Concept: Takotsubo cardiomyopathy
Takotsubo syndrome (TTS) is characterized by an acute left ventricular dysfunction and is associated with life-threating complications in the acute phase. The underlying disease mechanism in TTS is still unknown. A genetic basis has been suggested to be involved in the pathogenesis.
Takotsubo cardiomyopathy is seen, though rarely, in anaphylaxis treated with epinephrine. Stress cardiomyopathy is most likely to occur in middle-aged women. The underlying etiology is believed to be related to catecholamine release in periods of intense stress. Catecholamines administered exogenously, and those secreted by neuroendocrine tumors (e.g., pheochromocytoma) or during anaphylaxis have been reported to cause apical ballooning syndrome, or takotsubo syndrome. However, reverse takotsubo stress cardiomyopathy is rarely seen or reported in anaphylaxis treated with epinephrine.
Although Takotsubo cardiomyopathy (TC) generally occurs after a stressful event out-of-hospital, it occasionally occurs secondary to acute medical illness after hospital admission. No study has examined and compared patient backgrounds and in-hospital outcomes between patients with out-of-hospital TC and those with in-hospital TC.
Stress induced cardiomyopathy (SIC) is becoming increasingly described as an underdiagnosed complication during common medical procedures. Reverse Takotsubo cardiomyopathy (RTC) is a variant of SIC that involves the basal and mid-ventricular segments and spares the apical segments. The authors present a rare case of RTC, following an inadvertent intrathecal injection during percutaneous epidural neuroplasty. Although the precise mechanism involved remains unclear, the direct neurohumoral effects of the hyperbaric anaesthetics and adhesiolytics appear to have resulted in a catecholamine surge and myocardial stunning that precipitated the SIC.
Capture myopathy (CM) syndromes in wildlife may be a model for human stress cardiomyopathy, including Takotsubo cardiomyopathy. Emotional stress or grief may trigger heart attack-like symptoms, and occasionally, sudden death in some humans. Similarly, wildlife exposed to predatory stresses, chase, or capture occasionally results in sudden death. To better understand the nature of vulnerability to stress-induced sudden death, we studied cases of CM in hooved mammals-ungulates–and hypothesized that CM would be associated with a syndrome of longevity-related traits.
Takotsubo stress cardiomyopathy (TSC) is a syndrome characterized by transient myocardial dysfunction with unknown etiology. Although recent studies have suggested that the syndrome is associated with comorbidity and has a dismal prognosis, there is a lack of comprehensive data describing the epidemiology and prognosis of TSC.
Neurocardiology is an emerging specialty that addresses the interaction between the brain and the heart, that is, the effects of cardiac injury on the brain and the effects of brain injury on the heart. This review article focuses on cardiac dysfunction in the setting of stroke such as ischemic stroke, brain hemorrhage, and subarachnoid hemorrhage. The majority of post-stroke deaths are attributed to neurological damage, and cardiovascular complications are the second leading cause of post-stroke mortality. Accumulating clinical and experimental evidence suggests a causal relationship between brain damage and heart dysfunction. Thus, it is important to determine whether cardiac dysfunction is triggered by stroke, is an unrelated complication, or is the underlying cause of stroke. Stroke-induced cardiac damage may lead to fatality or potentially lifelong cardiac problems (such as heart failure), or to mild and recoverable damage such as neurogenic stress cardiomyopathy and Takotsubo cardiomyopathy. The role of location and lateralization of brain lesions after stroke in brain-heart interaction; clinical biomarkers and manifestations of cardiac complications; and underlying mechanisms of brain-heart interaction after stroke, such as the hypothalamic-pituitary-adrenal axis; catecholamine surge; sympathetic and parasympathetic regulation; microvesicles; microRNAs; gut microbiome, immunoresponse, and systemic inflammation, are discussed.
- Canadian journal of anaesthesia = Journal canadien d'anesthesie
- Published about 2 years ago
Takotsubo cardiomyopathy (TTCM) is a form of stress cardiomyopathy that may occur in the perioperative period and among the critically ill. Therefore, anesthesiologists should be aware of its diagnosis and treatment. The aim of this narrative review is describe the features of TTCM and its relevance to the practice of anesthesiology.
Takotsubo cardiomyopathy (TC) is believed to be an increasingly diagnosed syndrome; however, data on its incidence are limited. The purpose of this study was to determine the reported incidence of TC in the United States and to examine its trend over several years. Data was obtained from the Nationwide Inpatient Sample, created by the Agency for Healthcare Research and Quality, for each of the years from 2006 to 2012. Hospital discharges with principal diagnosis of TC, identified using Internal Classification of Diseases, Ninth Revision, code 429.83, were included. We tabulated estimated total numbers of discharges, incidence per 100,000 persons, mean length of stay, inhospital death rates, and diagnoses stratified by age group and gender. The reported incidence of TC based on principal diagnosis at hospital discharge increased significantly over the study period, with 315 cases ± 43 (standard error) in 2006 and 6,230 cases ± 232 (standard error) in 2012 (p <0.001 for trend). Mean length of hospital stay was stable over the study period (3.4 days in 2006 vs 3.6 days in 2012; p = 0.74 for trend). The diagnosis was most frequent in patients aged 65 to 84 years (50% of all diagnoses in 2012), followed by those aged 45 to 64 years (39% of all diagnoses in 2012). Women accounted for >90% of diagnoses throughout the study period. In conclusion, the reported incidence of TC has increased significantly from 2006 to 2012, most likely because of increasing recognition of the syndrome.
Recent hypotheses have suggested the pathophysiological role of catecholamines in the evolution of the Takotsubo syndrome (TTS). The extent of cardiac and circulatory compromise dictates the use of some form of supportive therapy. This study was designed to investigate the clinical outcomes associated with catecholamine use in TTS patients.