubo syndrome may have multiple causes, including an increased catecholamine release due to pheochromocytoma.We present the case of a 56-years-old woman with confirmed Takotsubo syndrome who was later diagnosed with pheochromocytoma and type 2 papillary renal cell carcinoma.
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Fan, Xuehui, Guoqiang Yang, Jacqueline Kowitz, Ibrahim Akin, Xiaobo Zhou, and Ibrahim El-Battrawy. "Takotsubo Syndrome: Translational Implications and Pathomechanisms." International Journal of Molecular Sciences 23, no. 4 (February 10, 2022): 1951. http://dx.doi.org/10.3390/ijms23041951.
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Takotsubo syndrome (TTS) is identified as an acute severe ventricular systolic dysfunction, which is usually characterized by reversible and transient akinesia of walls of the ventricle in the absence of a significant obstructive coronary artery disease (CAD). Patients present with chest pain, ST-segment elevation or ischemia signs on ECG and increased troponin, similar to myocardial infarction. Currently, the known mechanisms associated with the development of TTS include elevated levels of circulating plasma catecholamines and their metabolites, coronary microvascular dysfunction, sympathetic hyperexcitability, inflammation, estrogen deficiency, spasm of the epicardial coronary vessels, genetic predisposition and thyroidal dysfunction. However, the real etiologic link remains unclear and seems to be multifactorial. Currently, the elusive pathogenesis of TTS and the lack of optimal treatment leads to the necessity of the application of experimental models or platforms for studying TTS. Excessive catecholamines can cause weakened ventricular wall motion at the apex and increased basal motion due to the apicobasal adrenoceptor gradient. The use of beta-blockers does not seem to impact the outcome of TTS patients, suggesting that signaling other than the beta-adrenoceptor-associated pathway is also involved and that the pathogenesis may be more complex than it was expected. Herein, we review the pathophysiological mechanisms related to TTS; preclinical TTS models and platforms such as animal models, human-induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) models and their usefulness for TTS studies, including exploring and improving the understanding of the pathomechanism of the disease. This might be helpful to provide novel insights on the exact pathophysiological mechanisms and may offer more information for experimental and clinical research on TTS.
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Zerhoudi, R., I. Essaket, K. Bourzeg, A. Zbitou, and A. Bouzerda. "Apical Ballooning Syndrome: A Cardiac Syndrome Mimicking Acute Myocardial Infarction." Scholars Journal of Medical Case Reports 10, no. 10 (October 4, 2022): 999–1006. http://dx.doi.org/10.36347/sjmcr.2022.v10i10.003.
Full textAbstract:
Introduction: Apical ballooning syndrome, Takotsubo cardiomyopathy, or broken heart syndrome, is a rare but currently well recognized clinical entity. It occurs after severe emotional or physical stress, most often in postmenopausal women, and mimics the symptoms and signs of acute coronary syndrome, in the absence of significant coronary injury. This cardiomyopathy is rapidly and completely reversible. The exact pathophysiological mechanism of the condition remains debated; several hypotheses have been put forward, the most credible of which seems to be a sudden hyperadrenergic reaction related to stress. Objective: To report the case of a patient with clinical features of possible myocardial infarction but diagnosed as Takotsubo cardiomyopathy. Case Report: The patient was a 64-year-old woman with no cardiovascular risk factors other than age and menopause, and no particular pathological history. She was admitted on Day 3 with infarct-like chest pain, which appeared following an episode of emotional stress, associated with NYHA stage III dyspnea. On admission, the patient was pain free. The clinical examination found a conscious patient, hemodynamically and respiratory stable, apyretic. The cardiovascular examination was unremarkable. The ECG was in sinus rhythm, showing a QS aspect in the anterosepto-apical area associated with negative T waves in the inferolateral area. The biological workup showed an inflammatory syndrome, with positive troponin at 650ng/l. The thoracic echocardiography showed an aspect of hypokinetic cardiopathy at the dilated stage with severe LV dysfunction (LVEF at 38%), a thin and flexible mitral valve with restriction of the small mitral valve with moderate mitral insufficiency (SOR at 20 cm2 and RV at 19 ml), a dilated left atrium. Coronary angiography showed angiographically healthy coronary arteries, and an MRI was performed, confirming the diagnosis of Takutsbo cardiomyopathy. Discussion and Conclusion: Takotsubo cardiomyopathy is an increasingly recognized clinical entity, characterized by apical left ventricular dysfunction with chest pain, electrocardiographic changes, minimal biomarker changes, and no coronary lesions. In most cases, an episode of emotional or physical stress precedes the event. Its pathophysiological mechanism remains unknown, but high circulating catecholamines seem to be the triggering factor and the most plausible explanation for this primary acquired cardiomyopathy. It is important to be aware of this diagnosis in patients presenting with ACS because its evolution is most often spontaneously favorable.
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Shilova, A. S., A. O. Shmotkina, A. A. Yafarova, and M. Yu Gilyarov. "Takotsubo Syndrome: Contemporary Views on the Pathogenesis, Prevalence and Prognosis." Rational Pharmacotherapy in Cardiology 14, no. 4 (September 4, 2018): 598–604. http://dx.doi.org/10.20996/1819-6446-2018-14-4-598-604.
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Takotsubo syndrome (TTS) is a reversible left ventricular dysfunction characterized by local apical hypokinesia usually triggered by a physical or emotional stress. According to the last available data TTS may represent 2% of all admissions for acute coronary syndromes. Despite the reliable prevalence, diagnosis of TTS remains difficult. The initial presentation, both clinically and electrocardiographically, is similar to an acute myocardial infarction (AMI). The biomarker profile is also similar, although the peaks of troponin and creatinine kinase levels are lower, and brain natriuretic peptide levels are higher in patients with TTS compared with ST-segment elevation AMI. Modified Mayo diagnostic criteria are the most common for the diagnosis. Pathogenesis of TTS currently is not well understood. Catecholamines appear to play a central role in the pathophysiology of TTS. However, it is conceivable that some people have a genetic predisposition to stress-induced TTS. A genetic predisposition has been suggested based on the few familial TTS cases described. Despite reversible myocardial dysfunction, acute heart failure is the most common complication in the acute phase of TTS. In-hospital mortality rate is comparable to that of ST-segment elevation AMI. There are no randomized clinical trials to support specific treatment recommendations in TTS. It is believed that the tactics of managing patients with TTS hospitalized with suspicion of acute coronary syndrome should comply with the protocol of management of patients with AMI while acute coronary pathology is not excluded.
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Sachdev, Esha, C. Noel Bairey Merz, and Puja K. Mehta. "Takotsubo Cardiomyopathy." European Cardiology Review 10, no. 1 (2015): 25. http://dx.doi.org/10.15420/ecr.2015.10.01.25.
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Takotsubo cardiomyopathy (TTC) is an acute, stress-induced cardiomyopathy with an increased prevalence in post-menopausal women. The syndrome is most frequently precipitated by an acute emotional or physical stressor and mimics acute myocardial infarction with symptoms, electrocardiogram (ECG) changes and cardiac troponin elevation that are indistinguishable from those caused by plaque rupture or coronary thrombosis. Diagnosis of TTC is made when coronary angiography reveals no obstructive coronary artery disease and the left ventricle demonstrates apical ballooning and basal hypercontractility. Other ventricular patterns have also been described. An abnormal myocardial response to the catecholamine surge from an emotional or a physical stressor is implicated in the pathophysiology, but the reasons for the high prevalence of TTC presentations in post-menopausal women are unknown. Several mechanisms including multi-vessel coronary vasospasm, endothelial and coronary microvascular dysfunction and direct catecholamine toxicity have been proposed. No specific guidelines for treatment of TTC have been established, but treatment is based on the American Heart Association/ American College of Cardiology guidelines for acute coronary syndrome/acute myocardial infarction and heart failure guidelines. In this review article, we discuss the characteristic clinical presentation of TTC and the commonly proposed mechanisms.
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Younger, Holly. "A review of Takotsubo (broken-heart) syndrome." British Journal of Cardiac Nursing 15, no. 12 (December 2, 2020): 1–6. http://dx.doi.org/10.12968/bjca.2020.0095.
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Background/aims Approximately 2500 people each year in the UK are affected by Takotsubo syndrome. The syndrome is linked to stress and has a higher incidence in women. With a growing population, the number of cases is set to rise. This article examines risk factors and possible causes of Takotsubo syndrome, such as transient ischaemia, catecholamine levels, oestrogen levels and coronary artery spasm. Issues around accurate diagnosis and treatment options are also discussed. Methods A literature review was carried out using online databases such as CINAHL and BNI, incorporating international journals from the year 2000 onwards, to give a broad spectrum of information. Results It is clear from the literature review that Takotsubo syndrome is still widely misunderstood, which can lead to misdiagnosis and incorrect treatment. There are many theories as to the cause of Takotsubo syndrome, but no definitive answer. Conclusions Further research around Takotsubo syndrome is needed to minimise misdiagnosis. Further studies into ECG and troponin changes associated with Takotsubo syndrome may make it possible for Takotsubo syndrome to be diagnosed on admission and not mistaken for acute coronary syndrome.
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Sheppard, Mary N. "Takotsubo Syndrome — Stress-induced Heart Failure Syndrome." European Cardiology Review 10, no. 2 (2015): 83. http://dx.doi.org/10.15420/ecr.2015.10.2.83.
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Takotsubo syndrome has been established as an entity in the past 30 years, particularly with the introduction of interventional angiography for investigation of chest pain. Typically, it occurs in middle-aged females as a response to a stressful event, such as bad news, death, accident, natural disaster, etc. but there is not always a specific trigger. Takotsubo mimics acute myocardial infarction with electrocardiogram changes and elevated troponins. On interventional angiography the coronary arteries are normal with typical apical ballooning of the left ventricle. This feature led to its descriptive name, given by Japanese cardiologists, as the left ventricle resembles a lobster trap with a narrow neck extending into a round ventricle. This leads to a reduction in cardiac function. Takotsubo is believed to be a response to catecholamine release following a stressful event resulting in temporary myocardial damage. It usually has a benign course with spontaneous return of cardiac function. However it may recur and in a small percentage of patients can result in sudden cardiac death with arrhythmia, acute myocardial infarction and cardiac rupture. It is usually treated symptomatically depending on the severity of presentation.
Dissertations / Theses on the topic "Takotsubo Syndrome, acute coronary syndrome, catecholamines"
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Ong, Gao Jing. "Takotsubo Syndrome: Precipitants, Clinical Course and Emerging Treatments." Thesis, 2022. https://hdl.handle.net/2440/136031.
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Introduction Clinically, patients with Takotsubo Syndrome(TTS) presents similarly to that of acute coronary syndromes(ACS). Recent evidence has demonstrated that not only is TTS a common condition, like ACS, it is also associated with significant morbidity and mortality in the short- and long-term. It is now also recognised that there are various precipitants and risk factors of TTS, and like ACS, this list continues to grow. However, the exact pathophysiology, natural history, as well as treatment options for TTS remain incompletely understood. The studies described in this thesis were carried out to delineate a number of aspects of the precipitation, complications and potential treatment of TTS. Methods We investigated (a)novel risk/precipitating factors for ACS and TTS, (b)prognostic impact of variability in severity of attacks of acute TTS and the rate of myocardial recovery, and (c)pharmacological strategies for limiting severity of acute attacks, as well as accelerating the recovery in TTS. We sought correlations of high ambient temperatures, pollution, and proximity to bushfires(as individual and cumulative stressors) with the incidence of ACS and TTS. We also investigated the impacts of exogenous catecholamines and catecholamine-potentiating drugs(CPD) on TTS. In regards to the impacts of variable severity of acute attacks of TTS, we sought correlations between severity of TTS attacks and the incidence of hypotension acutely, as well as the recovery in quality of life at 3 months’ follow up. Finally, we designed a double-blinded randomised controlled trial to help determine pharmacological strategies for the treatment of TTS. Novel risk/precipitating factors: Incidence of ACS increased with not only increased ambient temperatures in warmer months of the year(rs=0.26, p=0.005), but also in the presence of high ambient temperatures, pollution and bushfires in combination(rs=0.25,p=0.005). We found no significant analogous correlations with TTS presentations however, with the caveat of small numbers. We also found that precipitation of TTS in association with drug-induced incremental catecholamine exposure was common(18% of total case-load), and associated with a non-significant trend(log rank X2=2.3, p=0.13) towards increased long-term mortality. Impacts of variable severity of acute attacks of TTS: Hypotension/shock occurred commonly(35%) in TTS patients acutely, and correlated with markers of attack severity including lower LVEF(p=0.009), higher plasma troponin-T(p=0.008) and NT-proBNP concentrations(p=0.046). Hypotension/shock was also a strong predictor of in-hospital mortality(p<0.001). However, the magnitude of acute TTS attacks did not significantly correlate with quality of life after 3 months. Design of randomised controlled trial: We utilised N-acetylcysteine(NAC) acutely, a potent anti-oxidant and a source of hydrogen sulphide to limit nitrosative stress, and then an ACE inhibitor(ramipril), due to its anti-inflammatory properties. Recruitment for NACRAM is now advanced, but treatment allocation remains blinded. Conclusions Our understanding of the differential pathophysiology of ACS and TTS continue to evolve and grow. We have confirmed that TTS is not only associated with both substantial mortality in the short-(especially in the presence of hypotension) and long-term, and also that TTS leads to significant morbidity in the long-term. Whilst the NACRAM clinical trial represents the first prospective therapeutic investigation in TTS, additional future studies are also needed to develop interventions to prevent the occurrence and recurrence of TTS.Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2022
Books on the topic "Takotsubo Syndrome, acute coronary syndrome, catecholamines"
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Lancellotti, Patrizio, and Bernard Cosyns. Cardiomyopathies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713623.003.0008.
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This chapter focuses on the role of echocardiography in dilated cardiomyopathy, showing diagnostic and associated findings along with the prognostic role of echocardiography. Primary myocardial disease is inadequate hypertrophy, independent of loading conditions and often other affected structures such as mitral valve apparatus, small coronary arteries, and cardiac interstitium. Arrhythmogenic RV cardiomyopathy is fatty or fibro-fatty infiltration of the RV with apoptosis and hypertrophied trabeculae of the RV. This chapter also details diagnostic findings and progression of this condition alongside relevant echocardiographic findings. Previously known as ‘spongy heart syndrome’, left ventricular non compaction is characterized by the absence of involution of LV trabeculae during the embryogenic process. This chapter demonstrates the diagnostic findings of this condition, and looks at the diagnostic findings and complications of Takotsubo cardiomyopathy, illustrating typical, RV apical and variant views. It also shows diagnostic findings in myocarditis in both the acute phase and follow-up.
Book chapters on the topic "Takotsubo Syndrome, acute coronary syndrome, catecholamines"
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Lyon, Alexander, Mark Sweeney, and Elmir Omerovic. "Takotsubo syndrome." In The ESC Handbook on Cardiovascular Pharmacotherapy, edited by Alexander Niessner, Sven Wassmann, and Udo Sechtem, 123–40. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198759935.003.0008.
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Takotsubo syndrome is an acute heart failure syndrome characterized by acute, reversible ventricular dysfunction, often in response to a physical or an emotional stressor. Takotsubo syndrome mimics acute myocardial infarction, presenting as chest pain or breathlessness, with electrocardiographic changes and troponin elevation, but with no explanatory coronary artery lesions on coronary angiography. It is increasingly commonly recognized in recent years as a cause of acute chest pain presentations. Although the majority of patients have a good prognosis following an episode of Takotsubo syndrome, it is becoming apparent that there is a significant burden of morbidity and mortality associated with this condition. The pathophysiology is likely to relate to an acute surge of catecholamines in response to stress, which results in multiple effects on the myocardium and vascular system. Currently, trial evidence is lacking, and management is based on clinical opinion, with optimal supportive care and avoidance of catecholamines as the mainstay of treatment in the acute phase. Non-catecholamine-related inotropes, such as levosimendan, have been reported in patients who require inotropic support, with anecdotal success. However, early consideration of referral to specialist centres for mechanical circulatory support is important in these severe cases. Evidence for medication to minimize recurrence is limited. Some observational data suggest angiotensin-converting enzyme inhibitors and beta-blockers may be beneficial in reducing mortality and preventing recurrence. However, there are no prospective data to inform treatment, and current management is guided by expert consensus.
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Madias, John E. "Management of takotsubo syndrome." In ESC CardioMed, 1305–7. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0322.
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The pathophysiology of takotsubo syndrome (TTS) is still elusive. Management is non-specific, extrapolated from established treatments for patients with acute coronary syndromes, and heart failure, or other medical or surgical conditions. The mainstay of therapy consists of the use of aspirin, beta blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), diuretics, and anticoagulation. Anticoagulation may be needed not only for evident intracardiac thrombus, but also for severe cardiac wall motion abnormalities. Severe heart failure or cardiogenic shock may necessitate the use of levosimendan, an inotropic agent and a calcium sensitizer, and the implementation of extracorporeal membrane oxygenator, or external cardiac assist devices. Inotropic catecholamines should be used sparingly, particularly in the presence of left ventricular outflow tract obstruction, although their use occasionally becomes inevitable in the presence of severe heart failure or cardiogenic shock. Pericardial tamponade and left ventricular free wall and septal perforations are managed as done routinely. Transcatheter repair has been employed successfully for ventricular septal perforation. Management of atrial fibrillation should follow established principles, and vigilance should be exercised for ventricular arrhythmias, particularly in connection with a prolonged QTc interval. Rarely, for persisting atrioventricular blocks or recurrent ventricular arrhythmias, cardiac electronic implanted devices may be necessary. There are no proven therapies to prevent recurrence of TTS; ACEIs/ARBs, but not beta blockers, have been linked to improved survival at 1-year post discharge. Since TTS is not a benign syndrome, it is hoped that specific management will emerge based on data from controlled randomized clinical trials or large international TTS registries.
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Madias, John E. "Management of takotsubo syndrome." In ESC CardioMed, 1305–7. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0322_update_001.
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The pathophysiology of takotsubo syndrome (TTS) is still elusive. Management is non-specific, extrapolated from established treatments for patients with acute coronary syndromes, and heart failure, or other medical or surgical conditions. The mainstay of therapy consists of the use of aspirin, beta blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), diuretics, and anticoagulation. Anticoagulation may be needed not only for evident intracardiac thrombus, but also for severe cardiac wall motion abnormalities. Severe heart failure or cardiogenic shock may necessitate the use of levosimendan, an inotropic agent and a calcium sensitizer, and the implementation of extracorporeal membrane oxygenator, or external cardiac assist devices. Inotropic catecholamines should be used sparingly, particularly in the presence of left ventricular outflow tract obstruction, although their use occasionally becomes inevitable in the presence of severe heart failure or cardiogenic shock. Pericardial tamponade and left ventricular free wall and septal perforations are managed as done routinely. Transcatheter repair has been employed successfully for ventricular septal perforation. Management of atrial fibrillation should follow established principles, and vigilance should be exercised for ventricular arrhythmias, particularly in connection with a prolonged QTc interval. Rarely, for persisting atrioventricular blocks or recurrent ventricular arrhythmias, cardiac electronic implanted devices may be necessary. There are no proven therapies to prevent recurrence of TTS; ACEIs/ARBs, but not beta blockers, have been linked to improved survival at 1-year post discharge. Since TTS is not a benign syndrome, it is hoped that specific management will emerge based on data from controlled randomized clinical trials or large international TTS registries.
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Citro, Rodolfo, and Eduardo Bossone. "Diagnostic testing in takotsubo syndrome." In ESC CardioMed, 1294–98. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0319.
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At onset, takotsubo syndrome (TTS) resembles the clinical picture of an acute coronary syndrome. The most frequent electrocardiographic findings are ST-segment elevation, T-wave inversion, and Q waves. The detection of ST-segment depression in lead aVR is associated with high specificity with TTS and can be useful for early suspicion. Although increased serum troponin levels are reported in about 90% of patients, the concentrations of troponin and other cardiac necrosis enzymes are usually lower in TTS than in acute myocardial infarction. Transthoracic echocardiography is the first-line non-invasive imaging modality in the acute phase showing a depressed left ventricular (LV) ejection fraction, which recovers within few days or weeks. LV wall motion abnormalities extend beyond the territory of distribution of a single coronary artery and involve symmetrically the LV walls (‘circumferential pattern’). Echocardiography also provides additional information regarding the presence of reversible significant mitral regurgitation, LV outflow tract obstruction, right ventricular involvement, and intraventricular thrombi. Coronary angiography is the cornerstone of diagnosis since TTS is characterized by the absence of atherothrombotic lesions of the epicardial coronary arteries. Coronary computed tomography angiography is an alternative to coronary angiography only in stable and pain-free patients showing the typical features of TTS, especially if coronary angiography is not readily available. Cardiac magnetic resonance is useful in patients with poor acoustic windows or with suspected TTS and incomplete LV myocardial function recovery during follow-up, helping to exclude a different aetiology. Nuclear imaging tests can be performed for prognostic purposes during the acute and subacute phase.
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Wittstein, Ilan. "Clinical presentation of takotsubo syndrome." In ESC CardioMed, 1288–94. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0318.
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Takotsubo syndrome (TTS), also known as stress cardiomyopathy, left ventricular apical ballooning syndrome, and broken heart syndrome, is a syndrome of acute heart failure and transient ventricular dysfunction that is frequently precipitated by acute emotional or physical stress. A wide variety of emotional and physical stressors have been associated with this syndrome, and while acute stress is temporally related to syndrome onset in the majority of patients, a subset of patients have no identifiable antecedent trigger at the time of presentation. The syndrome has a striking predilection for older postmenopausal women, though it has been reported in men and in younger patients as well. The incidence of TTS is higher than initially thought and accounts for up to 5–10% of women presenting with a suspected acute coronary syndrome. Several groups have proposed variable criteria for the diagnosis of TTS, but universally accepted criteria are currently lacking. While patients with TTS typically present with chest pain, dynamic electrocardiographic changes, and elevated cardiac biomarkers, characteristic features of the syndrome that help to distinguish it from an acute myocardial infarction include the absence of plaque rupture and coronary thrombosis, unique patterns of ventricular dysfunction that typically involve more than one vascular territory, and rapid and complete recovery of ventricular systolic function. While the prognosis associated with TTS is generally favourable, the condition is not benign and has been associated with serious complications such as cardiogenic shock, thromboembolic events, and life-threatening arrhythmias. This chapter will highlight the clinical features that characterize TTS and that are central to its diagnosis.
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Wittstein, Ilan. "Clinical presentation of takotsubo syndrome." In ESC CardioMed, 1288–94. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0318_update_001.
Full textAbstract:
Takotsubo syndrome (TTS), also known as stress cardiomyopathy, left ventricular apical ballooning syndrome, and broken heart syndrome, is a syndrome of acute heart failure and transient ventricular dysfunction that is frequently precipitated by acute emotional or physical stress. A wide variety of emotional and physical stressors have been associated with this syndrome, and while acute stress is temporally related to syndrome onset in the majority of patients, a subset of patients have no identifiable antecedent trigger at the time of presentation. The syndrome has a striking predilection for older postmenopausal women, though it has been reported in men and in younger patients as well. The incidence of TTS is higher than initially thought and accounts for up to 5–10% of women presenting with a suspected acute coronary syndrome. Several groups have proposed variable criteria for the diagnosis of TTS, but universally accepted criteria are currently lacking. While patients with TTS typically present with chest pain, dynamic electrocardiographic changes, and elevated cardiac biomarkers, characteristic features of the syndrome that help to distinguish it from an acute myocardial infarction include the absence of plaque rupture and coronary thrombosis, unique patterns of ventricular dysfunction that typically involve more than one vascular territory, and rapid and complete recovery of ventricular systolic function. While the prognosis associated with TTS is generally favourable, the condition is not benign and has been associated with serious complications such as cardiogenic shock, thromboembolic events, and life-threatening arrhythmias. This chapter will highlight the clinical features that characterize TTS and that are central to its diagnosis.
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Prasad, Abhiram. "Incidence and definition of takotsubo syndrome." In ESC CardioMed, 1278–80. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0314.
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Takotsubo syndrome (TTS) is also commonly known as apical ballooning syndrome and stress cardiomyopathy. The incidence of TTS has consistently been estimated to be close to 2% of all patients presenting with an initial diagnosis of an acute coronary syndrome, and perhaps as high as about 5% of women. TTS is a diagnosis of exclusion and in the absence of a diagnostic test, there is the need for diagnostic criteria. The Mayo Clinic diagnostic criteria are the most widely cited. The Heart Failure Association of the European Society of Cardiology published the most recent criteria in 2015.
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Prasad, Abhiram. "Incidence and definition of takotsubo syndrome." In ESC CardioMed, 1278–80. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0314_update_001.
Full textAbstract:
Takotsubo syndrome (TTS) is also commonly known as apical ballooning syndrome and stress cardiomyopathy. The incidence of TTS has consistently been estimated to be close to 2% of all patients presenting with an initial diagnosis of an acute coronary syndrome, and perhaps as high as about 5% of women. TTS is a diagnosis of exclusion and in the absence of a diagnostic test, there is the need for diagnostic criteria. The Mayo Clinic diagnostic criteria are the most widely cited. The Heart Failure Association of the European Society of Cardiology published criteria in 2015. An update to this chapter includes the most recent criteria from 2018.
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"Acute Chest Pain." In Manual of Cardiovascular Medicine, edited by Thomas F. Lüscher, 85–90. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198850311.003.0010.
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Chest pain is a very common symptom and may be due to ischaemia related to coronary artery disease (i.e. angina pectoris), takotsubo syndrome, perimyocarditis, aortic dissection, oesophageal spasms, pulmonary embolism with pleuritis, musculo-skeletal pain, or psychosomatic disturbances. Management involves clinical assessment, ECG, and diagnostic tests, such as biomarkers, imaging, and eventually coronary angiography. Acute chest pain can be life-threatening and should be evaluated urgently and in a comprehensive manner.
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Taiwo, Shogade, and Akpabio Akpabio. "Overview of the Global Prevalence and Diagnostic Criteria of Takotsubo Syndrome." In Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions. IntechOpen, 2021. http://dx.doi.org/10.5772/intechopen.93319.
Full textAbstract:
Takotsubo syndrome (TTS) is an acute and reversible abnormal condition of the heart also known as stress cardiomyopathy, apical ballooning syndrome, or broken heart syndrome. It is an uncommon disease that mostly occurs among Asians though studies have shown its occurrence in other parts of the world. The typical takotsubo syndrome patient has a unique circumferential left ventricular contraction abnormality that extends beyond a coronary artery supply territory and appears to follow the anatomical cardiac sympathetic innervation.
Conference papers on the topic "Takotsubo Syndrome, acute coronary syndrome, catecholamines"
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Melo, Isadora Vieira de, Eduardo Guimarães Lacerda, Gustavo de Freitas Mendonça Gontijo, Hugo Haran Souza Andrade, Marlon Séles de Paula, Matheus Fernandes Alves dos Reis, Renato Tales Gomes, et al. "Case report: Takotsubo cardiomyopathy in a patient with Alzheimer’s disease." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.425.
Full textAbstract:
Context: The Takotsubo cardiomyopathy (TTC) is an acute cardiac dysfunction, clinically similar to myocardial ischemia, more common in postmenopausal women and related to emotional stress. Case report: A 71-year-old female patient, with Alzheimer’s disease (AD), sought emergency care after severe chest pain. Electrocardiogram showed ST segment elevation in the anteroseptal wall. Physical exam: HR=108bpm, PA=126x78mmHg, SaO2=6%. Complementary exams showed a mild lesion in the middle third of the anterior descending artery, moderate impairment of left ventricular (LV) function by apical aneurysm without thrombi, mitral prolapse with mild reflux and an ejection fraction of 37%, suspecting of TTC. Conclusions: TTC is defined as a transient, usually reversible and segmental LV dysfunction, configuring a differential diagnosis of acute coronary syndrome. An overactivation of the sympathetic autonomic nervous system can cause catecholamine toxicity to the heart. Although several studies show a lower emotional response capacity in patients with cognitive impairment, more recent studies suggest that this emotional responsiveness is not so affected by dementia. Therefore, patients with AD may be susceptible to developing TTC, both because of the multiple drugs that they are exposed, increasing catecholamine levels, and because of the disease itself, that represents a stressful context. Thus, TTC is often associated with emotional stress and should not be overlooked in patients with AD.