Biventricular Takotsubo syndrome in a patient with coronary abnormality and end-stage renal disease

Abstract

The Takotsubo syndrome is a clinical entity consisting of transient, regional left ventricular (LV) contraction abnormalities in the absence of signifi cant epicardial coronary artery disease. Patients usually present with acute hemodynamic deterioration following an emotional or physical stress. The Takotsubo syndrome is uncommon among patients with end-stage renal disease (ESRD) and patients with congenital coronary abnormalities, such as right coronary artery (RCA) originating from left sinus of Valsalva. Here we describe a patient presenting with acute respiratory distress and anterolateral ST-T segment changes, with negative troponin-I and elevated levels of brain natriuretic peptide. Coronary angiography showed a right coronary artery arising from the left sinus of Valsalva without obstructive coronary artery disease, while ventriculography and echocardiogram showed fi ndings compatible with apical ballooning. Magnetic resonance imaging confi rmed the diagnosis of a biventricular Takotsubo cardiomyopathy. SOUHRNTako-tsubo (stresová) kardiomyopatie je klinickou jednotkou, při níž dochází k přechodným, regionálním abnormalitám stahů levé komory (LK) v nepřítomnosti významného postižení epikardiálních koronárních tepen. K lékaři se pacienti obvykle dostavují s akutním hemodynamickým zhoršením po emocionální nebo fyzické zátěži. U nemocných s terminálním selháním ledvin a u osob s vrozenými anomáliemi koronárních tepen, např. s pravou věnčitou tepnou odstupující z levého Valsalvova sinu, se tako-tsubo kardiomyopatie běžně nevyskytuje. V našem příspěvku popisujeme pacienta s akutní dechovou tísní a změnami anterolaterálního segmentu ST-T, negativním troponinem I a zvýšenými hodnotami natriuretického peptidu typu B. Koronarografi e zjistila anomální odstup pravé věnčité tepny z levého Valsalvova sinu bez přítomnosti obstrukční ischemické choroby srdeční, zatímco nálezy ventrikulografi ckého a echokardiografi ckého vyšetření ukazovaly na stresovou kardiomyopatii. Vyšetření magnetickou rezonancí potvrdilo diagnózu biventrikulární tako-tsubo kardiomyopatie.

Cardiac implantable devices and takotsubo syndrome. A rare but potential eventuality

“…Typically it is characterized by apical ballooning of the left ventricle, with reduced apical contractility and hyperkinesia of the basal segments. Potentially life-threatening complications include cardiogenic shock, arrhythmias or acute pulmonary edema [1][2][3]. It is well-known that it often follows an emotionally or physically stressful episode and that most of the patients are women in post-menopausal age [1,4].…”

Tako-tsubo syndrome and atrial fibrillation. New trigger for cardiomyopathy. A clinical case

“…Takotsubo syndrome (TS) is described as a pathology with a good prognosis characterized by the presence of a transient left ventricular wall disease without signifi cant culprit obstructive CAD. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The "golden standard" for a defi nitive diagnosis is invasive coronary angiography and ventriculography, with an integrated multi-imaging approach, such as echocardiography, fi rst--line non-invasive technique, and cardiac magnetic resonance (CMR), in order to discriminate TS from other acute cardiac syndromes with troponin elevation and ventricular disfunction. [16][17][18][19] Important hallmarks of TS are a relatively small increase in T/I troponin, the left ventricle "apical ballooning" (wall motion diskinesis characterized by apical akinesis and basal hyperkinesis) at echocardiography and ventriculography associated with normal epicardial coronary vessels at angiography.…”

Atypical presentation of Takotsubo syndrome early after pacemaker implantation

“…This condition mimics an acute myocardial infarction (AMI) because of the symptoms and the new onset of ST segment elevation and/or negative T waves, but without fi ndings of acute obstructive coronary artery disease at angiography, although these can be present in 10-29% of cases. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The diagnosis is made with invasive coronary angiography and ventriculography, together with transthoracic echocardiography which can show different patterns: typical "apical ballooning" of the left ventricle (LV), characterized by apical akinesis and hyperkinesis of the basal segments, or atypical patterns, including the midventricular, basal, and focal wall motion patterns, all of these with reduced ejection fraction. 20 The exact mechani- sm of TTS is unknown, but it is hypothesized that a sudden massive surge of circulatory catecholamines (adrenaline, noradrenaline) from a physical or emotional stress may play a central role.…”

“…However, potentially life-threatening complications are cardiogenic shock, arrhythmias, acute pulmonary edema, and stroke. 12,[26][27][28][29][30][31] In-hospital mortality is about 2% and long-term prognosis is mostly favorable with complete resolution. 26,[32][33][34][35] However, recent studies have challenged the notion that TTS portends a benign outcome, stating that longterm mortality is higher compared with mortality in the general population, and outcomes resemble those of patients with acute coronary syndrome and ST-segment elevation myocardial infarction.…”