Reversible Left Ventricular Dysfunction "Takotsubo" Cardiomyopathy Associated With Hyperthyroidism

Abstract

SUMMARYMyocardial stunning with hyperthyroidism is rare. A 79-year old woman with hyperthyroidism was admitted to our hospital complaining of palpitations due to paroxysmal atrial fibrillation. An echocardiogram showed akinesis of the apical wall which was not observed 2 weeks before admission. Cardiac catheterization performed in the acute phase showed normal coronary arteries and no evidence of provocative spasms. The wall motion abnormality disappeared entirely after 1 week in hospital. We report a case of transient left ventricular dysfunction, so called "takotsubo" cardiomyopathy, associated with hyperthyroidism. (Jpn Heart J 2004; 45: 889-894)

Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis

“…2 In 2004, Miyakazi and colleagues described thyrotoxicosis-associated TC by demonstrating myocardial stunning with use of thallium-201 and 99m Tc-pyrophosphate scintigrams. 7 The effect of T 3 on the myocardium is profound, because T 3 up-regulates the transcription of calcium-ATPase protein and β-adrenergic receptors. 8 In certain populations, such as postmenopausal women who tend to be predisposed to TC, calcium influx in addition to ATPase up-regulation might lead to wall-motion abnormalities consistent with TC.…”

Transient left ventricular dysfunction (tako-tsubo phenomenon): Findings and potential pathophysiological mechanisms

“…Additional cardiovascular disorders include previous cerebral infarction (23), syncope of unknown origin (23), sick sinus syndrome (23,40), chronic or paroxysmal atrial fibrillation (22,23,(40)(41)(42), aortic regurgitation due to a bicuspid aortic valve (32) and angina pectoris (22).…”

“…Other underlying disorders reported in patients with TTP include depression (23,43,44), dementia (23), chronic emphysema (23), chronic obstructive pulmonary disease (20,43), hyperthyroidism (20,42), retroperitoneal fibrosis (45), ShyDrager syndrome (40), hypokalemia-related myopathy (46), Guillain-Barré syndrome (47,48), myasthenia gravis (49), syndrome malin (44), amyotrophic lateral sclerosis (50), metabolic myopathy (51), Parkinson's disease (44), neurosis (22), pulmonary fibrosis (22), alcoholism (22,46), acute renal failure (22), hepatic cirrhosis (52), chronic pancreatitis (52), rheumatoid arthritis (20) and dysphagia (53).…”

“…The idea that TTP is related to a disturbance of cardiac sympathetic innervation is supported by scintigraphic findings. Perfusion defects in the anteroseptal wall are detected by thallium-201 ( 201 Tl) myocardial scintigraphy without technetium-99m pyrophosphate uptake in the matching area; extensive perfusion defects are also detected around the apex by 123 iodine metaiodobenzylguanidine scintigraphy (42,44,46,47,55,(62)(63)(64). When assessed semiquantitatively, the metaiodobenzylguanidine images had higher defect scores than those with 201 Tl scintigraphy during the acute phase, as well as throughout the following year.…”

Management of Tako-tsubo Syndrome

“…Rare cases of Tako-tsubo in the literature include instances precipitated by hypoglycemia [25], hyperthyroidism [26], Tako-tsubo LV dysfunction cocaine [27], alcohol withdrawal [28], pneumothorax [29], and subdural hematoma [30]. All of these precipitants are associated with increased sympathetic drive.…”