Tako-Tsubo Syndrome in a 12-Year-Old Girl: Exhausted Heart, Not Broken Heart

Dessardo, Sandro; Tomulić, Vjekoslav; Dessardo, Nada Sindičić

doi:10.1007/s00246-011-0038-1

Cited by 15 publications

(10 citation statements)

References 10 publications

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“…Post event echocardiography in military cases is usually normal (156,196,224,352). In nonmilitary cases identifiable predisposing factors have been found, including left ventricular dysfunction (20,89) and acute coronary syndrome (137). A review of published cases and series revealed potential risk factors in approximately 50% of civilian cases (245).…”

Section: Immersion Pulmonary Edemamentioning

confidence: 99%

Human Physiology in an Aquatic Environment

Pendergast

Moon

Krasney

et al. 2015

Comprehensive Physiology

139

137

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Water covers over 70% of the earth, has varying depths and temperatures and contains much of the earth's resources. Head-out water immersion (HOWI) or submersion at various depths (diving) in water of thermoneutral (TN) temperature elicits profound cardiorespiratory, endocrine, and renal responses. The translocation of blood into the thorax and elevation of plasma volume by autotransfusion of fluid from cells to the vascular compartment lead to increased cardiac stroke volume and output and there is a hyperperfusion of some tissues. Pulmonary artery and capillary hydrostatic pressures increase causing a decline in vital capacity with the potential for pulmonary edema. Atrial stretch and increased arterial pressure cause reflex autonomic responses which result in endocrine changes that return plasma volume and arterial pressure to preimmersion levels. Plasma volume is regulated via a reflex diuresis and natriuresis. Hydrostatic pressure also leads to elastic loading of the chest, increasing work of breathing, energy cost, and thus blood flow to respiratory muscles. Decreases in water temperature in HOWI do not affect the cardiac output compared to TN; however, they influence heart rate and the distribution of muscle and fat blood flow. The reduced muscle blood flow results in a reduced maximal oxygen consumption. The properties of water determine the mechanical load and the physiological responses during exercise in water (e.g. swimming and water based activities). Increased hydrostatic pressure caused by submersion does not affect stroke volume; however, progressive bradycardia decreases cardiac output. During submersion, compressed gas must be breathed which introduces the potential for oxygen toxicity, narcosis due to nitrogen, and tissue and vascular gas bubbles during decompression and after may cause pain in joints and the nervous system.

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Section: Immersion Pulmonary Edemamentioning

confidence: 99%

Human Physiology in an Aquatic Environment

Pendergast

Moon

Krasney

et al. 2015

Comprehensive Physiology

139

137

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“…(These latter diagnoses were not included in Table 1.) Of the 50 IPE cases found to have evidence of cardiac dysfunction, valvular disease was found in 6 cases (6,29,34) and LV dysfunction was found in 26 cases (5,11,14,20,27,35,60) ( Table 2). The mean age of those with risk factors for coronary artery disease (hypertension, hypercholesterolemia, or smoking history) was 53.0 T 6.8 yr versus 45.7 T 12.0 yr in those without risk factors (P = 0.0001).…”

Section: Resultsmentioning

confidence: 99%

“…An effort was made not to double-count cases that were likely to have been included in more than one case report or series (25,45,68). One additional article was also included, in which the case described a syndrome consistent with IPE but was not labeled as IPE or swimming-induced pulmonary edema (20). Articles related to breath-hold (apnea) diving were excluded owing to the distinct mechanism for pulmonary edema in apnea diving that does not occur during scuba diving or surface swimming (lung squeeze) (38).…”

Section: Methodsmentioning

confidence: 99%

Immersion Pulmonary Edema and Comorbidities

Peacher

Martina

Otteni

et al. 2015

Medicine &Amp; Science in Sports &Amp; Exercise

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Cardiopulmonary disease may be a common predisposing factor in IPE in the recreational swimming/diving population, whereas pulmonary hypertension due to extreme exertion may be more important in military cases. Individuals with past history of IPE in our case series had a greater proportion of comorbidities compared to published cases. The role of underlying cardiopulmonary dysfunction may be underestimated, especially in older swimmers and divers. We conclude that an episode of IPE should prompt the evaluation of cardiac and pulmonary function.

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“…1,3 Peak effects of immune modulation may take days to weeks, and given the severity of this disease process, some suggest that treatment begin prior to meeting all confirmatory diagnostic criteria. 8 The chest symptoms and electrocardiographic changes mimic those of acute myocardial infarction, but occur in the absence of coronary artery disease. 4 For patients with primary HLH and those with secondary HLH who fail to respond to first-line immunosuppressive therapy, hematopoietic stem cell transplantation is the goal.…”

Section: Discussionmentioning

confidence: 99%

A 6-Year-Old Girl With Undiagnosed Hemophagocytic Lymphohistiocytosis and Takotsubo Cardiomyopathy

Otillio¹,

Harris²,

Tuuri³

2014

Pediatric Emergency Care

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Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder of highly stimulated immune responses to antigens that leads to life-threatening inflammation and multiple organ dysfunction. At presentation, HLH may uncommonly mimic septic shock. In this case, we present a 6-year-old girl presenting to the pediatric emergency department with a febrile illness and anemia that subsequently developed decompensated shock, initially thought to be septic. She was ultimately diagnosed with HLH. During initial HLH treatment, this patient also developed takotsubo cardiomyopathy, a unique pattern of reversible left ventricular dysfunction characterized by transient apical ballooning and hypokenesis of the left ventricle that spontaneously resolves. There are very few case reports of HLH-associated takotsubo cardiomyopathy. We believe that this is the first case of takotsubo cardiomyopathy in a child with HLH.

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Tako-Tsubo Syndrome in a 12-Year-Old Girl: Exhausted Heart, Not Broken Heart

Cited by 15 publications

References 10 publications

Human Physiology in an Aquatic Environment

Human Physiology in an Aquatic Environment

Immersion Pulmonary Edema and Comorbidities

A 6-Year-Old Girl With Undiagnosed Hemophagocytic Lymphohistiocytosis and Takotsubo Cardiomyopathy

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