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      Takotsubo syndrome and impending thyroid storm: a case report and brief review of the literature Translated title: Síndrome de Takotsubo y tormenta tiroidea inminente: reporte de un caso y breve revisión de la literatura

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          Abstract

          Abstract Stress cardiomyopathy also called Takotsubo cardiomyopathy is characterized by transient regional systolic dysfunction of the left ventricle with electrocardiographic changes and an increase in troponin levels imitating myocardial infarction, but in the absence of angiographic evidence of obstructive coronary artery disease. Although the exact causal process has not been determined, it has been mentioned in connection with thyroid diseases. We describe a woman's case that experienced severe chest pain along with electrical and analytical abnormalities. Significant ventricular dysfunction was present, and the invasive coronary angiography revealed no lesions, which was compatible with stress cardiomyopathy. Impending thyroid storm due to Graves' disease was observed as a trigger and it is imperative to identify and treat any clinical variables that could put patients at risk for Takotsubo syndrome or have an impact on the course of their treatment.

          Translated abstract

          Resumen La miocardiopatía por estrés, también llamada miocardiopatía de Takotsubo, se caracteriza por una disfunción sistólica regional transitoria del ventrículo izquierdo con cambios electrocardiográficos y un aumento en los niveles de troponina que simulan un infarto de miocardio, pero en ausencia de evidencia angiográfica de enfermedad arterial coronaria obstructiva. Aunque no se ha determinado el proceso causal exacto, se ha mencionado en relación con las enfermedades de la tiroides. Describimos el caso de una mujer que presentaba dolor torácico intenso junto con anomalías eléctricas y analíticas. Presentaba importante disfunción ventricular y la coronariografía invasiva no mostraba lesiones, lo que era compatible con miocardiopatía de estrés. La tormenta tiroidea inminente debido a la enfermedad de Graves se observó como desencadenante y es imperativo identificar y tratar cualquier variable clínica que pueda poner a los pacientes en riesgo de síndrome de Takotsubo o tener un impacto en el curso de su tratamiento.

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          Most cited references15

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          Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

          New England Journal of Medicine, 373(10), 929-938
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            Neurohumoral features of myocardial stunning due to sudden emotional stress.

            Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown. We evaluated 19 patients who presented with left ventricular dysfunction after sudden emotional stress. All patients underwent coronary angiography and serial echocardiography; five underwent endomyocardial biopsy. Plasma catecholamine levels in 13 patients with stress-related myocardial dysfunction were compared with those in 7 patients with Killip class III myocardial infarction. The median age of patients with stress-induced cardiomyopathy was 63 years, and 95 percent were women. Clinical presentations included chest pain, pulmonary edema, and cardiogenic shock. Diffuse T-wave inversion and a prolonged QT interval occurred in most patients. Seventeen patients had mildly elevated serum troponin I levels, but only 1 of 19 had angiographic evidence of clinically significant coronary disease. Severe left ventricular dysfunction was present on admission (median ejection fraction, 0.20; interquartile range, 0.15 to 0.30) and rapidly resolved in all patients (ejection fraction at two to four weeks, 0.60; interquartile range, 0.55 to 0.65; P<0.001). Endomyocardial biopsy showed mononuclear infiltrates and contraction-band necrosis. Plasma catecholamine levels at presentation were markedly higher among patients with stress-induced cardiomyopathy than among those with Killip class III myocardial infarction (median epinephrine level, 1264 pg per milliliter [interquartile range, 916 to 1374] vs. 376 pg per milliliter [interquartile range, 275 to 476]; norepinephrine level, 2284 pg per milliliter [interquartile range, 1709 to 2910] vs. 1100 pg per milliliter [interquartile range, 914 to 1320]; and dopamine level, 111 pg per milliliter [interquartile range, 106 to 146] vs. 61 pg per milliliter [interquartile range, 46 to 77]; P<0.005 for all comparisons). Emotional stress can precipitate severe, reversible left ventricular dysfunction in patients without coronary disease. Exaggerated sympathetic stimulation is probably central to the cause of this syndrome. Copyright 2005 Massachusetts Medical Society.
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              Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction.

              Apical ballooning syndrome (ABS) is a unique reversible cardiomyopathy that is frequently precipitated by a stressful event and has a clinical presentation that is indistinguishable from a myocardial infarction. We review the best evidence regarding the pathophysiology, clinical features, investigation, and management of ABS. The incidence of ABS is estimated to be 1% to 2% of patients presenting with an acute myocardial infarction. The pathophysiology remains unknown, but catecholamine mediated myocardial stunning is the most favored explanation. Chest pain and dyspnea are the typical presenting symptoms. Transient ST elevation may be present on the electrocardiogram, and a small rise in cardiac troponin T is invariable. Typically, there is hypokinesis or akinesis of the mid and apical segments of the left ventricle with sparing of the basal systolic function without obstructive coronary lesions. Supportive treatment leads to spontaneous rapid recovery in nearly all patients. The prognosis is excellent, and a recurrence occurs in <10% of patients. Apical ballooning syndrome should be included in the differential diagnosis of patients with an apparent acute coronary syndrome with left ventricular regional wall motion abnormality and absence of obstructive coronary artery disease, especially in the setting of a stressful trigger.
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                Author and article information

                Journal
                ijm
                Iberoamerican Journal of Medicine
                Iberoam J Med
                Hospital San Pedro (Logroño, La Rioja, Spain )
                2695-5075
                2695-5075
                2022
                : 4
                : 3
                : 169-173
                Affiliations
                [1] Barranquilla Atlántico orgnameUniversidad del Norte orgdiv1Department of Internal Medicine Colombia
                [2] Barranquilla Atlántico orgnameUniversidad del Norte orgdiv1Department of Public Health Colombia
                Article
                S2695-50752022000300007 S2695-5075(22)00400300007
                10.53986/ibjm.2022.0026
                39c9167f-2ce6-4d0d-8b83-f6112d6ad9be

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 10 July 2022
                : 24 June 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 5
                Product

                SciELO Spain

                Categories
                Case Report

                Graves' disease,Enfermedades tiroideas,Enfermedad de Graves,Síndrome de Takotsubo,Cardiomiopatía,Hipertiroidismo,Thyroid diseases,Takotsubo syndrome,Hyperthiroidism,Cardiomiopathy

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