An autopsy case of left ventricular apical ballooning probably caused by pheochromocytoma with persistent ST-segment elevation

Ueda, Hiroyasu; Hosokawa, Yoshiya; Tsujii, Ui; Miyawaki, Masami; Mitsusada, Nobuhiro; Yasuga, Yuji; Hiraoka, Hisatoyo; Nakatsuka, Shin‐ichi

doi:10.1016/j.ijcard.2009.03.096

Cited by 18 publications

(9 citation statements)

References 6 publications

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“…The most widely accepted hypothesis suggests that TTC is caused by an excessive release of catecholamines after exposure to emotional or physical stress, 10,30,32 resulting in catecholamine-induced myocardial stunning. 33 Similar regional wall motion abnormalities have been observed in patients with high catecholamine levels due to pheochromocytoma 34,35 and subarachnoid hemorrhage. 36,37 Moreover, in a rat model of TTC, ST segment elevation and regional left ventricular dysfunction due to immobilization stress could be prevented by a-adrenoreceptor and b-adrenoreceptor antagonists.…”

Section: Key Pointsmentioning

confidence: 66%

Gender-Related Differences in Takotsubo Cardiomyopathy

Athanasiadis

Sechtem

2013

Heart Failure Clinics

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Section: Key Pointsmentioning

confidence: 66%

Gender-Related Differences in Takotsubo Cardiomyopathy

Athanasiadis

Sechtem

2013

Heart Failure Clinics

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“…Furthermore, in 73% of patients with TS, the course of LAD does not fulfil the criteria of long wrap-around LAD [ 32 ]. Long-lasting (hours or even days) ST segment elevation in patients with TS also challenges the hypothesis of aborted myocardial infarction, in which rapid resolution of ST elevation after reperfusion is an important feature [ 33 , 34 ].…”

Section: Pathophysiologymentioning

confidence: 99%

Epidemiology, pathogenesis, and management of takotsubo syndrome

2017

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Takotsubo syndrome is a recently recognized acute cardiac disease entity with a clinical presentation resembling that of an acute coronary syndrome. The typical takotsubo syndrome patient has a unique circumferential left (bi-) ventricular contraction abnormality profile that extends beyond a coronary artery supply territory and appears to follow the anatomical cardiac sympathetic innervation. The syndrome predominantly affects postmenopausal women and is often preceded by emotional or physical stress. Patients with predisposing factors such as malignancy and other chronic comorbidities are more prone to suffer from takotsubo syndrome. The pathogenesis of takotsubo syndrome is elusive. Several pathophysiological mechanisms involving myocardial ischemia (multivessel coronary artery spasm, microvascular dysfunction, aborted myocardial infarction), left ventricular outlet tract obstruction, blood-borne catecholamine myocardial toxicity, epinephrine-induced switch in signal trafficking, and autonomic nervous system dysfunction have been proposed. The syndrome is usually reversible; nevertheless, during the acute stage, a substantial number of patients develop severe complications such as arrhythmias, heart failure including pulmonary edema and cardiogenic shock, thromboembolism, cardiac arrest, and rupture. Treatment of precipitating factors, predisposing diseases, and complications is fundamental during the acute stage of the disease. The epidemiology, pathogenesis, and management of takotsubo syndrome are reviewed in this paper.

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“…There may be dilatation or oedema in the distribution characteristic of an anatomical variant of Takotsubo syndrome, but if post-mortem examination is delayed then non-specific contraction may prevent this assessment. [46][47][48] A hypercontracted left ventricle at autopsy, with increased wall thickening, but a normal heart weight has been reported in the context of severe stress (death in systole). Contraction-band necrosis of individual myocytes with interstitial oedema and a mixed inflammatory cell infiltrate are described in this phenomenon.…”

Section: Pathologymentioning

confidence: 99%

Takotsubo Syndrome — Stress-induced Heart Failure Syndrome

Sheppard

2015

European Cardiology Review

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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.

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An autopsy case of left ventricular apical ballooning probably caused by pheochromocytoma with persistent ST-segment elevation

Cited by 18 publications

References 6 publications

Gender-Related Differences in Takotsubo Cardiomyopathy

Gender-Related Differences in Takotsubo Cardiomyopathy

Epidemiology, pathogenesis, and management of takotsubo syndrome

Takotsubo Syndrome — Stress-induced Heart Failure Syndrome

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