Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis

Patel, Keval V; Griffing, George T.; Hauptman, Paul J.; Stolker, Joshua M.

doi:10.14503/thij-15-5046

Cited by 13 publications

(17 citation statements)

References 7 publications

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“…The endothelial dysfunction typically persists for only a few weeks after an episode of TC, and it responds to specific therapy involving nitrates, calcium antagonists, and possibly L-arginine. 2,3 Like Patel and colleagues, 1 we emphasize the importance of prospective and safe mechanistic investigations in the quest to clarify the nature of TC.…”

Section: Takotsubo Cardiomyopathymentioning

confidence: 83%

“…Establishing Diagnosis and Causes through Prospective Testing T he accompanying case report by Patel and colleagues 1 concerns recurrent takotsubo cardiomyopathy (TC) in the context of hyperthyroidism's onset. The authors deserve compliments on their interesting article and their correct phenotypic diagnosis of both TC and hyperthyroidism.…”

Section: Takotsubo Cardiomyopathymentioning

confidence: 99%

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Takotsubo Cardiomyopathy: Establishing Diagnosis and Causes through Prospective Testing

Angelini¹

2016

Texas Heart Institute Journal

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T he accompanying case report by Patel and colleagues 1 concerns recurrent takotsubo cardiomyopathy (TC) in the context of hyperthyroidism's onset. The authors deserve compliments on their interesting article and their correct phenotypic diagnosis of both TC and hyperthyroidism. Their report prompts me to comment about the importance of prospectively establishing the cause and nature of TC.The medical literature's focus on clinical conditions associated with TC seems intended to clarify causative or predisposing factors in the genesis of TC. Indeed, a simple association of hyperthyroidism with TC might suggest that the former causes the latter; however, to convince the medical community, a prospective approach should document a substantial association.Ideally, this involves duplicating the exposure to the possible cause (in this case, excessive thyroidal hormones) and carefully looking for signs of recurrent TC, usually by means of echocardiographic monitoring. The authors 1 did this in one recurrent episode. Although thyroid hormones are not known to activate any recognized mechanism that might produce TC, the second episode of TC upon the reappearance of hyperthyroidism is a significant observation arising from an implied natural experiment.Recurrent TC is observed in fewer than 10% of cases. Its recurrence presents an opportunity to better understand the causative factors that are still at work. Two kinds of studies offer promise in this regard: 1) those that focus on reproducing TC through the administration of short-acting, suspected causative agents (typically, catecholamines in patients who develop TC after dobutamine stress testing); and 2) studies of acetylcholine (Ach) stimulation as a test of endothelial dysfunction.Endothelial dysfunction might be an underreported predisposing condition that underlies many clinical episodes of TC. [2][3][4] In light of the benign, short-term, and local effects of Ach, 2-4 we and our colleagues have launched an international, multicenter investigation of its use in studying TC. 5 In pilot studies during the first few weeks after an episode of TC, Ach has frequently yielded amazingly effective results-reproducing symptoms, electrocardiographic changes, and left ventricular segmental dysfunction (at the time of severe and diffuse coronary spasm) similar to the changes that occur spontaneously during the presenting stage of TC. Then, within mere seconds, infused intracoronary nitroglycerin consistently reverses the coronary and left ventricular changes. The Ach test is correlated with the history of TC (potentially making Ach a specific diagnostic tool) and seems to predict TC recurrence (potentially making Ach an important prognostic marker). The endothelial dysfunction typically persists for only a few weeks after an episode of TC, and it responds to specific therapy involving nitrates, calcium antagonists, and possibly L-arginine. 2,3Like Patel and colleagues, 1 we emphasize the importance of prospective and safe mechanistic investigations in the quest to clarify the ...

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Section: Takotsubo Cardiomyopathymentioning

confidence: 83%

Section: Takotsubo Cardiomyopathymentioning

confidence: 99%

Takotsubo Cardiomyopathy: Establishing Diagnosis and Causes through Prospective Testing

Angelini¹

2016

Texas Heart Institute Journal

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“…[7][8][9][10] The possible relationship between dilated cardiomyopathy, Takotsubo cardiomyopathy, and Graves' disease is reported in the literature. 11,12 Hübner et al experimentally revealed impairment of cardiac performance in both adolescent and adult mice with Graves' disease. The cardiac performance could be partly restored by early hormonal treatment, but adult mice lacked this recovery potential.…”

Section: Discussionmentioning

confidence: 99%

Changes in left ventricular function and contractile homogeneity in young adults with newly diagnosed hyperthyroidism due to Graves' disease

Zhou¹,

Tan²,

Lee

et al. 2019

J of Clinical Ultrasound

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Purpose The aim of this study was to investigate myocardial dysfunction and mechanical abnormalities in young patients with Graves' disease before therapy, using two‐dimensional speckle tracking echocardiography. Methods We performed a comprehensive transthoracic echocardiographic examination, including segmental and global radial strain, and time‐to‐peak radial strain, in 47 young patients with hyperthyroidism and 34 healthy adults. The time‐to‐peak radial strain was corrected by RR interval. The variables derived from radial myocardial deformation by the six‐basal, six‐mid, and six‐apical segmental model were compared to investigate the difference of the myocardial function between the two groups. Results Early diastolic mitral inflow velocity, E/A ratio, early diastolic mitral annular velocity, and e′/a′ ratio were lower in patients with Graves' disease than in controls. The left ventricular end‐diastolic volume, left ventricular end‐systolic volume, stroke volume, cardiac output, heart rate, late diastolic mitral inflow velocity, and late diastolic mitral annular velocity were slightly higher in patients than in controls. Radial strain, global radial strain, and corrected time‐to‐peak radial strain were lower in the patient group. Conclusions The decreased radial strain, global radial strain, and corrected time‐to‐peak radial strain in young patients with newly diagnosed hyperthyroidism due to Graves' disease could serve as an early sign of subclinical cardiac involvement.

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“…Elevated levels of thyroid hormones cause exaggerated inotropic and chronotropic responses to catecholamines. There is over-regulation of beta-adrenergic receptors by thyroid hormones in many tissues, including the heart [ 8 , 19 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Myocardiopathy and Hyperthyroidism: A Case Report and Literature Review

et al. 2017

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Patient: Male, 34Final Diagnosis: Takotsubo myocardiopathy and hyperthyroidismSymptoms: Chest pain • dyspneaMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Rare co-existance of disease or pathologyBackground:Takotsubo cardiomyopathy (TM), also called stress myocardiopathy or transient left ventricular apical ballooning syndrome, is characterized by acute left ventricular dysfunction with reversible wall motion abnormalities. TM resembles acute coronary syndrome (ACS) in the absence of coronary artery disease (CAD).In several reports, TM has been described in association with hyperthyroidism, suggesting the potential role of thyrotoxicosis in the pathophysiology.Case Report:We present the case of a 34-year-old man with TM associated with hyperthyroidism caused by Graves’ disease. In this case, TM was also preceded by an emotional trigger.The diagnosis of TM was based on clinical manifestations, electrocardiographic and echocardiographic abnormalities, and the absence of coronary artery disease (CAD) in the angiography. A diagnosis of hyperthyroidism was made based on hormonal and antibody measurements. The patient had a favorable outcome, and the cardiac and thyroid disorders resolved.Conclusions:Our case illustrates that thyroid disease, mainly hyperthyroidism, should be considered in patients with TM with or without previous emotional triggers. As in our patient, the outcome in TM is usually favorable, with reversibility of cardiac abnormalities.

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Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis

Cited by 13 publications

References 7 publications

Takotsubo Cardiomyopathy: Establishing Diagnosis and Causes through Prospective Testing

Takotsubo Cardiomyopathy: Establishing Diagnosis and Causes through Prospective Testing

Changes in left ventricular function and contractile homogeneity in young adults with newly diagnosed hyperthyroidism due to Graves' disease

Takotsubo Myocardiopathy and Hyperthyroidism: A Case Report and Literature Review

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