Morphologic features and pathology of the elderly heart
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
There are several reports of morphological changes in takotsubo cardiomyopathy. Its histology is similar to those seen in patients with ischemic electrocardiographic changes after an acute intracranial injury and cardiotoxic effects induced by catecholamines (116,123). Endomyocardial biopsies showed contraction bands, interstitial infiltrates consisting primarily of mononuclear lymphocytes and macrophages, and myocardial fibrosis, but no coagulation myocardial necrosis (112,115,119,124). This was evidenced by the absence of terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling (TUNEL) positive myocytes, indicating the absence of apoptosis (124). An autopsy case report demonstrated patchy myofibril degeneration of the myocardium with contraction band necrosis and myocyte edema at the cardiac apex (125). A study using electron microscopy showed that the main alterations included vacuoles filled with cellular debris and myelin bodies, contraction bands, and clusters of mitochondria with abnormalities in the sizes and shapes (124). After functional recovery, the myocytes showed a nearly normal rearrangement of the intracellular structures by electron microscopy.
Specialized Circulations in Susceptible Tissues
Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos in 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
Mary N. Sheppard in 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.
Takotsubo cardiomyopathy and its variants: a case series and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Syed Mustajab Hasan, Jay D. Patel, Mohammed Faluk, Jigar Patel, Premranjan Singh
All patients found to have Takotsubo cardiomyopathy share one factor in common which is the presence of a precipitating stressful event. This may lead to an augmented sympathetic response leading to a catecholamine surge which as been thought to play a central role in the development of this syndrome. Serum catecholamine levels in patients with Takotsubo cardiomyopathy are significantly elevated when compared to patients at rest and in patients who presented with heart failure secondary to myocardial ischemia [6]. Per literature review, multiple hypotheses have been proposed to explain the variable appearance of the heart in response to the aforementioned stress response. Let us delve into the vascular and myocardial aspects of the development of Takotsubo cardiomyopathy. Firstly, let us explore the involvement of coronary vessel spasms which can be seen via diagnostic angiography as multivessel vasospasm which may be a result of the aforementioned catecholamine response. Histopathologic evaluation also revealed myocardial changes that could be attributed to infarction. Similarly, endomyocardial biopsies in the acute setting also showed disorganized proteins but no signs of cell death [7].
Bacillus subtilis-associated abdominal catastrophe in a Japanese patient with peritoneal dialysis-related peritonitis
Published in Cogent Medicine, 2020
Sae Aratani, Yuta Nakagawa, Yuichiro Sumi, Yukinao Sakai
However, on Day 17 of hospitalization, the patient complained of dyspnea. The ECG showed ST elevation in the precordial lead. The patient was moved to the cardiac care unit and subjected to urgent coronary angiography (CAG). The CAG revealed neither obstruction nor stenosis. The patient was diagnosed with Takotsubo cardiomyopathy. Intravenous nitrogen was administered and non-invasive positive pressure ventilation and continuous hemodiafiltration (CHDF) were introduced. The patient’s general condition did not allow him to undergo the surgical operation; therefore, after discharge from the cardiac care unit, the PD catheter was removed and the patient was switched to maintenance hemodialysis. Until Day 50 of hospitalization, antibiotic treatment was continued. However, blood analysis again showed an increase in serum CRP on Day 61. Therefore, abdominal CT was performed for the seventh time, which identified the fistula between the sigmoid colon and pelvic abscess (Figure 2). We again consulted the surgeons, and the colon was surgically removed on Day 67. The arteriovenous fistula was created and the patient was discharged on Day 112 with maintenance hemodialysis and colostomy.
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.
Related Knowledge Centers
- Adrenaline
- Cardiomyopathy
- Pheochromocytoma
- Vasospasm
- Catecholamine
- Ischemia
- Norepinephrine
- Cardiac Muscle
- Cardiac Output
- Vasoconstriction