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      Coronary artery disease mimicking Tako-tsubo cardiomyopathy: a case report

      case-report
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      Publication date (Electronic):
      Journal: Cases Journal
      Publisher: Cases Network Ltd

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          Abstract

          Tako-tsubo cardiomyopathy is a syndrome mostly observed in post-menopausal women, which mimics myocardial infarction with an ST elevation; and coronary angiography shows apical ballooning but a normal left anterior descending. Although coronary artery disease is considered as an exclusion criterion, for differential diagnosis of this type of cardiomyopathy, Tako-tsubo cardiomyopathy cases accompanied by coronary artery disease were also reported. In this report, we are presenting a patient who exhibits different findings than a classical Tako-tsubo cardiomyopathy case because of her young age, coexisting atherosclerotic lesion, smaller diameter of the apical systolic ballooning and absence of an increase in cardiac enzymes.

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          Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review.

          Thomas M. Pilgrim, Thomas Wyss (2008)
          Transient left ventricular apical ballooning syndrome (TLVABS) is an acute cardiac syndrome mimicking ST-segment elevation myocardial infarction characterized by transient wall-motion abnormalities involving apical and mid-portions of the left ventricle in the absence of significant obstructive coronary disease. Searching the MEDLINE database 28 case series met the eligibility criteria and were summarized in a narrative synthesis of the demographic characteristics, clinical features and pathophysiological mechanisms. TLVABS is observed in 0.7-2.5% of patients with suspected ACS, affects women in 90.7% (95% CI: 88.2-93.2%) with a mean age ranging from 62 to 76 years and most commonly presents with chest pain (83.4%, 95% CI: 80.0-86.7%) and dyspnea (20.4%, 95% CI: 16.3-24.5%) following an emotionally or physically stressful event. ECG on admission shows ST-segment elevations in 71.1% (95% CI: 67.2-75.1%) and is accompanied by usually mild elevations of Troponins in 85.0% (95% CI: 80.8-89.1%). Despite dramatic clinical presentation and substantial risk of heart failure, cardiogenic shock and arrhythmias, LVEF improved from 20-49.9% to 59-76% within a mean time of 7-37 days with an in-hospital mortality rate of 1.7% (95% CI: 0.5-2.8%), complete recovery in 95.9% (95% CI: 93.8-98.1%) and rare recurrence. The underlying etiology is thought to be based on an exaggerated sympathetic stimulation. TLVABS is a considerable differential diagnosis in ACS, especially in postmenopausal women with a preceding stressful event. Data on longterm follow-up is pending and further studies will be necessary to clarify the etiology and reach consensus in acute and longterm management of TLVABS.
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            Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy.

            , Sachio Kawai, Hitonobu Tomoike … (2007)
            It is important to differentiate takotsubo cardiomyopathy from other types of transient ventricular dysfunction. These guidelines, resulting from a workshop sponsored by the Ministry of Health, Labour, and Welfare, Idiopathic Cardiomyopathy Research Committee, outline the steps necessary for diagnosis of takotsubo cardiomyopathy. The survey was conducted by mailing a questionnaire to the researchers of the 203 institutions that had made presentations on this disease at scientific meetings of the Japanese Circulation Society from November 1989 to October 2002. The questionnaires were sent and collected on January 10, 2003. Based on the results of the questionnaire, the first edition of the guidelines for diagnosis of takotsubo cardiomyopathy was prepared and evaluated at the 2003 group meeting of the Research Committee. Out of 33 researchers in Japan who had published research papers on this disease, 21 responded to the request and provided their opinions. The guidelines were revised and were approved at the 2004 group meeting. This summary provides standard guidelines for patients with takotsubo cardiomyopathy.
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              Gender differences in sympathetic nervous system regulation.

              I Chapa, S. Haywood, D. Lange … (1999)
              1. Females are protected against the development of hypertension. The purpose of the current review is to present the evidence for gender differences in the regulation of the sympatho-adrenal nervous system and to determine if these differences support the hypothesis that, in females, the regulation of the sympathetic nervous system (SNS) is altered such that sympatho-adrenal activation is attenuated or sympatho-adrenal inhibition is augmented. 2. The central control of sympatho-adrenal function is different in females and responses vary during the oestral and menstrual cycles. Pathways regulating the SNS appear to be less sensitive to excitatory stimuli and more sensitive to inhibitory stimuli in females compared with males. 3. Gender differences in arterial baroreflex sensitivity suggest that females may have a greater baroreflex sensitivity, such that alterations in blood pressure are more efficiently controlled than in males. Cardiopulmonary reflex inhibition of sympathetic nerve activity is greater in females, possibly resulting in a greater renal excretory function. 4. An attenuated sensitivity to adrenergic nerve stimulation, but not to noradrenaline (NA), suggests that gender differences in noradrenergic neurotransmission may protect females against sympathetic hyperactivity. Gender differences in the regulation of NA release via presynaptic alpha 2-adrenoceptors, the vasoconstrictor response to the cotransmitter neuropeptide Y and the clearance of catecholamines are consistent with this hypothesis. 5. Similarly, attenuated stress-induced increases in plasma catecholamines in women suggest that females are less sensitive and/or less responsive to adrenal medullary activation. This is supported by findings of gender differences in adrenal medullary catecholamine content, release and degradation. 6. We conclude that there is strong evidence that supports the hypothesis that, in females, the regulation of the SNS is altered such that sympatho-adrenal activation is attenuated or sympatho-adrenal inhibition is augmented.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cases J
                Title: Cases Journal
                Publisher: Cases Network Ltd
                ISSN (Electronic): 1757-1626
                Publication date (Electronic): 06 August 2009
                Publication date Collection: 2009
                Volume: 2
                Electronic Location Identifier: 6374
                Affiliations
                [1]simpleDepartment of Cardiology, Adana Numune Education and Research Hospital AdanaTurkey
                Article
                Publisher ID: 6374
                DOI: 10.4076/1757-1626-2-6374
                PMC ID: 2769292
                PubMed ID: 19918582
                SO-VID: 466a5994-b5eb-4e66-a7d4-1c0feb5a6d80
                Copyright © © 2009 Kurt; licensee Cases Network Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 04 March 2009
                Date accepted : 22 July 2009
                Categories
                Subject: Case report

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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