Takotsubo cardiomyopathy in a patient with previously undiagnosed hypertrophic cardiomyopathy with obstruction

Brabham, William W.; Lewis, Geoffrey F.; Bonnema, D. Dirk; Nielsen, Christopher D.; O’Brien, Terrence X.

doi:10.1016/j.carrev.2010.09.007

Cited by 14 publications

(12 citation statements)

References 10 publications

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“…A stressful emotional or physical trigger usually precedes Tako-tsubo cardiomyopathy, although it can be absent in as many as 20% of the cases. However, both in our case and in the case published by Brabham et al 1 a trigger factor was not evident supporting the notion that the previously undiagnosed hypertrophic cardiomyopathy contributes to Tako-tsubo cardiomyopathy. A potential mechanism could include a catecholamine surge exacerbating the resting LVOT gradient owing to a higher density of sympathetic innervation, resulting in a marked increase in intraventricular pressure, increased apical wall stress, reduced subendocardial blood flow leading to apical ballooning 4…”

Section: Discussionsupporting

confidence: 71%

“…However, coexistent persistent hypertrophic cardiomyopathy with obstruction in a patient presenting with Tako-tsubo cardiomyopathy is a much rarer phenomenon. To date, only one other case has been published in the literature of a patient admitted with a non-STEMI and shown to have both Tako-tsubo cardiomyopathy and a previously undiagnosed hypertrophic cardiomyopathy with obstruction 1. Ours is the first case to report a patient presenting with a STEMI and shown to have unobstructed coronaries, Tako-tsubo phenomenon and persistent hypertrophic cardiomyopathy with obstruction.…”

Section: Discussionmentioning

confidence: 77%

“…However, the combination of Tako-tsubo cardiomyopathy and previously undiagnosed hypertrophic obstructive cardiomyopathy has only been reported once before1 and is therefore of interest. We feel that patients presenting with an ST elevation myocardial infarction, who are subsequently shown to have unobstructed coronaries, should be investigated for both Tako-tsubo and hypertrophic cardiomyopathies.…”

Section: Introductionmentioning

confidence: 99%

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One heart, two cardiomyopathies

Vassiliou¹,

Agrawal

Ryding

2012

BMJ Case Reports

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A 63-year-old woman with no previous medical problems presented with acute chest pain and an ECG consistent with an acute anterior myocardial infarction. At emergency angiography, she was found to have smooth unobstructed coronary arteries. On invasive left ventriculography, overall poor systolic function was noted with apical hypokinesis and basal hyperkinesis, consistent with Tako-tsubo phenomenon. Echocardiography demonstrated a hypertrophic left ventricle and left ventricular outflow obstruction due to systolic anterior motion of the mitral valve and moderate mitral regurgitation. Following appropriate management, she was discharged 6 days later. An outpatient MRI confirmed normalisation of the left ventricular systolic function; however, there was still significant left ventricular hypertrophy and dynamic obstruction. Although most patients presenting with chest pain and an ECG with ST elevation will have an acute coronary event, our patient had normal coronaries but both Tako-tsubo and hypertrophic cardiomyopathies. BACKGROUND

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

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One heart, two cardiomyopathies

Vassiliou¹,

Agrawal

Ryding

2012

BMJ Case Reports

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“…2B and C). The echocardiogram showed extensive akinesia of the septum, the anterior wall and apical segments, suggestive of Takotsubo syndrome [5,6] (Fig. 3I and J).…”

Section: Dear Editormentioning

confidence: 96%

How far do we want to go in the treatment of obstruction in Hypertrophic Cardiomyopathy?

Pastor

Petrillo

Navarro

et al. 2015

International Journal of Cardiology

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“…[8][9][10][11][12] All 5 patients had systolic anterior motion of the mitral valve, which created an LV outflow tract gradient that would increase LV wall stress and possibly contribute to increased apical wall stress and ballooning. 11,13 Wall thickness in patients with HCM typically exceeds 15 mm in affected segments; in one series on apical HCM, 2 the average was 19 mm. However, wall thickness in HCM can vary considerably, and mild cases with thicknesses of 13 to 15 mm have been reported.…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Apical Ballooning Syndrome Masking Apical Hypertrophic Cardiomyopathy

Roy¹,

Hakim²,

Hurst³

et al. 2014

Texas Heart Institute Journal

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Apical akinesis and dilation in the absence of obstructive coronary artery disease is a typical feature of stress-induced (takotsubo) cardiomyopathy, whereas apical hypertrophy isS tress-induced cardiomyopathy involving akinesis of the left ventricular (LV) apex can mimic acute coronary syndrome but typically lacks obstructive coronary artery disease (CAD).1 Regional wall-motion abnormalities are usually transient, and the overall prognosis is favorable. Hypertrophic cardiomyopathy (HCM) is an autosomal dominant genetic disorder that can be localized in the LV apex. 2 We describe the cases of 2 patients whose diagnoses of apical-variant HCM were initially masked by their presentations with apical ballooning. Case Reports Patient 1In June 2011, a 43-year-old white woman with a history of alcohol abuse emergently presented with confusion, agitation, and shortness of breath of 2 days' duration. She had discontinued alcohol use and metoprolol succinate therapy 3 days before presentation. Her medical history included hypertension, previous tobacco use, and alcoholrelated liver disease. She had no known coronary disease. Her temperature was 36.7 °C; heart rate, 125 beats/min; blood pressure, 100/64 mmHg; respiratory rate, 34 breaths/min; and oxygen saturation, 96% on room air. Physical examination revealed tachycardia, non-tender hepatomegaly, and mild pitting edema in the lower extremities. The patient was confused, disoriented, and irritable without focal neurologic deficits.An electrocardiogram (ECG) showed sinus tachycardia with T-wave inversions and nonspecific ST-T-wave abnormalities in the anterolateral leads. Laboratory results included an elevated troponin T level of 0.27 ng/mL (normal, <0.03 ng/mL) and normal renal function. A transthoracic echocardiogram (TTE) showed an LV ejection fraction (LVEF) of 0.47 with hyperdynamic basal function but with a dilated, akinetic apex that suggested an apical variant of stress-induced cardiomyopathy (Fig. 1).

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Takotsubo cardiomyopathy in a patient with previously undiagnosed hypertrophic cardiomyopathy with obstruction

Cited by 14 publications

References 10 publications

One heart, two cardiomyopathies

One heart, two cardiomyopathies

How far do we want to go in the treatment of obstruction in Hypertrophic Cardiomyopathy?

Two Cases of Apical Ballooning Syndrome Masking Apical Hypertrophic Cardiomyopathy

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