Takotsubo Cardiomyopathy Coexisting with Acute Pericarditis and Myocardial Bridge

Sezavar, S H; Toofaninejad, Neda; Hajsadeghi, Shokoufeh; Beni, Hassan Riahi; Ghanavati, Roya; Hajahmadi, Marjan; Hassanzadeh, Morteza

doi:10.1155/2016/5189741

Cited by 9 publications

(11 citation statements)

References 27 publications

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“…To explain the confounding clinical picture, we support the “inflammatory hypothesis”. According to this proposed mechanism, SIC can be considered a variant of regional inflammatory myocarditis with extension of the myocardial inflammation to the overlying pericardium, leading to pericarditis [27–29]. The evidence of inflammation of the myocardium has been previously reported both on endomyocardial biopsy [27,30] and on cMRI [31].…”

Section: Discussionmentioning

confidence: 99%

“…According to this proposed mechanism, SIC can be considered a variant of regional inflammatory myocarditis with extension of the myocardial inflammation to the overlying pericardium, leading to pericarditis [27–29]. The evidence of inflammation of the myocardium has been previously reported both on endomyocardial biopsy [27,30] and on cMRI [31]. The role of intense catecholamine surge secondary to the chest pain caused by pericardial inflammation has also been proposed and may explain how pericarditis can trigger SIC [27,32].…”

Section: Discussionmentioning

confidence: 99%

“…Differentiating clinically between the 2 entities can be difficult [27–36]. Sequential ECG may be helpful in differentiating myopericarditis-variant SIC from classic myopericarditis.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge

et al. 2019

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Patient: Female, 47 Final Diagnosis: Stress induced cardiomyopathy Symptoms: Chest pain Medication: — Clinical Procedure: Catch • echo Specialty: Cardiology Objective: Challenging differential diagnosis Background: Stress induced cardiomyopathy (SIC) is characterized by non-obstructive coronary arteries and characteristic ventricular apical ballooning. The exact pathogenesis of SIC is not well recognized. We present an unusual case of SIC that mimicked acute myopericarditis and discuss the effect of this masquerading presentation of SIC in recognizing pathophysiological association between myopericarditis and SIC and limitations of current diagnostic criteria. Case Report: A 47-year-old female presented with flu-like illness and pleuritic chest pain. An electrocardiogram (ECG) showed diffuse PR depressions and ST elevations, troponin 5 ng/mL, hemoglobin 14.2 mg/dL, leukocytosis (white blood cell count of 15.1×10 3 /uL) and erythrocyte sedimentation rate (ESR) of 22.4 mm/hour. Echocardiogram showed reduced ejection fraction (EF) with apical ballooning. Catheterization showed non-obstructive coronary disease. The patient was given colchicine and ibuprofen for 1 day with symptom resolution over the next 2 days and repeat echocardiogram with preserved EF. Troponin trended down to 3.24 ng/mL and 0.44 ng/mL, 6 hours apart. ECG showed resolution of PR depressions and subsequent T wave inversions in 1, AVl, V1–V6 by day 3. The diagnosis of myopericarditis was favored by viral prodrome, fever, pleuritic pain, pericardial rub, ECG findings, and elevated ESR. History of emotional stress, characteristic ballooning of left ventricle apex with rapid resolution favored SIC. Conclusions: This case showed that SIC and myocarditis need not be mutually exclusive and differentiating clinically between these 2 entities can be difficult. Alternatively, SIC can accompany other cardiac conditions like myocardial infarction, pericarditis, and myocarditis making diagnosis and management challenging. Clinicians need to be cautious while making this differentiation as duration and type of therapy may be significantly different. SIC can be considered a variant of regional inflammatory myocarditis wherein pericarditis may result secondary to extension of myocardial inflammation to overlying pericardium. The current Mayo Clinic criteria for diagnosis of SIC appears to be outdated, not accounting for such atypical presentations, and therefore needs to be revised.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge

et al. 2019

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“…The authors reported a case in which an 84‐year‐old woman was diagnosed as having TTS with acute pericarditis as revealed on ECG. Currently, numerous studies demonstrate the coexistence of acute pericarditis and TTS . In these studies, several cases of PR deviation can be found.…”

Section: Discussionmentioning

confidence: 99%

PR deviation as a risk marker for cardiac events in patients with Takotsubo syndrome

Shimizu

Fujii

Yamawake

et al. 2018

Pacing Clinical Electrophis

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Background: PR segment deviation (PRD: defined as PR elevation in aVR and PR depression in lead II/III) on electrocardiography is frequently observed in patients with acute pericarditis; however, there have been few studies that explore the occurrence of PRD in patients with Takotsubo syndrome (TTS). The clinical significance of PRD in TTS is not clearly elucidated. Methods & results:A total of 52 consecutive patients with TTS in sinus rhythm (73.9 ± 13.8 years, nine males) were enrolled in the study. The major cardiac events were defined as sustained ventricular tachycardia or ventricular fibrillation, Killip class 4 heart failure, and cardiac death within 30 days. PRD in the hyperacute phase (within 48 h from the onset of TTS) was observed in 15 patients (29%), and all PRDs disappeared or diminished at 1 week later. The PRD (+) group had a higher value of C-reactive protein level (median: 1.80 mg/dL [0.31-3.26] vs 0.20 mg/dL [0.06-0.81], P = 0.013) and creatine kinase-muscle/brain isoenzyme (median: 60 IU/L vs 17 IU/L [13-26], P < 0.001) and a lower level of left ventricular ejection fraction (42.7 ± 7.2% vs 48.8 ± 9.4%, P = 0.041) than the PRD (−) group. Multivariate analysis showed that PRD was a significant and independent predictor for major cardiac events (odds ratio = 21.0, 95% confidence interval = 1.18-273).Conclusions: TTS patients with PRD in the hyperacute phase showed a high incidence of major cardiac events. Therefore, PRD may help to identify TTS patients at high risk for cardiac event.

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“…To explain the confounding clinical picture, we support the "inflammatory hypothesis". According to this proposed mechanism, SIC can be considered a variant of regional inflammatory myocarditis with extension of the myocardial inflammation to the overlying pericardium, leading to pericarditis [27][28][29]. The evidence of inflammation of the myocardium has been previously reported both on endomyocardial biopsy [27,30] and on cMRI [31].…”

mentioning

confidence: 99%

Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge

Sharma

Tigadi

Khurana

et al. 2019

Journal of the American College of Cardiology

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Challenging differential diagnosis Background:Stress induced cardiomyopathy (SIC) is characterized by non-obstructive coronary arteries and characteristic ventricular apical ballooning. The exact pathogenesis of SIC is not well recognized. We present an unusual case of SIC that mimicked acute myopericarditis and discuss the effect of this masquerading presentation of SIC in recognizing pathophysiological association between myopericarditis and SIC and limitations of current diagnostic criteria. Case Report:A 47-year-old female presented with flu-like illness and pleuritic chest pain. An electrocardiogram (ECG) showed diffuse PR depressions and ST elevations, troponin 5 ng/mL, hemoglobin 14.2 mg/dL, leukocytosis (white blood cell count of 15.1×10 3 /uL) and erythrocyte sedimentation rate (ESR) of 22.4 mm/hour. Echocardiogram showed reduced ejection fraction (EF) with apical ballooning. Catheterization showed non-obstructive coronary disease. The patient was given colchicine and ibuprofen for 1 day with symptom resolution over the next 2 days and repeat echocardiogram with preserved EF. Troponin trended down to 3.24 ng/mL and 0.44 ng/mL, 6 hours apart. ECG showed resolution of PR depressions and subsequent T wave inversions in 1, AVl, V1-V6 by day 3. The diagnosis of myopericarditis was favored by viral prodrome, fever, pleuritic pain, pericardial rub, ECG findings, and elevated ESR. History of emotional stress, characteristic ballooning of left ventricle apex with rapid resolution favored SIC. Conclusions:This case showed that SIC and myocarditis need not be mutually exclusive and differentiating clinically between these 2 entities can be difficult. Alternatively, SIC can accompany other cardiac conditions like myocardial infarction, pericarditis, and myocarditis making diagnosis and management challenging. Clinicians need to be cautious while making this differentiation as duration and type of therapy may be significantly different. SIC can be considered a variant of regional inflammatory myocarditis wherein pericarditis may result secondary to extension of myocardial inflammation to overlying pericardium. The current Mayo Clinic criteria for diagnosis of SIC appears to be outdated, not accounting for such atypical presentations, and therefore needs to be revised.

show abstract

Takotsubo Cardiomyopathy Coexisting with Acute Pericarditis and Myocardial Bridge

Cited by 9 publications

References 27 publications

Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge

Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge

PR deviation as a risk marker for cardiac events in patients with Takotsubo syndrome

Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge

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