Transient takotsubo syndrome and its recurrence: Why does it happen, why does it end, and why does it rarely reappear?

Angelini, Paolo

doi:10.1016/j.ijcard.2021.02.033

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…On the other hand, in COVID-19 patients, irrespective of the severity of the clinical manifestation, several conditions which may favour TTS onset can occur: like catecholamine-induced myocyte injury and neurogenic myocardial stunning, cytokine storm, immune-mediated damage, direct viral myocyte injury, procoagulant state, microvascular coronary impairment due to endothelial injury, and vasospasm (9,10). The hypothesis is that SARS-COV-2 infection, even asymptomatic, may precipitate TTS onset in predisposed patients, where endothelial dysfunction plays a pivotal role as cause of microvascular impairment (11). The existence of an individual susceptibility can likely manifest itself with episodes of relapse many years apart, in a different social and emotional context, with a different trigger event or in its absence (12).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Asymptomatic SARS-COV2 infection triggering recurrent Takotsubo syndrome

Dall’Ara,

Compagnone,

Carletti

et al. 2024

Front. Cardiovasc. Med.

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Takotsubo syndrome (TTS) is a rare disease mimicking acute coronary syndrome, often triggered by physical or emotional stress, and characterized by transient left ventricular dysfunction. Recurrences are described in about 5% of cases and may have different clinical and imaging patterns. In the present report, SARS-COV-2 infection, even in the absence of symptoms and overt emotional stress, seems correlated with recurrence of TTS, due to the absence of other recognized triggers. The hypothesis is that in predisposed patients, events like catecholamine-induced myocyte injury, direct viral damage, cytokine storm, immune-mediated damage, and procoagulant state, all possibly induced by the infection, may elicit endothelial dysfunction as substrate for TTS onset.

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Section: Discussionmentioning

confidence: 99%

Case Report: Asymptomatic SARS-COV2 infection triggering recurrent Takotsubo syndrome

Dall’Ara,

Compagnone,

Carletti

et al. 2024

Front. Cardiovasc. Med.

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“…Our own preliminary experience in the field of TTC leads us to hypothesize that CED is generally a necessary predisposing condition for the occurrence of spontaneous coronary spasticity (and hence for inducing TTC) in patients during COVID-19 (34,35,(39)(40)(41). Specifically, our group theorizes the following sequence of processes in TTC: If the "CED-to-spastic ischemic spell to myocardial stunning" theory is correct, it is reasonable to propose that CED could underlie the reported increases in the incidence of TTC during the current COVID-19 pandemic (discussed more extensively below) (24,44,45).…”

Section: Pulmonary-to-myocardial Cell Invasion and Humoral Repercussionsmentioning

confidence: 99%

COVID-19 and the Heart: Could Transient Takotsubo Cardiomyopathy Be Related to the Pandemic by Incidence and Mechanisms?

Angelini

Postalian²,

Hernandez-Vila³

et al. 2022

Front. Cardiovasc. Med.

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Typical emergency hospital care during the COVID-19 pandemic has centered on pulmonary-focused services. Nonetheless, patients with COVID-19 frequently develop complications associated with the dysfunction of other organs, which may greatly affect prognosis. Preliminary evidence suggests that cardiovascular involvement is relatively frequent in COVID-19 and that it correlates with significant worsening of clinical status and mortality in infected patients. In this article, we summarize current knowledge on the cardiovascular effects of COVID-19. In particular, we focus on the association between COVID-19 and transient takotsubo cardiomyopathy (TTC)—two conditions that preliminarily seem epidemiologically associated—and we highlight cardiovascular changes that may help guide future investigations toward full discovery of this new, complex disease entity. We hypothesize that coronary endothelial dysfunction, along with septic state, inflammatory storm, hypercoagulability, endothelial necrosis, and small-vessel clotting, may represent a fundamental hidden link between COVID-19 and TTC. Furthermore, given the likelihood that new genetic mutations of coronaviruses or other organisms will cause similar pandemics and endemics in the future, we must be better prepared so that a substantial complication such as TTC can be more accurately recognized, its pathophysiology better understood, and its treatment made more justifiable, timely, and effective.

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Can Significant Coronary Artery Disease Coexist With Transient Takotsubo Cardiomyopathy, and How Does Spasm Interrelate?

Angelini

Uribe

Salem

2023

Texas Heart Institute Journal

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An 86-year-old woman being treated for metastatic breast cancer developed severe chest pain at rest during a follow-up visit at a hospital's outpatient oncology clinic. An electrocardiogram showed severe ST-segment elevation. The patient was given sublingual nitroglycerin and was transferred to the emergency department. Diagnostic coronary angiography revealed moderate coronary artery disease with calcific stenoses and transient spastic occlusion of the left anterior descending coronary artery. For this patient, sublingual nitroglycerin aborted the spastic event and apparent transient takotsubo cardiomyopathy. Chemotherapy can potentially cause endothelial dysfunction and increased coronary spasticity, which could result in takotsubo cardiomyopathy.

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Transient takotsubo syndrome and its recurrence: Why does it happen, why does it end, and why does it rarely reappear?

Cited by 3 publications

References 10 publications

Case Report: Asymptomatic SARS-COV2 infection triggering recurrent Takotsubo syndrome

Case Report: Asymptomatic SARS-COV2 infection triggering recurrent Takotsubo syndrome

COVID-19 and the Heart: Could Transient Takotsubo Cardiomyopathy Be Related to the Pandemic by Incidence and Mechanisms?

Can Significant Coronary Artery Disease Coexist With Transient Takotsubo Cardiomyopathy, and How Does Spasm Interrelate?

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