Cardiogenic Shock Secondary to Takotsubo Cardiomyopathy in a Patient with Preexisting Hypertrophic Obstructive Cardiomyopathy.
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ABSTRACT:
SUBMITTER: Nalluri N
PROVIDER: S-EPMC6058765 | biostudies-literature | 2018 Jun
REPOSITORIES: biostudies-literature
Publications
Cardiogenic Shock Secondary to Takotsubo Cardiomyopathy in a Patient with Preexisting Hypertrophic Obstructive Cardiomyopathy.
Nalluri Nikhil N Asti Deepak D Anugu Viswajit Reddy VR Ibrahim Uroosa U Lafferty James C JC Olkovsky Yefim Y
CASE (Philadelphia, Pa.) 20171229 3
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Project description:Takotsubo cardiomyopathy (TCM) is a condition characterized by transient left ventricular dysfunction and apical ballooning, best seen on an echocardiogram or left ventriculogram. It mimics acute myocardial infarction but without evidence of coronary artery disease on an angiogram. Hypertrophic cardiomyopathy (HCM) is an autosomal dominant heart muscle disease that is significant with hypertrophy of the left ventricle with various morphologies. We hereby report a case of TCM in a male patient with a known history of HCM. The patient's hemodynamic findings were challenging because the TCM produced an increased left ventricular outflow tract (LVOT) gradient that was previously not seen on his prior echocardiogram or cardiac catheterizations. Assessment and continuous monitoring are warranted in such a rare case. Supportive care afterward with beta blockers, along with echocardiogram surveillance, are the mainstay of management of such a patient.
| S-EPMC6333265 | biostudies-other
Project description:BackgroundTakotsubo cardiomyopathy (TTC) has a preponderance for females, particularly postmenopausal. However, recent data from multicenter registries identified a worse prognosis in male patients, particularly with cardiogenic shock. We aim to investigate gender disparities in outcomes of TTC-associated cardiogenic shock (TTC-CS).MethodsThe National Readmission Database (2016-2020) was utilized to identify TTC-CS hospitalizations. Cohorts were stratified by gender. A Propensity Score Matching (PSM) model, which utilized complete Mahalanobis Distance Matching within the Propensity Score Caliper following multivariate regression, successfully matched males and females. Pearson's χ2 test was applied to the propensity-matched cohorts to compare outcomes.ResultsAmong 12,803 TTC-CS hospitalizations, the majority (74.1 %) were females (N: 9490), and 25.9 % were males (N: 3313). On propensity-matched cohorts (2609), males were found to have higher in-hospital mortality (31 % vs. 26 %, p < 0.001), higher incidence of sudden cardiac arrest (14 % vs. 10.8 %, p < 0.001), endotracheal intubation (52.1 % vs. 48.8 %, p: 0.001), acute liver injury (18 % vs. 15.9 %, p: 0.004), acute stroke (7.2 % vs. 5.8 %, p: 0.004), cardiac arrhythmias (55.1 % vs. 49.3 %, p < 0.001) and acute kidney injury (63.1 % vs. 49 %, p < 0.001); while female patients were found to have higher utilization of mechanical circulatory support (MCS) modalities (16.1 % vs 13.2 %, p < 0.001).Males had a higher adjusted cost of hospitalization ($54,537 vs. $42,805, p < 0.001) with a higher median length of hospital stay (10 vs. 9 days, p < 0.001). The two groups had no significant difference in 30, 90, and 180-day readmission rates (p > 0.05). From 2016 to 2020; mortality has not changed significantly for TTC-CS, while the use of percutaneous coronary angiogram (PCA) and MCS has down-trended (p-trend < 0.05).ConclusionFor TTC-CS hospitalization, males have higher in-hospital mortality and complication rates, along with higher LOS and cost of hospitalization. Despite advances in the management of CS, there was no significant difference in mortality from 2016 to 2020.
| S-EPMC11419888 | biostudies-literature
Project description: Not available
| S-EPMC6689523 | biostudies-literature
Project description:Background Cardiogenic shock from most causes has unfavorable prognosis. Hypertrophic cardiomyopathy (HCM) can uncommonly present with apical ballooning and shock in association with sudden development of severe and unrelenting left ventricular (LV) outflow obstruction. Typical HCM phenotypic features of mild septal thickening, outflow gradients, and distinctive mitral abnormalities differentiate these patients from others with Takotsubo syndrome, who have normal mitral valves and no outflow obstruction. Methods and Results We analyzed 8 patients from our 4 HCM centers with obstructive HCM and abrupt presentation of cardiogenic shock with LV ballooning, and 6 cases reported in literature. Of 14 patients, 10 (71%) were women, aged 66±9 years, presenting with acute symptoms: LV ballooning; depressed ejection fraction (25±5%); refractory systemic hypotension; marked LV outflow tract obstruction (peak gradient, 94±28 mm Hg); and elevated troponin, but absence of atherosclerotic coronary disease. Shock was managed with intravenous administration of phenylephrine (n=6), norepinephrine (n=6), β-blocker (n=7), and vasopressin (n=1). Mechanical circulatory support was required in 8, including intra-aortic balloon pump (n=4), venoarterial extracorporeal membrane oxygenation (n=3), and Impella and Tandem Heart in 1 each. In refractory shock, urgent relief of obstruction by myectomy was performed in 5, and alcohol ablation in 1. All patients survived their critical illness, with full recovery of systolic function. Conclusions When cardiogenic shock and LV ballooning occur in obstructive HCM, they are marked by distinctive anatomic and physiologic features. Relief of obstruction with targeted pharmacotherapy, mechanical circulatory support, and myectomy, when necessary for refractory shock, may lead to survival and normalization of systolic function.
| S-EPMC8751867 | biostudies-literature
Project description:This case report concerns an 81-year-old woman with previously well-controlled hypertrophic obstructive cardiomyopathy (HOCM). She was referred to our hospital because of the acute onset of takotsubo syndrome. Echocardiography revealed basal hyperkinesis due to takotsubo syndrome superimposed on septal hypertrophy, which resulted in the reappearance of prominent left ventricular outflow tract obstruction (LVOTO). Although she developed cardiogenic shock triggered by atrial fibrillation, LVOTO was successfully mitigated by aggressive fluid resuscitation, rhythm control, and the administration of β-blocker. We herein report a rare case with catastrophic hemodynamics due to the incidental combination of HOCM and takotsubo syndrome.
| S-EPMC7184076 | biostudies-literature
Project description:A patient with known obstructive hypertrophic cardiomyopathy developed worsening left ventricular outflow tract obstruction, severe mitral regurgitation, and apical ballooning leading to cardiogenic shock, a combination in which treatment of each component could worsen the others. Emergency veno-arterial extracorporeal membrane oxygenation, levosimendan, and noradrenaline transiently restored adequate systemic perfusion and gas exchange. Surgical myectomy offered a more definitive solution. (Level of Difficulty: Intermediate.).
| S-EPMC8311032 | biostudies-literature
Project description:Reverse takotsubo cardiomyopathy (rTCM) is characterized by basal ballooning and accounts for approximately 1% of all TCM. To our knowledge, there have been no reports describing rTCM complicated by acute, severe, transient mitral regurgitation (MR). A 75-year-old woman with a medical history of hypertension, dyslipidemia, and anxiety presented to the hospital with 2 days of substernal chest pain, dyspnea, and nausea. Initial troponin was 0.203 ng/mL, and electrocardiography showed sinus tachycardia at 121 bpm, with inferior and anterolateral ST segment depressions. Transthoracic echocardiogram (TTE) found an ejection fraction of 30%, apical hyperkinesis, severe hypokinesis of the basal to mid segments of the left ventricle (LV), and a severe central MR jet. Cardiac angiography demonstrated non-obstructive coronary artery disease, and elevated left ventricular end diastolic pressures. Left ventriculography showed a hyperdynamic apex and severe basal hypokinesis. The patient was treated medically, clinical status improved, and was discharged on day 3. TTE four weeks later, showed an ejection fraction of 60-65%, mild MR, and normal LV function. rTCM is the rarest variant of TCM. Basal and mid-myocardial stunning can cause severe secondary MR leading to acute congestive heart failure, mimicking acute coronary syndrome with acute MR. rTCM with rapidly reversible severe MR has not previously been described. <Learning objective: Mitral regurgitation secondary to reverse takotsubo cardiomyopathy can mimic coronary flow obstruction syndromes and when recognized early, can improve with amelioration of cardiomyopathy. Acute severe mitral regurgitation in reverse takotsubo cardiomyopathy is likely secondary to basilar dilatation. Reverse takotsubo cardiomyopathy represents approximately 1% of all takotsubo cardiomyopathy cases.>.
| S-EPMC8642629 | biostudies-literature
Project description:The development of cardiogenic shock due to the coexistence of Takotsubo cardiomyopathy and thyroid crisis in patients has been scarcely reported. A 46-year-old female presented with chest pain, palpitations, nausea, and vomiting for 8 h. She was initially considered to have acute myocardial infarction due to elevated cardiac markers and abnormal electrocardiogram changes. Immediately after the coronary angiography revealed a normal coronary artery, the patient developed refractory cardiogenic shock. Echocardiography demonstrated a typical apical ballooning type of Takotsubo cardiomyopathy with a left ventricular ejection fraction (LVEF) of 32%. A combination of norepinephrine and dopamine and an intra-aortic balloon pump (IABP) was used to support haemodynamic stability but failed to improve the patient's condition. Immediately after the laboratory tests revealed previously unknown hyperthyroidism on the second hospital day, a rapid atrial fibrillation (AF) suddenly occurred. Nifekalant successfully restored sinus rhythm in a short time. The patient persistently complained of chest tightness, palpitations, and sweating for the first 4 days until levosimendan and antithyroid crisis treatment were used. Takotsubo cardiomyopathy and thyroid crisis can co-occur and present as cardiogenic shock. In the presence of severe cardiac dysfunction and untreated hyperthyroidism, nifekalant is an ideal option for the new onset of AF. The combination of heart failure treatment and antithyroid crisis drugs can effectively restore cardiac function and is associated with good clinical outcomes.
| S-EPMC9552998 | biostudies-literature
Project description:Currently, there are 2 proposed causes of acute left ventricular ballooning. The first is the most cited hypothesis that ballooning is caused by direct catecholamine toxicity on cardiomyocytes or by microvascular ischemia. We refer to this pathogenesis as Takotsubo syndrome. More recently, a second cause has emerged: that in some patients with underlying hypertrophic cardiomyopathy, left ventricular ballooning is caused by the sudden onset of latent left ventricular outflow tract obstruction. When it becomes severe and unrelenting, severe afterload mismatch and acute supply-demand ischemia appear and result in ballooning. In the context of 2 causes, presentations might overlap and cause confusion. Knowing the pathophysiology of each mechanism and how to determine a correct diagnosis might guide treatment.
| S-EPMC10727392 | biostudies-literature
Project description:A growing body of evidence suggests that inflammation may play a key role in the development of Takotsubo stress cardiomyopathy. Here, we report the case of a 63-year-old woman who presented with chest pain and was diagnosed with this cardiomyopathy. After an initial improvement, the patient experienced a systemic inflammatory response of unclear origin and deteriorated rapidly into obstructive shock. Her presentation was considered consistent with cytokine storm. She was, therefore, treated with steroids with rapid improvement in her clinical picture. She relapsed after the taper. Endomyocardial biopsy soon after initiation of pulse dose steroids showed macrophage and lymphocytic infiltration. This case highlights the potential intimate connection between systemic inflammatory response and Takotsubo stress cardiomyopathy and contributes to the evolving understanding of inflammation in the pathogenesis of this disease.
| S-EPMC9309717 | biostudies-literature