Iatrogenic corticosteroids induced Takotsubo cardiomyopathy

Moon, Thomas J.; Sado, Daniel; Dworakowski, Rafał

doi:10.1016/j.carrev.2017.09.013

Cited by 7 publications

(3 citation statements)

References 12 publications

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“…56,57 More, most of clinical conditions after the procedure could probably be explained by a reactivation of rheumatoid arthritis, treated with steroid therapy IV. 58 The peculiarity of this case, in fact, was the atypical symptoms of TTS and the combination of different predisposing factors: female sex in post-menopausal period, anamnesis of chronic infl ammatory disease, use of drugs which increase stress and atrio-ventricular block itself. What we observed remarks that in such a patient at risk for TTS the implantation of a PM, even if it's a minimally invasive procedure, needs to be carefully considered as a possible cause of this syndrome in the peri-procedural setting.…”

Section: Discussionmentioning

confidence: 82%

Atypical presentation of Takotsubo syndrome early after pacemaker implantation

Demurtas¹,

Restelli²,

Pistelli³

et al. 2022

Cor Vasa

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Takotsubo syndrom (TTS) je formou kardiomyopatie navozené akutním stresem s dysfunkcí levé komory ve většině případů bez obstrukční ischemické choroby srdeční, i když ta může být přítomna v 10-29 % případů. Spouštěčem pro rozvoj takotsubo syndromu může být i málo invazivní výkon spojený s fyzickým nebo emocionálním stresem. Popis případu: Popisujeme případ 87leté ženy s vysokou, již dříve přítomnou zátěží stresem, u níž došlo k rozvoji takotsubo syndromu s neobvyklými symptomy po nekomplikované implantaci trvalého kardiostimulátoru. Závěry: Tento případ ukazuje, že TTS je nutno zvažovat jako potenciální komplikaci po implantaci kardiostimulátoru, zvláště u postmenopauzálních žen. Je třeba vytvořit multicentrické registry a provést další studie, abychom zjistili, jak a u které kategorie pacientů mohou i málo invazivní výkony vést ke vzniku TTS.

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Section: Discussionmentioning

confidence: 82%

Atypical presentation of Takotsubo syndrome early after pacemaker implantation

Demurtas¹,

Restelli²,

Pistelli³

et al. 2022

Cor Vasa

View full text Add to dashboard Cite

show abstract

“…It enhances the inotropic actions of catecholamines and facilitates increased vasoconstriction by the sympathetic nervous system [7,8]. Unsurprisingly, there has been association of TCM during induction of steroid therapy for unrelated illnesses reflecting the enhanced actions of catecholamines at alpha and beta receptors [13]. This association can be explained by the improved sensitivity of the cardiac myocardium to the adrenergic system and an exaggerated catecholamineinduced myocardial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune polyendocrine syndrome II presenting paradoxically as Takotsubo cardiomyopathy: a case report and reappraisal of pathophysiology

et al. 2022

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Background Takotsubo cardiomyopathy (TCM) is a rare disease entity characterized by acute, non-ischemic, reversible myocardial dysfunction that mimics acute myocardial infarction. Activation and excessive outflow of sympathetic nervous system are believed to be central to the figure in the disease pathogenesis. Adrenocortical hormones potentiate the systemic actions of sympathetic nervous system and accordingly are essential for regulation of myocardial function. We present an unusual case of a middle-aged woman with primary adrenal insufficiency who presented paradoxically with TCM. Case presentation A 50-year-old woman with past history of hypothyroidism presented to emergency department with history of acute chest pain and syncope. There was no significant drug history or history of an emotional or physical stimulus prior to admission. Prominent pigmentation over the tongue and skin creases of hands were noted. On presentation, she was in shock and had ventricular tachycardia which required electrical cardioversion. The subsequent electrocardiogram demonstrated diffuse T-wave inversions with prolonged QTC. There was apical hypokinesia on echocardiogram, and cardiac biomarkers were elevated. There was persistent inotropic requirement. She had marked postural symptoms, and a postural blood pressure drop of 50 mm Hg was present. Initial laboratory parameters were significant for hyperkalemia (7.8 mEq/L) and hyponatremia (128 mEq/L). These findings prompted evaluation for adrenal insufficiency which was confirmed with appropriate tests. Autoimmune polyendocrine syndrome II was thus diagnosed based on the above findings. Coronary angiography revealed normal coronaries. The diagnoses of TCM was established in accordance with the International Takotsubo Diagnostic Criteria. She was started on stress dose steroid replacement therapy and improved dramatically. At one month of follow-up, the patient is asymptomatic, and there was normalization of her left ventricular function. Conclusions Intricate relationship and interplay exist between the steroid hormones and catecholamines in the pathogenesis of TCM. Steroid hormones not only potentiate the actions of catecholamines, but they also regulate and channelize catecholaminergic actions preventing their deleterious effects on the cardiac tissue. Hence, both steroid deficiency and exogenous steroid replacement may precipitate TCM. Evidence from more such cases and larger perspective studies in future will further improve our understanding of this complex disease process and its myriad associations.

show abstract

“…It enhances the inotropic actions of catecholamines and facilitates increased vasoconstriction by the sympathetic nervous system (7,8). Unsurprisingly there has been association of TCM during induction of steroid therapy for unrelated illnesses re ecting the enhanced actions of catecholamines at alpha and beta receptors (12). This association can be explained by the improved sensitivity of the cardiac myocardium to the adrenergic system and an exaggerated catecholamine induced myocardial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune polyendocrine syndrome II presenting paradoxically as Takotsubo cardiomyopathy: A case report and reappraisal of pathophysiology

Batta

Gupta

Singal

et al. 2022

Preprint

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BackgroundTakotsubo cardiomyopathy (TCM) is a rare disease entity characterized by acute, non-ischemic, reversible myocardial dysfunction that mimics acute myocardial infarction. Activation and excessive outflow of sympathetic nervous system is believed to be central to the figure in the disease pathogenesis. Adrenocortical hormones potentiate the systemic actions of sympathetic nervous system and accordingly are essential for regulation of myocardial function. We present an unusual case of a middle-aged woman with primary adrenal insufficiency who presented paradoxically with TCM. Case presentation A 50-year-old woman with past history of hypothyroidism presented to emergency department with history of acute chest pain and syncope. There was no significant drug history or history of an emotional or physical stimulus prior to admission. Prominent pigmentation over the tongue and skin creases of hands were noted. On presentation she was in shock and had ventricular tachycardia which required electrical cardioversion. The subsequent electrocardiogram demonstrated diffuse T-wave inversions with prolonged QTC. There was apical hypokinesia on echocardiogram and cardiac biomarkers were elevated. There was persistent inotropic requirement. She had marked postural symptoms and a postural blood pressure drop of 50mm Hg was present. Initial laboratory parameters were significant for hyperkalemia (7.8mEq/L) and hyponatremia (128mEq/L). These findings prompted evaluation for adrenal insufficiency which was confirmed with appropriate tests. Autoimmune polyendocrine syndrome II was thus diagnosed based on the above findings. Coronary angiography revealed normal coronaries. The diagnoses of TCM was established in accordance with the International takotsubo diagnostic criteria. She was started on stress dose steroid replacement therapy and improved dramatically. At one month of follow-up, the patient is asymptomatic and there was normalization of her left ventricular function. ConclusionsIntricate relationship and interplay exist between the steroid hormones and catecholamines in the pathogenesis of TCM. Steroid hormones not only potentiate the actions of catecholamines, they also regulate and channelize catecholaminergic actions preventing their deleterious effects on the cardiac tissue. Hence, both steroid deficiency and exogenous steroid replacement may precipitate TCM. Evidence from more such cases and larger perspective studies in the future will further improve our understanding of this complex disease process and its myriad associations.

show abstract

Iatrogenic corticosteroids induced Takotsubo cardiomyopathy

Cited by 7 publications

References 12 publications

Atypical presentation of Takotsubo syndrome early after pacemaker implantation

Atypical presentation of Takotsubo syndrome early after pacemaker implantation

Autoimmune polyendocrine syndrome II presenting paradoxically as Takotsubo cardiomyopathy: a case report and reappraisal of pathophysiology

Autoimmune polyendocrine syndrome II presenting paradoxically as Takotsubo cardiomyopathy: A case report and reappraisal of pathophysiology

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