Reversible Myocardial Contraction Abnormalities in Patients With an Acute Noncardiac Illness

Sharkey, Scott W.; Shear, Wendy; Hodges, Morrison; Herzog, Charles A.

doi:10.1378/chest.114.1.98

Cited by 121 publications

(97 citation statements)

References 22 publications

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“…Women have been shown to have increased catecholamine production and a higher incidence of transient LV dysfunction after subarachnoid hemorrhage. 7,8 It is not unreasonable to postulate a similar neurocardiac response in this syndrome based on our observations. Several mechanisms have been proposed in this syndrome, including multivessel epicardial coronary spasm, microvascular spasm induced by catecholamines, direct catecholamine stunning, LV outflow tract obstruction, and neurogenically mediated myocardial dysfunction.…”

Section: Discussionsupporting

confidence: 61%

Takotsubo Syndrome in African‐American women with atypical presentations: a single‐center experience

Patel

Kantharia

Morris

et al. 2007

Clinical Cardiology

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BackgroundTakotsubo syndrome is comprised of the clinical presentation of an acute myocardial infarction with electrocardiographic (ECG) changes of acute ischemia, chest pain, positive biomarkers, a pathognomonic left ventricular apical wall motion abnormality, and no culprit coronary disease at cardiac catheterization.HapothesisThis study aimed at a further definition of the clinical characteristics of this syndrome in African‐American (AA) patients based on our experience at a single center.MethodsPatients who presented with this syndrome between June 2003 and June 2005 were evaluated. All patients underwent coronary angiography and noninvasive cardiac investigation, including transthoracic two‐dimensional echocardiography.ResultsFive AA women (mean age 65 years) presented with the characteristics of the syndrome. No patient experienced chest pain, with three presenting with shortness of breath and two with nausea. Hypertension was the most common risk factor for coronary artery disease (CAD) in these patients. All but one patient had ST elevation on ECG, and troponin I elevation was present in all. Cardiac catheterization showed no obstructive CAD. The most common trigger was exarcebation of a current medical condition. All five patients developed deep, broad, diffuse T‐wave inversions with a prolonged QT interval. There was no mortality during the hospital stay.ConclusionsTakotsubo syndrome is experienced by AA patients. Female AA patients may experience atypical symptoms at presentation. The development of broad, diffuse, T‐wave inversions with a prolonged QT interval within 2–48 h of presentation should be considered an additional criterion when diagnosing Takotsubo syndrome. Copyright © 2007 Wiley Periodicals, Inc.

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Section: Discussionsupporting

confidence: 61%

Takotsubo Syndrome in African‐American women with atypical presentations: a single‐center experience

Patel

Kantharia

Morris

et al. 2007

Clinical Cardiology

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“…Although reversible LV systolic dysfunction is frequently observed in cases of acute ischemia induced by coronary artery disease, this abnormality can complicate critically ill patients in the absence of significant coronary narrowing. Sharkey et al 4 reported the diagnoses in such patients included central nervous system injury, sepsis, acute pulmonary disease, metabolic abnormality, and postnoncardiac surgery. Moreover, transient LV dysfunction in patients under emotional or physical stress, known as LV apical ballooning, is a recently recognized condition.…”

Section: Discussionmentioning

confidence: 99%

Transient global left ventricular dysfunction in a localized myocardial infarction related to occlusion of the distal left anterior descending artery

Yoon

Lee

Choi

et al. 2006

Clinical Cardiology

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Summary:In some patients with acute myocardial infarction (MI), wall motion in the noninfarcted area declines globally despite localized myocardial damage. In most, an infarctrelated lesion is the proximal part of the left anterior descending artery (LAD). Previous studies have reported that hypokinesis of remote myocardium may be related to multivessel disease, impaired coronary flow, or coronary flow reserve in nonculprit arteries. This report describes the case of a 53-year-old man who presented with severe global left ventricular (LV) dysfunction after an acute MI associated with distal LAD occlusion. Follow-up echocardiographic examination revealed nearly normalized LV function 5 days after the episode. We discuss a plausible mechanism of dysfunction of noninfarcted myocardium.

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“…Reversible left ventricular dysfunction is observed in patients under strong emotional stress or in patients with subarachnoid hemorrhage. [1][2][3][4][5][6][7] The exact mechanism of this phenomenon, however, is still unknown.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…1) These patients have the following characteristics: the appearance of deep T-wave inversion in the precordial leads of the ECG, the presence of apical wall motion abnormality on an echocardiogram, and mild CK elevation. 1) Apical left ventricular dysfunction without any lesions in the corre- sponding coronary arteries is reported to occur in many clinical circumstances, especially after strong emotional stress or in subarachnoid hemorrhage. [1][2][3][4][5][6][7] The pathogenesis of the apical left ventricular dysfunction is thought to be a result of epicardial vasospasm, 8) myocarditis, 2) catecholamine cardiotoxicity, 9) cardiomyopathy, 5) or microvascular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reversible Left Ventricular Systolic Dysfunction-Reversibility of Coronary Microvascular Abnormality.

Ako¹,

Takenaka²,

Uno³

et al. 2001

Jpn Heart J

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SUMMARYReversible left ventricular wall motion abnormalities mimicking myocardial infarction have been reported in patients with a noncardiac illness. Their coronary angiograms do not demonstrate organic stenosis or epicardial coronary vasospasm. In this article, two cases of reversible left ventricular contraction abnormality are presented. Electrocardiography showed deep inverted T waves in precordial leads, and the echocardiography revealed diffuse akinesis of the apical region in the acute phase. Coronary angiography showed no significant stenosis or occlusion in either patient. Thallium scintigraphy showed no defect, while the metaiodobenzylguanidine scintigraphy demonstrated significant defects in the apex. The relative coronary flow reserve ratio, measured with an intracoronary Doppler flow wire, was significantly reduced in both patients. Myocardial contrast echocardiography revealed a reversible perfusion defect in the apex in the acute phase in case 2. Transiently impaired coronary microcirculation was thought to be involved in the pathogenesis of the reversible left ventricular dysfunction observed in these patients. (Jpn Heart J 2001; 42: 355-363)

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Reversible Myocardial Contraction Abnormalities in Patients With an Acute Noncardiac Illness

Cited by 121 publications

References 22 publications

Takotsubo Syndrome in African‐American women with atypical presentations: a single‐center experience

Takotsubo Syndrome in African‐American women with atypical presentations: a single‐center experience

Transient global left ventricular dysfunction in a localized myocardial infarction related to occlusion of the distal left anterior descending artery

Reversible Left Ventricular Systolic Dysfunction-Reversibility of Coronary Microvascular Abnormality.

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