Stress Cardiomyopathy: The Midventricular Variant

Grigorov, M.; Spindel, Jeffrey; Katrapati, Praneeth; Stoddard, Marcus F.; Varbanova, Marina

doi:10.1016/j.case.2022.06.008

Cited by 2 publications

(6 citation statements)

References 11 publications

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“…Similar electrocardiographic findings were noted in our cohort, where we observed a more substantial ST-segment elevation in leads V2–V5. On the other hand, ST-segment depression is not frequently documented in the literature, even though it is more closely linked to atypical forms ( 21 , 29 , 30 ). In a study published by Ghadri et al ( 6 ), the incidence of ST-segment depression occurs in 7% of typical TTS cases compared to 10.8% in the atypical cases; while Obeid et al ( 21 ) reported 2% incidence of isolated ST-segment depression in typical TTS compared to 10.6% in atypical variants ( p = 0.019).…”

Section: Discussionmentioning

confidence: 99%

Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome

Padilla-Lopez,

Duran-Cambra,

Belmar-Cliville

et al. 2023

Front. Cardiovasc. Med.

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IntroductionTakotsubo syndrome (TTS) encompasses distinct variants, with midventricular (MV) as the most common atypical subtype. While electrocardiogram (ECG) abnormalities are well documented in typical TTS, they are less explored in MV-TTS.MethodsA retrospective case-control study was conducted where ECGs were reviewed at three time points from symptom onset (within the first 12 h, at 48 h, and at 5–7 days) and compared between patients with typical TTS (n = 33) and those with MV-TTS (n = 27), as classified by ventriculography.Results12-h ECG findings revealed that typical TTS featured ST-segment elevation through anterior leads V3–V6, with maximal deviation in V3 (0.98 ± 0.99 mm) and V4 (0.91 ± 0.91 mm), whereas MV-TTS featured ST-segment depression in inferior leads (−0.24 ± 0.57 mm in II, −0.30 ± 0.52 mm in III, and −0.32 ± 0.47 mm in aVF) and in precordial leads V4–V6. In 48-h ECG findings, the most significant change was T wave inversion, which was more widespread and deeper in typical TTS, with the most pronounced negative T wave depths, exceeding 3 mm, observed in leads V3–V5; in contrast, in MV-TTS, T wave inversion was evident in fewer leads and showed less depth, with the most pronounced negative T waves reaching 1 mm at most in leads I, aVL, and V2. While the QTc interval was prolonged in both groups at 48 h, this prolongation was more pronounced in typical TTS than in MV-TTS (523 ± 52 ms vs. 487 ± 66 ms; p = 0.029). In ECGs at 5–7 days, results essentially returned to baseline.ConclusionPatients with MV-TTS exhibited a distinctive pattern of ECG abnormalities, marked by ST-segment depression in inferolateral leads, less profound and less extensive T wave inversion that mostly affected leads I, aVL and V2, and attenuated QT interval prolongation compared to typical TTS.

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Section: Discussionmentioning

confidence: 99%

Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome

Padilla-Lopez,

Duran-Cambra,

Belmar-Cliville

et al. 2023

Front. Cardiovasc. Med.

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“…Treatment of TCM, a transient disorder, is typically supportive management, which includes the elimination of the physical and emotional stressors that can help alleviate symptoms [ 1 ]. It has been hypothesized that long-term beta-blocker therapy may reduce the likelihood of recurrence and can improve symptoms of TCM [ 4 ]. Other management of TCM includes preventing the development of acute decompensated congestive heart failure, which can progress to cardiogenic shock.…”

Section: Discussionmentioning

confidence: 99%

“…Other management of TCM includes preventing the development of acute decompensated congestive heart failure, which can progress to cardiogenic shock. Additionally, mid-ventricular TCM increases the risk of development of pleural or pericardial effusions and intraventricular thrombus in severe left ventricular dysfunction [ 4 ]. These potential complications warrant close clinical monitoring before discharge.…”

Section: Discussionmentioning

confidence: 99%

“…Atypical variants of TCM involve other parts of the left ventricle including the basal, focal, and mid-ventricular areas [ 1 , 3 ]. Per the International Takotsubo Registry, the mid-ventricular variant of TCM is only found in 14.6% of TCM cases, whereas the apical variant is seen in 82% of cases [ 4 ]. The basal and focal variants are seen in 4.5% and 1.1% of cases, respectively [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Per the International Takotsubo Registry, the mid-ventricular variant of TCM is only found in 14.6% of TCM cases, whereas the apical variant is seen in 82% of cases [ 4 ]. The basal and focal variants are seen in 4.5% and 1.1% of cases, respectively [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Mid-ventricular Takotsubo Cardiomyopathy With Coexisting Myocardial Bridge

Dugal,

DiCaro,

Massey

et al. 2024

Cureus

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Typical takotsubo cardiomyopathy (TCM) is a reversible form of myocardial injury that presents with a characteristic ballooning abnormality of the left ventricular apex. Typical TCM has been associated with myocardial bridging; however, mid-ventricular variant TCM has not. We describe a rare case of mid-ventricular variant TCM with a coexisting left anterior descending artery myocardial bridge and discuss management strategies. Furthermore, we propose potential pathophysiological mechanisms that may contribute to the symptomatic presentation of both conditions as a manifestation of common etiological factors.

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Stress Cardiomyopathy: The Midventricular Variant

Cited by 2 publications

References 11 publications

Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome

Comparative electrocardiographic analysis of midventricular and typical takotsubo syndrome

Mid-ventricular Takotsubo Cardiomyopathy With Coexisting Myocardial Bridge

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