Fatal Tako-Tsubo cardiomyopathy recurrence after β2-agonist administration

Venditti, F.; Bellandi, Benedetta; Parodi, Guido

doi:10.1016/j.ijcard.2012.03.005

Cited by 13 publications

(7 citation statements)

References 7 publications

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“…The rationale for β‐adrenergic block in TTC was actually based on several observations, and β‐blockers are still commonly believed to be the elective therapy after an episode of TTC. Increased circulating levels of catecholamines could be found during the acute phase of stress cardiomyopathy, and, in some case reports, TTC episodes were triggered by β2‐agonist drugs administered for the treatment of chronic obstructive pulmonary disease . Paur et al, in an in vivo rat model, found that high doses of epinephrine, through the pleiotropic β2‐adrenergic receptor (β2‐AR), activated the inhibitory G (Gi)‐protein, inducing direct cardiomyocyte depression .…”

Section: Discussionmentioning

confidence: 99%

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Lack of Efficacy of Drug Therapy in Preventing Takotsubo Cardiomyopathy Recurrence: A Meta‐analysis

Santoro

Ieva

Musaico

et al. 2014

Clinical Cardiology

127

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Background: Efficacy of chronic drug therapy in prevention of stress-induced cardiomyopathy recurrences is not well established. We therefore aimed to evaluate in this meta-analysis whether pharmacological treatment can effectively prevent takotsubo cardiomyopathy (TTC) recurrences, according to available studies. Hypothesis: There is no evidence for preventing TTC recurrence by drug therapy. Methods: After a PubMed search, we conducted a meta-analysis of available studies (clinical nonrandomized registries) on efficacy of drug therapy in preventing recurrence of TTC. Results: A total of 23 (4.5%) TTC recurrences occurred in the 511 patients included in the analysis. Seven studies on the effects of β-blockers on prevention of TTC recurrence were evaluated; the odds ratio (OR) was 0.44 and the 95% confidence interval (CI) was 0.15-1.31. In 5 studies on the effects of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, the OR was 0.42 and the 95% CI was 0.08-2.36; in 3 studies on statins, the OR was 0.74 and the 95% CI was 0.07-7.3; and in 4 studies on aspirin, the OR was 0.33 with a 95% CI of 0.05-2.17 (P value not significant in all cases). Conclusions: A meta-analysis of the efficacy of different medications through the clinical TTC registries available showed no clinical evidence for a standard drug treatment in the chronic management of TTC. β-Blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, and aspirin do not seem to significantly reduce recurrences of TTC. Randomized, adequately powered studies are needed to further assess this issue. IntroductionTakotsubo cardiomyopathy (TTC) is a rapidly reversible form of acute heart failure occurring mainly in postmenopausal women after an episode of physical or emotional stress 1 and is associated with a typical left ventricular (LV) contraction pattern. 2 Increased catecholamine levels were thought to be the primary precipitator of the condition, 3 but the exact mechanism is still not well elucidated. 4,5 The initial treatment for TTC is usually the same as adopted for acute heart failure, except for contraindication to β-adrenergic inotropes 6 ; data on the efficacy of chronic pharmacological therapy, however, are scanty. Despite its relatively good long-term prognosis, 7 recurrences of TTC are not infrequent, with a rate ranging from 5% to 11.4% within the first 4 years and an incidence per year of 2.4%. 8,9 β-Blockers are commonly used chronically to prevent TTC recurrence, but, given the rarity of TTC, there are no randomized studies supporting this approach.We therefore conducted a meta-analysis of currently available studies to evaluate whether drug therapy can effectively prevent TTC recurrences.

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Section: Discussionmentioning

confidence: 99%

“…Although the negative inotropic effect of epinephrine was enhanced, with the addition of propranolol or carvedilol, there was no increase in mortality. Drugs with high β2‐AR‐Gi agonism (eg, propranolol, carvedilol) should therefore be avoided …”

Section: Discussionmentioning

confidence: 99%

Lack of Efficacy of Drug Therapy in Preventing Takotsubo Cardiomyopathy Recurrence: A Meta‐analysis

Santoro

Ieva

Musaico

et al. 2014

Clinical Cardiology

127

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“…Other studies have also shown stress cardiomyopathy in the setting of an acute asthma exacerbation or after repeated use of beta2-agonist inhalation [10][11][12][13][14][15][16][17]. Most of the cases involved elderly women with a history of asthma presenting with dyspnea rather than chest pain [12][13][14][15][16][17][18][19]. Only 1 case involved a male patient who presented with asthma exacerbation complicated with stress cardiomyopathy after frequent inhalation of steroids and long acting beta2-agonist [17].…”

Section: Discussionmentioning

confidence: 99%

Rare Association of Takotsubo Cardiomyopathy with Right Bundle Branch Block in the Dual Setting of Asthma Exacerbation and Psychiatric Illness

et al. 2020

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Rare co-existance of disease or pathology Background: Takotsubo cardiomyopathy is characterized by a transient left ventricular dysfunction without obstructive coronary artery disease that mimics an acute myocardial infarction. The electrocardiogram findings of Takotsubo cardiomyopathy usually present with ST-segment elevation or depression, T-wave inversion, left bundle branch block or high-grade atrioventricular block. Case Report: This is a report of a case of a 58-year-old male diagnosed with Takotsubo cardiomyopathy that occurred in the setting of an acute asthma exacerbation and psychiatric exacerbation with novel electrocardiogram findings of right bundle branch block. Transthoracic echocardiogram showed a preserved ejection fraction with left ventricular apical ballooning and hyperkinesis of the basal segments. The nuclear stress test showed a fixed perfusion defect at the apical segment, but the patient refused further testing such as coronary angiography. The patient was managed medically, and a repeat echocardiogram done after 8 weeks from discharge showed a complete resolution of the apical ballooning. Conclusions: It is important to recognize that patients with psychiatric illness and asthma exacerbation are predisposed to develop Takotsubo cardiomyopathy. It is also reasonable to suspect Takotsubo cardiomyopathy in the presence of new electrocardiogram findings aside from those typically seen in acute myocardial infarction, especially if it is associated with apical ballooning.

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“…In this latter group, chemotherapy-induced takotsubo in the setting of malignancy was the most common. Unlike cases with catecholamine infusions, chemotherapy- 6 Nebulized epinephrine Acute airway obstruction 1 mg/5 mL nebulization therapy twice total Esnault et al 7 Epinephrine Iatrogenic 1 mg once subcutaneously Sundboll et al 8 Epinephrine and cocaine Biopsy of tumor Topical use with 3.2 mg of epinephrine and 320 mg of cocaine Kajander et al 9 Epinephrine Anaphylaxis Epinephrine 0.1 mg IV Khoueiry et al 10 48 Inhaled albuterol COPD NA Parsa et al 49 Inhaled albuterol Asthma 10 inhalations before admission Venditti et al 50 Salmeterol Bronchitis NA Abbreviations: COPD, chronic obstructive pulmonary disease; IM, intramuscular; IV, intravenous; NA, not applicable. induced cases of TCM appear much less uniform and convincing (Table 3).…”

Section: Discussionmentioning

confidence: 99%