Tako-Tsubo syndrome: an important differential diagnosis in patients with acute chest pain

Primetshofer, Daniela; Agladze, Rusudan; Krätzer, H; Reisinger, J.; Siostrzonek, Peter

doi:10.1007/s00508-009-1275-7

Cited by 17 publications

(14 citation statements)

References 29 publications

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“…Across many different series, approximately 2% of all patients presenting to the hospitals with suspected acute coronary syndrome are usually identified with takotsubo syndrome 6,11,12 , with the postmenopausal female predominance described above [13][14][15][16] . If only female cases with suspected acute coronary syndrome are considered, up to 10% patients are ultimately diagnosed with takotsubo syndrome 10 .…”

Section: Epidemiologymentioning

confidence: 99%

Epidemiology and pathophysiology of Takotsubo syndrome

2015

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Takotsubo syndrome is an acute cardiac syndrome first described in 1990 and characterized by transient left ventricular dysfunction affecting more than one coronary artery territory, and often in a circumferential apical, mid-ventricular or basal distribution. A number of pathophysiological explanations for this syndrome with its intriguing appearance have been proposed, and there is a growing awareness that these are not mutually exclusive, and that the reversible apical myocardial dysfunction observed could result from more than one pathophysiological phenomenon. The pathophysiology of takotsubo syndrome is complex, with integration of both neuroendocrine physiology involving the cognitive centres of the brain and hypothalamic-pituitary-adrenal axis, and the cardiovascular responses to the sudden sympathetic activation and surge in circulating catecholamines. The latter have been explored in detail, starting with the histological findings at biopsy, with the multiple morphological changes seen in the myocardium matching those seen after established catecholamine cardiotoxic effects. Clinically, both the acute prognosis and recurrence rate are unfortunately worse than previously reported. It is clear that the modern cardiology community has much still to learn regarding the epidemiology and the underlying pathophysiology of this fascinating condition in order to improve diagnostic and treatment pathways. 3 Key points Approximately 2% of all patients presenting to the hospitals with suspected acute coronary syndrome are usually identified with takotsubo syndrome. There is a predominance in post-menopausal women compared to men or younger women. Both the acute and long-term mortality are higher than previously recognized.The cumulative incidence of recurrence increased from 1.2% at first 6 months to nearly 5% at 6 years, and there is no current evidence to support treatment with any specific to prevent recurrence. Systemic surges in catecholamines may cause vascular effects including acute coronary vasospasm and severe acute hypertension due to acute peripheral vasospasm followed by later peripheral vasodilation and hypotension. In the clinical setting, profound hypotension and cardiogenic shock is a common complication, however, it is not solely related to the extent of impairment of left ventricular (LV) systolic function, and thus probably relates in part to inappropriate peripheral vasodilation. Biopsies during acute takotsubo syndrome are characterized by multiple morphological changes that are similar to those after catecholamine cardiotoxic effects supporting a direct effect in addition to the vascular influences. The apical myocardium of the left ventricle has the highest density of β-adrenergic receptors (βAR), and is therefore most sensitive to circulating catecholamines.

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Section: Epidemiologymentioning

confidence: 99%

Epidemiology and pathophysiology of Takotsubo syndrome

2015

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“…Studies have shown that SCM was associated with chronic psychological or neurological diseases [14,15]. Our results implied that the influence of the chronic circulatory diseases on SCM may be underestimated.…”

Section: Scm Profile In Patients With Chronic Diseasesmentioning

confidence: 66%

“…Summers MR et al [14] reported that psychiatric illness had a high prevalence antecedes the onset of SCM. Primetshofer D et al [15] found that SCM patients frequently suffered from neurological disease. Whether SCM is likely to prevalence in individuals with high level of catecholamines, such as chronic circulatory diseases patients, is not well understood.…”

Section: Introductionmentioning

confidence: 99%

Stress Cardiomyopathy was Prone to Occur in Patients with Chronic Diseases: Maybe a Good Thing

Chong¹,

Hou²,

Zhang³

2016

Cardiovasc Pharm Open Access

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Background：Stress Cardiomyopathy (SCM) is an increasingly reported disease as a syndrome of acute, severe, but reversible, which is commonly triggered by an acute strong physical or emotional stress. But little is known whether chronic diseases may contribute to the occurrence of SCM.Method：The case reports about SCM from January 1998 to May 2014 were searched in the PubMed using the Medical Subject Headings: "tako-tsubo cardiomyopathy" or "stress cardiomyopathy" or ''ampulla syndrome'' or ''apical ballooning syndrome'' or ''broken heart syndrome''. The publications were excluded which didn't meet the inclusion criteria. SCM patients with and without chronic diseases were CD group and NCD group, respectively. The CD group was further classified into nine subgroups according to underlying chronic diseases. The circulatory diseases group which had the highest percentage in CD group was analyzed further.Results: 1331 literatures about SCM were collected, in which 1052 documents were eligible. In these documents, 1206 patients were reported, 795 had chronic diseases, 411 had no significant past medical history. The average age in NCD group was younger than that in CD group (57.3 ± 0.9 years versus 62.4 ± 0.6 years, P < 0.01). The number of SCM patients with Circulatory diseases was the most, then was Endocrine, Digestive, Respiratory, etc. The proportion of hypertension was 74.0% in circulatory diseases followed by dyslipidemia 29.3%, arrhythmia 10.1%, coronary artery disease 5.8%, etc.Conclusion：According to our results, the chronic diseases, especially hypertension, rose the rate of occurrence and delayed the onset age of SCM.

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“…It Son's departure for holidays [15] Hospital discharge [16] Official letter [17] Dinner invitation [17] has been known for many years that the psychological stress of a burglary can precipitate a major health crisis in elderly patients, necessitating urgent admission to a hospital [2]. TTC, induced by emotional or physical stress, has been a well-acknowledged acute cardiac problem with considerable morbidity and mortality due to arrhythmia, cardiogenic shock, and ventricular rupture [1,3].…”

Section: Discussionmentioning

confidence: 99%

Assault-induced Takotsubo cardiomyopathy associated with persisting anterograde amnesia and myopathy

et al. 2010

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Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction, electrocardiographic changes, and minimal release of myocardial enzymes that mimic acute myocardial infarction in patients without coronary artery disease. Takotsubo cardiomyopathy is frequently triggered by emotional or physical stress and occurs primarily in post-menopausal women. The pathomechanism of Takotsubo cardiomyopathy is, so far, unknown. Stress-induced amnesia is probably induced by perturbation of the hippocampal function. Assault-induced Takotsubo cardiomyopathy associated with amnesia has not been reported so far. In a 77-year-old Caucasian female, hospitalized because of confusion, anterograde amnesia, and hypertension after she had been assaulted by a female who sneaked up to her when she was unlocking the door of her apartment, Takotsubo cardiomyopathy was diagnosed based on clinical findings, electrocardiography, echocardiography, and coronary angiography. Follow-up after 8 weeks showed a regression of electrocardiographic and echocardiographic abnormalities; the amnesia for the assault, however, remained unchanged. This case shows that Takotsubo cardiomyopathy may be triggered by emotional stress induced during an assault. Assault-induced stress may not only induce Takotsubo cardiomyopathy but also amnesia for some of the events that occurred during the act.

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Tako-Tsubo syndrome: an important differential diagnosis in patients with acute chest pain

Cited by 17 publications

References 29 publications

Epidemiology and pathophysiology of Takotsubo syndrome

Epidemiology and pathophysiology of Takotsubo syndrome

Stress Cardiomyopathy was Prone to Occur in Patients with Chronic Diseases: Maybe a Good Thing

Assault-induced Takotsubo cardiomyopathy associated with persisting anterograde amnesia and myopathy

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