Stress (Tako-tsubo) cardiomyopathy in critically-ill patients

Abstract

SC is a rare reversible cardiac impairment in the critically-ill patient that can induce arrhythmias and cardiogenic shock. The likely mechanisms are combined: catecholamine toxicity, stress or neurological involvement and less frequently ischemia or LVOT obstruction.

Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes

“…In the United States, absolute mortality from TTC is much higher in patients with sepsis (20.6% in this study) than other patient types with TTC (4%) 32. In an unselected critical ill population, mortality was 15%, which is similar to that noted in this cohort of severe sepsis patients 33. This interaction between sepsis and TTC is worthy of further mechanistic studies, similar to previous literature on septic cardiomyopathy 34.…”

Takotsubo syndrome in hemodynamically unstable patients admitted to the intensive care unit – a retrospective study

“…8 One would therefore expect that TS should not be an uncommon phenomenon in the ICU. [17][18][19] In a large prospective study, the authors described LV dysfunction in 20% of the patients and new onset of non-ischemic LV dysfunction in 3.4% of patients. In addition, another 40 patients had RWMAs, which could not be attributed to CAD or ACS, but they did not fulfill our TS criteria due to missing data or insufficient clinical investigations.…”

“…[5][6][7][8][9]11 Recent data suggest that physical triggers outnumber the emotional triggers and secondary TS is an increasingly recognized condition. 8,9,[14][15][16][17][18] Despite the likely prognostic implications of TS in critical illness, TS in the ICU setting has not been sufficiently studied. 8,9,[12][13][14][15] Important physical triggers of TS are conditions that are commonly observed in the intensive care unit (ICU), such as respiratory insufficiency, sepsis, major surgery, neurological emergencies and internal bleeding.…”

“…8,[12][13][14] Furthermore, secondary TS carries a particularly poor prognosis. [16][17][18][19] After retrospectively identifying a TS population in a general, mixed ICU, we sought to (i) estimate the incidence of TS in hemodynamically unstable ICU-patients; (ii) identify predictors of TS in this population; (iii) study the impact of TS on prognosis and course of hospitalization. 8,9,[14][15][16][17][18] Despite the likely prognostic implications of TS in critical illness, TS in the ICU setting has not been sufficiently studied.…”

Prevalence and Risk Factors of Stress Cardiomyopathy After Convulsive Status Epilepticus in ICU Patients

“…Acute neurologic diseases may also induce cardiac disturbances, including acute heart failure (4). Stress cardiomyopathy (SC) has been described in various clinical settings, including CSE, and also appears to be rapidly and fully reversible (4)(5)(6). Although the pathophysiology of SC remains unclear, a sudden release of endogenous catecholamines is suspected to alter the coronary vasomotricity or to have direct toxicity on cardiomyocytes (7), resulting in anatomopathological abnormalities called "contraction bands" (8).…”