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Specialized Circulations in Susceptible Tissues
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
These hemodynamic factors provide complexities to the measurement and interpretation of coronary blood flow under different conditions. As already pointed out, it is still possible to discuss mean pressure and mean flow as coronary resistance, “steal” and coronary reserve, but one must be more circumspect in interpretation of pressure–flow relationships with respect to microvascular change. These principles are of crucial importance for the interpretation of coronary flow in disease states and under conditions where cardiac function is altered. Takotsubo cardiomyopathy (O'Rourke et al., 2019c), discussed in this chapter, is a case in point. An even broader spectrum on coronary thrombosis and myocardial infarction is added in this book to explain advances in clinical management of coronary disease over the last 100 years.
Cardiac Hypertrophy, Heart Failure and Cardiomyopathy
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
This is a cardiac syndrome characterized by transient LV dysfunction with apical ballooning, electrocardiographic changes that can mimic acute myocardial infarction, and release of myocardial enzymes in the absence of obstructive coronary artery disease. This syndrome was first described in 1991 in Japan and named Takotsubo which is a pot with a round bottom and narrow neck used for trapping octopuses in Japan. It has also been called LV apical ballooning syndrome or stress cardiomyopathy. It has now been reported throughout the world. It particularly occurs in post-menopausal women. Symptoms are often preceded by emotional or physical stress. Norepinephrine concentration is elevated in most patients. Takotsubo cardiomyopathy has a favourable prognosis with a low mortality and a complete recovery of the contractile function in nearly all cases. Rare fatal cases describe contraction band necrosis within myocytes at autopsy at the apex of the left ventricle.32 The same kind of reversible myocardial dysfunction is occasionally encountered in patients with intracranial haemorrhage or other acute cerebral accidents (neurogenic myocardial stunning).33 Takotsubo cardiomyopathy is impossible to define at autopsy unless there has been clinical evidence during life and pathologically there is localized evidence of ischaemia such as contraction band necrosis or localized acute infarction.
Grief
Published in Lisa Zammit, Georgeanne Schopp, Relational Care, 2022
Lisa Zammit, Georgeanne Schopp
Families experience loss with physical symptoms of sleep disturbance, appetite changes, and general malaise. There may be increased risk of new onset disease or exacerbation of chronic disease states. The stress generated by loss causes a physical response. Researchers have shown that Takotsubo cardiomyopathy is caused by an impaired ability to process and regulate emotions (Khalid, et al., 2018). Broken heart syndrome is a common phenomenon with spouses dying within days or months of each other.
Takotsubo cardiomyopathy following liver transplantation and COVID-19 infection
Published in Baylor University Medical Center Proceedings, 2023
Evan Winrich, Agastya D. Belur, Amal Shine, Loretta L. Jophlin
When considering the posttransplant immunosuppressed state, pulmonary infection must be considered when patients develop new respiratory symptoms or oxygen requirements. Symptoms such as chest pain, dyspnea, or telemetry changes including sustained tachycardia should prompt a cardiac workup including an ECG, troponin levels, and transthoracic echocardiogram. Characteristic echocardiogram findings in takotsubo cardiomyopathy include transient hypokinesis, akinesis, or dyskinesis in the left ventricular mid segments with or without apical involvement. New ECG changes including ST segment elevation or T wave inversion may be present but resolve over days to weeks.5 Modest elevation of cardiac troponins may also be noted. All patients with suspected takotsubo cardiomyopathy should be considered for left heart catheterization with coronary angiography if clinically stable to exclude myocardial ischemia as the cause of echocardiography changes and elevated cardiac biomarkers. If no coronary abnormalities are noted and takotsubo cardiomyopathy is diagnosed, management is typically supportive, as cardiac function normalizes within a few weeks.6 Repeat imaging including an echocardiogram should be done in the weeks following diagnosis to track the return of cardiac function.
Takotsubo cardiomyopathy associated with Group C Streptococcus septic miscarriage: a case report
Published in Journal of Obstetrics and Gynaecology, 2022
W. Jih, G. Walker, P. Deonarine, L. F. A. Wong
Takotsubo cardiomyopathy is a rare condition that is often misdiagnosed and underdiagnosed (Medina de Chazal et al. 2018). In 2018, the International Takotsubo Diagnostic Criteria (InterTAK Diagnostic Criteria) defined the required conditions for a diagnosis of TTC (Ghadri et al. 2018):Transient LV dysfunction presenting as apical ballooning or midventricular, basal, or focal wall abnormalities. RV involvement can be present.Emotional, physical or combined trigger precedes the event, but this is not obligatory.Neurologic disorders can be a trigger.New ECG abnormalities are present, but rare cases without exist.Cardiac biomarkers are moderately elevated.Coronary artery disease is not a contradiction.No evidence of infectious myocarditis.Postmenopausal women are predominantly affected.
Takotsubo cardiomyopathy in the setting of a myasthenic crisis
Published in International Journal of Neuroscience, 2021
Adam Ranellone, Michael G. Abraham
It has been shown that stressful emotional events can lead to stress, or takotsubo, cardiomyopathy [1]. Takotsubo cardiomyopathy (TC) is characterized by transient reversible left ventricular dysfunction in the absence of obstructive artery disease with hypo- or akinesis of the apex with hypercontractility of the base, giving it the appearance of an octopus pot and the name. The Mayo Clinic diagnostic criteria for TC defines four criteria for the diagnosis of TC: a) transient left ventricular systolic (LV) dysfunction, b) absence of obstructive coronary disease or angiographic evidence of acute plaque rupture or wall motion abnormalities that are not in the distribution of the coronary disease, c) new ST-segment elevation and/or T wave inversion on electrocardiography (ECG) or modest elevation in cardiac troponin, and d) absence of pheochromocytoma or myocarditis [4]. Takotsubo cardiomyopathy is transient in nature and generally resolves without intervention. A minority of patients may develop more severe complications such as shock and acute heart failure (HF) that require intensive therapy.