Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection.
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ABSTRACT:
SUBMITTER: Sala S
PROVIDER: S-EPMC7184339 | biostudies-literature | 2020 May
REPOSITORIES: biostudies-literature
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Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection.
Sala Simone S Peretto Giovanni G Gramegna Mario M Palmisano Anna A Villatore Andrea A Vignale Davide D De Cobelli Francesco F Tresoldi Moreno M Cappelletti Alberto Maria AM Basso Cristina C Godino Cosmo C Esposito Antonio A
European heart journal 20200501 19
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Project description:BackgroundTriangular ST-segment elevation or 'shark-fin' sign has been described as a specific indicator of acute coronary occlusion and large myocardial ischaemia, translating into poorer prognosis. However, this electrocardiographic presentation has been reported in rare cases of Tako-Tsubo syndrome and associated with more severe physical stressors and neurological involvement.Case summaryWe present a rare case of a 51-year-old woman presenting with incoming epileptic attacks and concomitant pyometra. Despite controlling epilepsy with phenytoin and the surgical treatment of the infection, she developed sepsis requiring vasopressors, and thereafter sustained ventricular tachycardia and diffuse ST-segment elevation with the 'shark-fin' sign. TTC was confirmed by the documentation of normal coronary arteries and the complete recovery of wall motion abnormalities at discharge.DiscussionHeterogeneous presentation and triggering conditions often challenge the diagnosis of Tako-Tsubo syndrome. The acknowledgement of different electrocardiographic and clinical manifestations can ease the diagnosis and the successful management of these patients, whose prognosis can be extremely severe in the acute phase, if unidentified.
| S-EPMC8189302 | biostudies-literature
Project description:Tako-Tsubo cardiomyopathy (TTC) is a reversible cardiomyopathy characterized by acute left ventricular segmental dysfunction, whose clinical presentation resembles that of acute myocardial infarction. The syndrome often follows a psychophysical stressful event and is characterized by echocardiographic evidence of akinesia of the left ventricular mid-apical segments. Atypical echocardiographic patterns of TTC have recently been described, often triggered by emotional stressors, rather than physical. In this report, we describe a case of atypical TTC triggered by an unusual stressor (recurrent nightmare) in a 45-year-old woman, with peculiar clinical presentation and evolution characterized by persistent loss of consciousness, neurological deterioration, absence of typical symptoms of TTC, and features suggestive of a hysterical crisis.
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| S-EPMC6353374 | biostudies-literature
Project description:Background The pericoronary fat attenuation index (pFAI) has emerged as a marker of coronary inflammation, which is measurable from standard coronary computed tomography angiography (CCTA). It compares well with gold-standard methods for the assessment of coronary inflammation and can predict future cardiovascular events. pFAI could prove invaluable to differentiate an inflammatory from a noninflammatory coronary artery status, helping unravel the mechanisms subtending an event classified as myocardial infarction with nonobstructive coronary arteries (MINOCA) or Tako-Tsubo syndrome (TTS). Methods and Results Patients admitted with MINOCA and TTS between 2011 and 2018, who had both CCTA and cardiac magnetic resonance during or shortly after the acute phase, were selected and pFAI measured in their CCTA; pFAI was also measured in control subjects who had CCTA for atypical chest pain workup, no obstructive coronary artery disease found in their CCTA, and no cardiac events at 2-year follow-up. In the n=106 MINOCA/TTS patients, mean pFAI was -68.37±8.29 versus -78.03±6.20 in the n=106 controls (P<0.0001), and the difference was confirmed also when comparing mean pFAI in each coronary artery between MINOCA/TTS and controls (P<0.0001). Nonobstructive coronary plaques at CCTA, high-risk plaques in particular, were more frequently found (P<0.01) in the MINOCA/TTS group compared with controls. Conclusions In MINOCA and TTS patients, CCTA is not only able to detect angiographically invisible atherosclerotic plaques, but its diagnostic yield can be expanded using the simple measurement of pFAI to characterize pericoronary fat tissue; in MINOCA/TTS mean pFAI demonstrates higher values compared with controls, a finding that has been associated with coronary artery inflammation.
| S-EPMC6755824 | biostudies-literature
Project description:Stress cardiomyopathy or Tako Tsubo cardiomyopathy is a cardiac pathology evoking acute coronary syndrome characterized by electrocardiographic signs, cardiac enzyme elevation and no obstructive coronary lesions. It generally affects postmenopausal women and it usually occurs after periods of intense stress. Disease onset is widely variable, ranging from anginal pain (most common) to cardiogenic shock. Exact pathophysiological mechanism continues to be debated. Various hypotheses have been posited. Abrupt elevation of adrenaline levels appears to be the most credible. In particular, there is no consensus on treatment and prevention. Questions may then be asked about the existence of an underlying psychiatric pathology or a personality predisposition and, therefore, about the role of the psychiatrist in the management of this condition.
| S-EPMC5554664 | biostudies-other
Project description:Background There are limited data on the presentation of Takotsubo cardiomyopathy ( TTC ) in severe sepsis. Methods and Results This was a retrospective cohort study using the National Inpatient Sample database (2007-2013) of all adults with severe sepsis. TTC was identified in patients with severe sepsis using previously validated administrative codes. The primary outcome was in-hospital mortality, and secondary outcomes included resource utilization and discharge disposition. Regression analysis was performed for the entire cohort and a propensity-matched sample. An exploratory analysis was performed for predictors of TTC incidence and mortality in TTC . During this 7-year period, in 7.1-million hospitalizations for severe sepsis, TTC was diagnosed in 10 746 (0.15%) admissions. TTC was noted more commonly in whites, females, and among 65- to 79-year-old individuals. TTC was independently associated with lower in-hospital mortality in severe sepsis (odds ratio, 0.58; 95% confidence interval, 0.51-0.65). This association was more prominent in females (odds ratio, 0.51; 95% confidence interval, 0.44-0.59]) compared with males (odds ratio, 0.69; 95% confidence interval, 0.55-0.85]). Presentation in later years of the study period, middle-age, female sex, and white race were independent predictors for the diagnosis of TTC . Age ≥80 years, black race, greater comorbidity, and multiorgan dysfunction were independently associated with higher in-hospital mortality among TTC admissions. Conclusions TTC is observed with increasing frequency in severe sepsis and was associated with a significantly lower in-hospital mortality compared with patients without TTC . Presentation in later years of the study period, middle age, female sex, and white race were independent predictors for the diagnosis of TTC in severe sepsis.
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| S-EPMC2931623 | biostudies-literature
Project description:BackgroundTako-tsubo stress cardiomyopathy is a clinical syndrome marked by transient reduction of left ventricular function in the setting of emotional or physical stress and in the absence of obstructive coronary artery disease. We describe a case of an atypical variant of Tako-tsubo in a male patient following an elective direct current cardioversion (DCCV).Case summaryA 78-year-old male whose atrial fibrillation persisted after earlier unsuccessful direct current DCCV and radiofrequency ablations presented to the emergency department for acutely worsening dyspnoea and orthopnoea 12 h following his most recent DCCV. Previously, he was known to have non-obstructive coronary artery disease. Evaluation was notable for troponin I 0.019 ng/mL (negative <0.050 ng/mL), pro-brain natriuretic peptide 2321 pg/mL (reference range 0.0-900 pg/mL). There were no acute electrocardiogram abnormalities. He required bilevel positive airway pressure but was weaned off eventually to room air. Transthoracic echocardiogram revealed newly reduced left ventricular ejection fraction of 45-50%, associated with hypokinesis of the basal anteroseptal segment, as well as akinesis of mid-inferoseptal and mid-anteroseptal segments. Apical contractility was preserved. On Day 5 of hospitalization, diagnostic left heart catheterization again revealed benign coronary anatomy, and he was discharged home the following day.DiscussionOnly five other cases of cardioversion mediated Tako-tsubo cardiomyopathy have been reported in the literature. To our knowledge, this is the first case of DCCV-induced atypical Tako-tsubo cardiomyopathy. Although overall prognosis is favourable, some have been observed to require advanced support therapy. Given risk for life-threatening complications, patients undergoing cardioversion should be educated on symptoms of congestive cardiomyopathy.
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