RESUMEN
Takotsubo cardiomyopathy (TCM) is characterized by transient left ventricular dysfunction, diagnosed via echocardiography or left ventriculography. In most cases, TCM involves an emotional, physical, or combined trigger. Acute coronary syndrome is one of the most frequent misdiagnoses in TCM patients due to electrocardiogram (ECG) abnormalities and elevated cardiac biomarkers. Typically, coronary angiography reveals no stenosis or occlusion of the coronary arteries. Hypertrophic cardiomyopathy (HCM) is a distinct pathology characterized by a hypertrophied left ventricle with various phenotypes. However, some reports have described TCM cases mimicking obstructive-type HCM in some patients. We present a case of a female patient diagnosed with TCM based on clinical, laboratory, and imaging tests. Differentiating TCM from HCM was challenging due to ventriculography and echocardiography findings, as hyperdynamic contraction of the basal segments of the left ventricle caused an increased left ventricular outflow tract (LVOT) gradient and severe mitral valve regurgitation. Detailed evaluation and close echocardiographic follow-up are essential in such rare cases.
Asunto(s)
Cardiomiopatía Hipertrófica , Electrocardiografía , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Cardiomiopatía de Takotsubo/fisiopatología , Femenino , Cardiomiopatía Hipertrófica/diagnóstico , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/fisiopatología , Diagnóstico Diferencial , Ecocardiografía , Persona de Mediana EdadRESUMEN
BACKGROUND Pheochromocytoma, a rare catecholamine-secreting tumor, often presents with paroxysmal or sustained hypertension, tachycardia, headache, and diaphoresis. Timely diagnosis is essential to prevent adverse complications. Less common presentations include pheochromocytoma crisis, with severe neurological and cardiac complications. CASE REPORT We report a unique case of a 25-year-old woman who initially presented with pheochromocytoma-induced hypertensive encephalopathy and acute coronary syndrome. Echocardiography revealed takotsubo-like cardiomyopathy, and magnetic resonance imaging of the brain revealed posterior reversible encephalopathy syndrome. Initial treatment focused on controlling her blood pressure and supporting cardiac function. Due to her recovering from immediate crisis and absence of further symptoms, the patient refused further follow-up. However, she eventually experienced another episode of hypertensive crisis 2 years later. Subsequent investigations with 24-h urine tests revealed elevated vanillylmandelic acid levels (7.93 mg/24 h), normetanephrine (2638.72 µg/24 h), and nor-metanephrine to creatinine ratio (3546.67) and normal urine metanephrine levels (195.92 µg/24 h) and metanephrine to creatinine ratio (263.33). Contrast-enhanced computed tomography of the abdomen revealed a 4.3×3.1×4-cm mass in the right adrenal gland. A DOTATATE positron emission tomography scan revealed a 3.9×4.3×2.7-cm localized right adrenal pheochromocytoma. Biochemical testing and adrenal imaging revealed a previously undiagnosed pheochromocytoma. Following targeted medical therapy and right adrenalectomy, the patient achieved complete resolution of her hypertension and associated symptoms. CONCLUSIONS Our case is a unique simultaneous presentation of posterior reversible encephalopathy syndrome and takotsubo-like cardiomyopathy, highlighting the importance to consider pheochromocytoma in acute neurological and cardiac presentations, even in the absence of typical symptoms.
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Neoplasias de las Glándulas Suprarrenales , Encefalopatía Hipertensiva , Feocromocitoma , Cardiomiopatía de Takotsubo , Humanos , Femenino , Feocromocitoma/complicaciones , Feocromocitoma/diagnóstico , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/diagnóstico , Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Adulto , Encefalopatía Hipertensiva/etiología , Encefalopatía Hipertensiva/diagnósticoRESUMEN
BACKGROUND: Myocardial bridging is a cardiac anomaly where a segment of epicardial coronary arteries runs through the myocardium and can rarely cause MI. Takotsubo syndrome is a stress-induced cardiomyopathy that can mimic MI. Catecholamine surge during stress can contribute to Takotsubo syndrome, but whether this surge can trigger an inconspicuous myocardial bridging to manifest symptomatically remains unclear, and alternately, whether a myocardial bridge might cause worsening of Takotsubo syndrome is also a matter that needs further research. CASE PRESENTATION: We report the case of a patient who initially presented with features of acute exacerbation of bronchiectasis and subsequently developed symptoms and ECG features suggestive of acute myocardial infarction. Echocardiography revealed features of takotsubo syndrome, and complete myocardial bridging was revealed via coronary angiography. The patient was managed conservatively with pharmacological treatment, and after a few days, echocardiographic features were reversed. As such, the diagnosis shifted toward Takotsubo syndrome with myocardial stunning due to co-existent myocardial bridging. CONCLUSION: We report a rare case of a patient with acute bronchiectasis exacerbation with features suggestive of acute myocardial infarction who had findings of Takotsubo syndrome and complete myocardial bridging. In the beginning, it was difficult to determine whether the symptoms arose due to acute MI resulting from myocardial bridging or were solely due to takotsubo syndrome because of stress from bronchiectasis. Although myocardial bridging is often overlooked as an etiology for acute MI, this case highlights the importance of expanding the differential diagnosis to myocardial bridging in the work-up for the cause of acute MI and how Takotsubo syndrome can mimic acute MI and pose a diagnostic challenge.
Asunto(s)
Angiografía Coronaria , Puente Miocárdico , Infarto del Miocardio , Valor Predictivo de las Pruebas , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/fisiopatología , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Cardiomiopatía de Takotsubo/terapia , Cardiomiopatía de Takotsubo/etiología , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/etiología , Diagnóstico Diferencial , Puente Miocárdico/complicaciones , Puente Miocárdico/diagnóstico por imagen , Puente Miocárdico/diagnóstico , Puente Miocárdico/fisiopatología , Aturdimiento Miocárdico/diagnóstico , Aturdimiento Miocárdico/etiología , Aturdimiento Miocárdico/fisiopatología , Femenino , Resultado del Tratamiento , Electrocardiografía , Anciano , MasculinoRESUMEN
INTRODUÇÃO Cardiomiopatia (CMP) induzida por estresse, como a cardiomiopatia de Takotsubo, pode ter características clínicas semelhantes à isquemia miocárdica, como elevação de troponinas, alterações no Eletrocardiograma (ECG), mas sem obstrução coronariana ou lesões isquêmicas. Semelhante, a CMP induzida por Feocromocitoma possui sintomas também semelhantes a CMP hipertrófica, hipertensão e edema pulmonar devido a fatores cardiogênicos ou não cardiogênicos. Ambas supracitadas podem ter associação com excesso de catecolaminas, mas raramente estão associadas. RELATO DO CASO Paciente masculino, 46 anos, diabético, com história de estresse por situações familiares importantes, recentemente. Chega no serviço de emergência, com queixas de dispnéia, náuseas e êmese, iniciados há 1 dia, associado a retenção urinária e parestesia em mãos e paraparesia de membros inferiores. Refere também tratamento com Amoxicilina + Clavulanato há um mês por Colecistite Aguda. Na chegada, paciente se encontrava taquicárdico, taquipneico e saturando 98% em uso de óculos nasal a 2l/min, além de acidose metabólica. Realizou-se uma tomografia computadorizada de abdome, que evidenciou uma massa em Adrenal, sugestivo de Feocromocitoma, bem como metanefrinas urinárias e catecolaminas positivas. Ainda na emergência, evoluiu com insuficiência respiratória aguda por edema agudo de pulmão, necessitando de manejo com Nitroglicerina e 03 ampolas de Furosemida e uso de máscara não reinalante a 10l/min. Foi encaminhado para Unidade de Terapia Intensiva, onde foi realizado um ECG com alterações primárias da repolarização, seguido de alterações nos valores de Troponina e alterações no Ecocardiograma (ECO) de acinesia apical, hipocinesia de todos os segmentos médios e contratilidade preservada em segmentos basais. Cateterismo cardíaco com achados semelhantes ao ECO e presença de balonamento na ventriculografia, além de ausência de lesões obstrutivas em coronárias. CONCLUSÃO A excepcionalidade desse caso diz respeito ao quadro de síndrome coronariana aguda com dois motivos plausíveis e evidenciados na condução do caso, sendo eles: CMP de Takotsubo e a induzida por Feocromocitoma. Fica evidente, pela evolução do quadro, a gravidade do mesmo e a importância de considerar diagnósticos diferenciais, inclusive os menos comuns.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Feocromocitoma , Cardiomiopatía de Takotsubo , Edema Pulmonar , Insuficiencia Respiratoria , Cateterismo Cardíaco , Catecolaminas , Colecistitis Aguda , Disnea , ElectrocardiografíaAsunto(s)
Mononeuropatías , Vasculitis Reumatoide , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/complicaciones , Cardiomiopatía de Takotsubo/fisiopatología , Femenino , Mononeuropatías/diagnóstico , Mononeuropatías/etiología , Mononeuropatías/tratamiento farmacológico , Vasculitis Reumatoide/diagnóstico , Vasculitis Reumatoide/tratamiento farmacológico , Resultado del Tratamiento , Índice de Severidad de la Enfermedad , Anciano , Persona de Mediana Edad , Electrocardiografía , Antirreumáticos/uso terapéuticoAsunto(s)
Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/diagnóstico , Femenino , Rotura Cardíaca/etiología , Rotura Cardíaca/diagnóstico por imagen , Rotura Cardíaca/diagnóstico , Persona de Mediana Edad , AncianoRESUMEN
INTRODUCTION: Takotsubo syndrome (TTS) is an acute transient nonischemic cardiomyopathy often characterized by its hallmark feature of left ventricular apical ballooning. The correlation between racial backgrounds and the prognosis of individuals with TTS remains poorly defined. Our study aimed to explore the influence of race on the trends, clinical presentations, and outcomes in patients diagnosed with TTS. METHODS: We queried the National Inpatient Sample (NIS) database from 2016 to 2020 and identified hospitalizations with TTS. We compared the clinical features and outcomes across three different races - non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic population. The primary outcome was in-hospital mortality. RESULTS: 76,505 weighted hospitalizations for TTS were identified, of which 65,495 (85.6%) were non-Hispanic White, 5,830 (7.6%) were non-Hispanic Black, and 5,180 (6.8%) were Hispanics. After propensity-score matching, NHB patients had higher odds of acute kidney injury (OR: 1.49, 95% CI: 1.21-1.84, p < 0.001) and mechanical ventilation (OR: 1.33, 95% CI: 1.04-1.68, p = 0.02). Hispanic patients had a higher incidence of acute kidney injury requiring dialysis when compared to NHW patients (OR: 2.53, 95% CI: 1.11-5.77, p = 0.027). There was no significant difference in terms of in-hospital mortality between NHB and Hispanic patients when compared to NHW patients. Notably, Hispanic populations experienced a higher mortality rate during the COVID-19 period. CONCLUSION: Our study suggested significant differences in the outcomes of TTS across different racial groups. Hispanic populations experienced a higher mortality rate with TTS during the COVID-19 era. Further research should emphasize discovering the factors contributing to the observed disparities.
Asunto(s)
COVID-19 , Mortalidad Hospitalaria , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/etnología , Cardiomiopatía de Takotsubo/epidemiología , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/terapia , Femenino , Masculino , Mortalidad Hospitalaria/tendencias , Mortalidad Hospitalaria/etnología , Anciano , Estados Unidos/epidemiología , COVID-19/epidemiología , COVID-19/etnología , Persona de Mediana Edad , Hispánicos o Latinos/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Estudios Retrospectivos , Hospitalización/tendencias , Hospitalización/estadística & datos numéricos , Disparidades en el Estado de Salud , Anciano de 80 o más Años , SARS-CoV-2 , IncidenciaRESUMEN
Takotsubo syndrome (TTS) might exhibit particular chronobiological patterns in its onset, characterized by variations according to time of the day, day of the week, and month of the year. The aim of this study was to fully explore the temporal patterns (circadian, weekly and seasonal) in the onset of TTS. A systematic review and meta-analysis of literature were conducted for studies (2006-2024) reporting the temporal patterns (circadian, weekly and/or seasonal) in the onset of TTS. Among the 4257 studies retrieved, 20 (including 64,567 subjects) fulfilled all eligibility criteria. Data were aggregated used random effects model as pooled risk ratio and the attributable risk (AR). The proportion analysis (including 8 studies; n=853) showed a decreasing pattern of the pooled rates of TTS shifting from the morning to the night (pooled TTS rates: 34.0%; 32.1%; 21.7%; 12.7% in the morning, afternoon, evening and night, respectively). The same pattern was observed stratifying by type of preceding stressful factor or event, considering physical stressors (pooled rates in the morning and night: 37.6% and 9.8%, respectively), and also in case no event could be identified. The pooled rates of TTS onset peaked on Monday and Tuesday (17.3% and 18.4% respectively), then declined during the week, reaching the lowest rates on Friday and Saturday (10.6% and 10.8%, respectively), with no sex differences. TTS onset reached the highest values on summer, and the lowest in winter (27.9% versus 21.7% in summer and winter, respectively). The TTS morning peak based analyses (â¼33% of all the registered events) account for a RR of 1.46 (95% CI: 1.38-1.54), the week-based for a RR of 1.26 (1.16-1.35), the season-based for a RR of 1.04 (1.04-1.05). TTS onset exhibits specific chronobiological patterns, characterized by a peak during the morning hours, and on Monday and Tuesday. Differing from other cardiovascular emergencies TTS was more frequent during summer. Further studies are needed to fully understand the underlying pathophysiological mechanisms in order to tailor relative management and preventive strategies.
Asunto(s)
Ritmo Circadiano , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/fisiopatología , Cardiomiopatía de Takotsubo/epidemiología , Cardiomiopatía de Takotsubo/diagnóstico , Ritmo Circadiano/fisiología , Estaciones del Año , Factores de RiesgoRESUMEN
BACKGROUND: This study aimed to evaluate the impact of race on in-hospital outcomes of Takotsubo cardiomyopathy using the National Inpatient Sample. METHODS AND RESULTS: We conducted a retrospective study using data from the National Inpatient Sample database 2006 to 2018. We focused on Takotsubo cardiomyopathy hospitalizations, excluding those with acute coronary syndrome as the primary diagnosis. Two study groups consisted of White patients or Black patients. Univariate and multivariable logistic models evaluated race's effect on death, cardiac arrest, cardiogenic shock, length of stay, while adjusting for potential confounders. The Bayesian model averaging technique was used to further elucidate the factors influencing death within each racial group. Significant differences were observed between the 2 racial groups. Black patients presented at a younger age, had a higher proportion of men, a higher burden of comorbidities, and a lower median household income compared with their White counterparts. In the univariate model, the Black cohort showed an increased risk of cardiac arrest (odds ratio, 1.45 [95% CI, 1.15-1.82]). However, the difference did not reach statistical significance in the multivariable model. Black patients also had a significantly longer hospital stay in both the univariate model (risk ratio, 1.26 [95% CI, 1.22-1.31]) and the multivariable model (risk ratio, 1.06 [95% CI, 1.04-1.07]). No significant difference in all-cause death was observed between the racial groups. CONCLUSIONS: The outcome differences between 2 racial groups in our study are likely influenced by racial disparities in demographics, comorbidities, and socioeconomic factors. Individualized care based on racial group needs is crucial in clinical practice.
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Negro o Afroamericano , Mortalidad Hospitalaria , Cardiomiopatía de Takotsubo , Población Blanca , Humanos , Cardiomiopatía de Takotsubo/etnología , Cardiomiopatía de Takotsubo/mortalidad , Cardiomiopatía de Takotsubo/diagnóstico , Femenino , Masculino , Estudios Retrospectivos , Anciano , Estados Unidos/epidemiología , Persona de Mediana Edad , Mortalidad Hospitalaria/tendencias , Mortalidad Hospitalaria/etnología , Población Blanca/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Factores de Riesgo , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Disparidades en el Estado de Salud , Anciano de 80 o más Años , Bases de Datos FactualesRESUMEN
The predictive value of various ECG repolarization markers for the emergence of VA in patients with TTS was reviewed. The literature reports on QT, more recently on Tpe, and rarely on some more QT-derived metrics, revealing a contribution of these variables for the prediction of VA, complicating the acute, subacute, and follow-up clinical trajectory of patients with TTS. More recent literature reveals that Tpe and some other QT-based metrics, have outperformed the traditionally employed QT marker, although certainty about this awaits confirmation by future carefully designed and implemented studies.
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Electrocardiografía , Cardiomiopatía de Takotsubo , Humanos , Electrocardiografía/métodos , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/fisiopatología , Cardiomiopatía de Takotsubo/complicaciones , Valor Predictivo de las Pruebas , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología , Arritmias Cardíacas/fisiopatología , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologíaRESUMEN
Blunt chest trauma (BCT) may rarely trigger stress-induced takotsubo syndrome (TTS) which requires dif f erential diagnosis with myocardial contusion and BCT-induced myocardial infarction. So far reported cases have been presented as apical ballooning or inverted (reverse) TTS forms but not as a midventricular variant. The authors described a case of a 53-year-old female admitted to Intensive Care Unit after motor vehicle accident with BCT and airbag deployment during car roll over. For some time after the accident, she was trapped in a car with her head bent to the chest. After being pulled out from the car, she had impaired consciousness and therefore was intubated by the rescue team. Trauma computed tomography scan did not reveal any injuries. However, ECG showed ST-segment depression in II, III, aVF, V4-6, and discrete ST-segment elevation in aVR. Troponin I and NTpro-BNP increased to 2062 ng/l and 6413 pg/ml, respectively. Echocardiography revealed mild midventricular dysfunction of the left ventricle with ejection fraction (EF) and global longitudinal strain (GLS) reduced to 45% and -17.6%, respectively. On day two, the patient's general condition improved and stabilized, so she was extubated. Normalization of ECG, EF and GLS (but not regional LS) was observed on day three. She was discharged home on day fi ve. Post-hospital examinations documented that segmental longitudinal strain remained abnormal for up to 4 weeks. The authors conclude that fast ECG and echocardiographic evolution may result in underestimation of the posttraumatic TTS diagnosis, especially if it takes atypical form and its course is mild. Longitudinal strain evaluation can be helpful in cardiac monitoring of trauma patients.
Asunto(s)
Electrocardiografía , Cardiomiopatía de Takotsubo , Traumatismos Torácicos , Heridas no Penetrantes , Humanos , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/diagnóstico , Femenino , Persona de Mediana Edad , Heridas no Penetrantes/complicaciones , Traumatismos Torácicos/complicaciones , Accidentes de Tránsito , EcocardiografíaRESUMEN
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are reported to cause stress cardiomyopathy (SC). This study evaluated the association between SSRI/SNRI use and the occurrence of cardiomyopathy in the publicly available U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. Disproportionate analysis and likelihood ratio tests were used to identify risk associated with SSRIs or SNRIs and the incidence of SC, using data from between from 2012 to 2022 acquired from the FAERS database. The study identified 132 individual case safety reports (ICSRs) of SC associated with SSRIs or SNRIs. Venlafaxine (48%) and fluoxetine (27%) were the most common antidepressants of the ICSRs. Approximately 80% of SC cases were reported in females, with individuals aged 45-65 years identified as a high-risk population. Both venlafaxine (ratio-scale information component [RSIC] 2.54, 95% CI 2.06-3.04) and fluoxetine (RSIC 3.20, 95% CI 2.31-4.47) were associated with SC, with likelihood ratio estimates of 3.55 (p = 0.02) for venlafaxine and 4.82 (p = 0.008) for fluoxetine. The median time to cardiomyopathy onset was 20 days, with hospitalization reported in 48.33% of patients. Venlafaxine and fluoxetine were associated with SC risk, particularly in middle-aged women. Caution should be exercised when using SSRIs or SNRIs combined with other serotonergic medications.
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Farmacovigilancia , Inhibidores Selectivos de la Recaptación de Serotonina , Inhibidores de Captación de Serotonina y Norepinefrina , Cardiomiopatía de Takotsubo , Humanos , Femenino , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Masculino , Persona de Mediana Edad , Anciano , Inhibidores de Captación de Serotonina y Norepinefrina/efectos adversos , Cardiomiopatía de Takotsubo/inducido químicamente , Cardiomiopatía de Takotsubo/epidemiología , Sistemas de Registro de Reacción Adversa a Medicamentos , Adulto , Estados Unidos/epidemiología , Clorhidrato de Venlafaxina/efectos adversos , Fluoxetina/efectos adversos , Bases de Datos Factuales , Factores de RiesgoRESUMEN
Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, is characterized by acute heart failure, reversible left ventricular dysfunction, and other complications such as life-threatening arrhythmias. The management of TTS is challenging due to its unpredictable clinical course and the lack of evidence-based treatment recommendations. In this case report, we present a 71-year-old female who developed TTS with ventricular tachycardia (VT) cardiac arrest following septic shock and an exploratory laparotomy for appendicitis. Despite the presence of VT cardiac arrest and a left ventricular ejection fraction of 30-35%, an implanted cardioverter-defibrillator (ICD) was not indicated due to the rapid and satisfactory recovery of the patient's ventricular function. This case highlights the importance of considering the clinical context and the transient nature of TTS in the decision-making process for ICD candidacy.
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Desfibriladores Implantables , Paro Cardíaco , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/terapia , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/complicaciones , Femenino , Anciano , Paro Cardíaco/terapia , Paro Cardíaco/etiología , Taquicardia Ventricular/terapia , Taquicardia Ventricular/etiología , Taquicardia Ventricular/diagnósticoAsunto(s)
Neoplasias Colorrectales Hereditarias sin Poliposis , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/complicaciones , Neoplasias Colorrectales Hereditarias sin Poliposis/complicaciones , Femenino , Persona de Mediana Edad , ElectrocardiografíaRESUMEN
BACKGROUND: Takotsubo syndrome (TS) is a reversible cause of heart failure; however, a minority of patients can develop serious complications, including cardiac rupture (CR). OBJECTIVES: Analyze case reports of CR related to TS, detailing patient characteristics to uncover risk factors and prognosis for this severe complication. METHODS: We conducted a systematic search of MEDLINE and Embase databases to identify case reports of patients with TS complicated by CR, from inception to October 2023. RESULTS: We included 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and an apical ballooning pattern was observed in all cases (100%). ST-segment elevation was reported in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery was attempted in 16 (36%) cases, and 28 (64%) patients did not survive. CONCLUSIONS: CR related to TS is a rare complication associated with high mortality and affecting elderly females, specially from White/Caucasian or East Asian/Japanese descent, presenting with anterior or lateral ST-segment elevation, and an apical ballooning pattern. Although data is limited and additional prospective studies are needed, the awareness of this life-threatening complication is crucial to early identify high-risk patients. CONDENSED ABSTRACT: Cardiac rupture is a rare complication of Takotsubo syndrome. We conducted a systematic review of cases complicated by cardiac rupture, and we identified 44 subjects (40 females and 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity, all with an apical ballooning pattern (100%). The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.
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Rotura Cardíaca , Cardiomiopatía de Takotsubo , Humanos , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/epidemiología , Cardiomiopatía de Takotsubo/etnología , Rotura Cardíaca/etiología , Rotura Cardíaca/diagnóstico , Rotura Cardíaca/epidemiología , Anciano , Femenino , Masculino , Anciano de 80 o más AñosRESUMEN
There is ample literature revealing an association of SCAD with TTS, while it is not clear whether these 2 pathological entities are mechanistically linked in the sense that the one triggers the other. Considering that physical/emotional stress triggers TTS, it is plausible that stress related to SCAD, could result in the emergence of TTS. Conversely, it has been speculated that the junction between hypercontractile and akinetic/dyskinetic myocardium regions in TTS could lead to a "hinge pivoting point", imparting vascular disruption in coronary arteries, crossing these abutting myocardial planes, in susceptible individuals, causing SCAD.