Inverted (Reverse) Takotsubo Cardiomyopathy following Cerebellar Hemorrhage

Piérard, Sophie; Vinetti, Marco; Hantson, Philippe

doi:10.1155/2014/781926

Cited by 17 publications

(27 citation statements)

References 11 publications

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“…TTS following an ICH has been reported in nine cases so far [29,97,[120][121][122][123][124][125][126]. In four of these cases TTS was associated with cerebellar hemorrhage [29,97,125,126].…”

Section: Intra-cerebral Hemorrhage (Ich)mentioning

confidence: 93%

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CNS disease triggering Takotsubo stress cardiomyopathy

Finsterer

Wahbi

2014

International Journal of Cardiology

122

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Section: Intra-cerebral Hemorrhage (Ich)mentioning

confidence: 93%

“…In four of these cases TTS was associated with cerebellar hemorrhage [29,97,125,126]. In a study of 948 patients with ICH, 36 developed acute heart failure but it is not mentioned how many of these were indeed TTS cases [127].…”

Section: Intra-cerebral Hemorrhage (Ich)mentioning

confidence: 99%

CNS disease triggering Takotsubo stress cardiomyopathy

Finsterer

Wahbi

2014

International Journal of Cardiology

122

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“…In addition to emotional and physical stress subarachnoid hemorrhage, cerebellar hemorrhage, diving, iatrogenic epinephrine use, epidural neuroplasty have been reported as precipitants of TCMP among others [5,[12][13][14] To the best of our knowledge there is only one case report of TCMP, specifically apical type TCMP following an thoracic epidural steroid injection. We describe first case of reverse TCMP following cervical epidural steroid injection.…”

Section: Discussionmentioning

confidence: 99%

Reverse Takotsubo Cardiomyopathy: A Rare Complication of Epidural Steroid Injection

Isakadze¹

2017

MOJCR

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Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy (TCMP) is characterized by a rapid, severe and usually reversible ventricular wall dysfunction, ST segment changes on EKG and troponin leak without evidence of obstructive coronary artery disease by coronary angiography. It represents approximately 1.2% of all troponin positive acute coronary syndromes [1]. Physical or emotional stressors have been identified as triggers precipitating this syndrome in the majority of the cases.Classification of TCMP is based on the distribution of wall motion abnormalities noted on Echocardiogram. Study of International Takotsubo Registry (1750 patients) identified 4 types of TCMP, apical (81.7%), midventricular (14.6%), basal/reverse (2.2%) and focal type (1.5%) [2]. These patterns of myocardial dysfunction are reminiscent of myocardial stunning associated with an increased catecholamine release. It has been hypothesized that the distribution of adrenergic receptors in myocardial tissue explains the difference in anatomical distribution of injury [3]. Here we present a case of a middle-aged female patient who developed acute severe heart failure caused by reverse TCMP following a cervical steroid injection.With this case report, we intend to highlight the possible association between epidural steroid injection and development of TCMP. We also emphasize the high clinical suspicion required to diagnose TCM in patients who present with acute coronary syndrome, heart failure, specific pattern of wall motion abnormalities and angiographically normal coronaries. We further illustrate the utility of cardiac MRI as a non-invasive study with increased sensitivity over other imaging modalities in diagnosing TCM. Case PresentationA highly functional middle-aged postmenopausal female with remote history of depression, cervical canal stenosis and no other significant medical history presented to the emergency room after awakening around midnight with severe headache, diaphoresis, palpitations, shortness of breath, nausea, vomiting and diarrhea. The patient was severely hypertensive upon presentation. At presentation she had severely elevated blood pressure (BP 220/150mm Hg), was diaphoretic and complained of severe sub sternal non-radiating chest pain. Physical examination revealed regular rhythm, with a heart rate of 122 beats per minute, mild respiratory distress and she was afebrile. Her jugular venous pressure was not elevated and no carotid bruits were present. Cardiac auscultation revealed normal first and second heart sounds with a 2/6 holosystolic murmur at the apex radiating to axilla. Her peripheral pulses were equal in all extremities. Lung fields were clear. She denied any acute stressors. Patient reported cervical spinal pain for which she had received a cervical steroid injection several hours before presentation. InvestigationsDue to her complains of chest pain, a stat electrocardiogram (EKG) was obtained. Initial EKG showed fascicular ventricular tachycardia with HR of 148 beats per minute, which s...

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“…In support of this theory is the fact that subarachnoid hemorrhage and pheochromocytoma have been found as common triggers for SIC [ 13 ]. For example, pathological findings consistent with myocyte necrosis with contraction bands were found in a patient with reverse Takotsubo induced by subarachnoid hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

An Emotional Stress as a Trigger for Reverse Takotsubo Cardiomyopathy: A Case Report and Literature Review

et al. 2016

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Patient: Female, 61Final Diagnosis: Reverse TakotsuboSymptoms: Dyspnea • chest painMedication: Lisinopril • Metoprolol • Aspirin • Atorvastatin • TicagrelorClinical Procedure: Cardiac catheterizationSpecialty: CardiologyObjective:Rare diseaseBackground:Reverse Takotsubo cardiomyopathy is one of the rarest types of stress-induced cardiomyopathy, which despite sharing similar pathogenic mechanisms with its more common counterpart, has different clinical manifestations, demographics, and laboratory values.Case Report:We present the case of a 61-year-old woman who came to the hospital with a chief complaint of chest pain and dyspnea. She was found to have elevated troponin and severely depressed left ventricular function. Echocardiography showed normal contracting apex, with the rest of the left ventricle being hypokinetic. Cardiac catheterization revealed mild coronary artery disease and confirmed echocardiographic findings showing hyperkinetic apex and dilated base. She was discharged home on ACE inhibitor and B-blocker. A repeat echocardiogram 2 weeks after the initial presentation showed complete resolution of cardiac dysfunction.Conclusions:Reverse Takotsubo cardiomyopathy is a rare disease mimicking acute coronary syndrome. It is essential to rule out organic coronary disease prior to attributing the presentation to Takotsubo cardiomyopathy. With supportive care, the long-term prognosis is good in the vast majority of patients.

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Inverted (Reverse) Takotsubo Cardiomyopathy following Cerebellar Hemorrhage

Cited by 17 publications

References 11 publications

CNS disease triggering Takotsubo stress cardiomyopathy

CNS disease triggering Takotsubo stress cardiomyopathy

Reverse Takotsubo Cardiomyopathy: A Rare Complication of Epidural Steroid Injection

An Emotional Stress as a Trigger for Reverse Takotsubo Cardiomyopathy: A Case Report and Literature Review

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