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      Isolated Right Ventricular Stress (Takotsubo) Cardiomyopathy

      case-report

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          Abstract

          A 79-year-old woman was admitted with a left femoral neck fracture and she immediately developed circulatory shock. Echocardiography showed a markedly enlarged right ventricle (RV) with systolic ballooning of the mid-ventricular wall and preserved contractility of the apex. The left ventricular (LV) motion was normal. Multi-detector-row computed tomography showed severe congestion of the contrast media in the right atrium with no forward flow to RV, but no pulmonary embolism. She was successfully treated with percutaneous veno-arterial extracorporeal membrane oxygenation. This case presented with acute, profound, but reversible RV dysfunction triggered by acute stress in a manner similar to that seen in LV stress cardiomyopathy.

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          2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.

          Stavros V Konstantinides, Adam Torbicki, Giancarlo Agnelli … (2014)
          Article 0 comments Cited 695 times – based on 0 reviews     Review now
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            Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan.

            K Tsuchihashi, K. Ueshima, T Uchida … (2001)
            To determine the clinical features of a novel heart syndrome with transient left ventricular (LV) apical ballooning, but without coronary artery stenosis, that mimics acute myocardial infarction, we performed a multicenter retrospective enrollment study. Only several case presentations have been reported with regard to this syndrome. We analyzed 88 patients (12 men and 76 women), aged 67 +/- 13 years, who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies. Thirt-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had emotional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or excessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave formation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56%) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York Heart Association function on discharge. The LV ejection fraction improved from 41 +/- 11% to 64 +/- 10%. Transient intraventricular pressure gradient and provocative vasospasm were documented in 13/72 (18%) and 10/48 (21%) of the patients, respectively. During follow-up for 13 +/- 14 months, two patients showed recurrence, and one died suddenly. A novel cardiomyopathy with transient apical ballooning was reported. Emotional or physical stress might play a key role in this cardiomyopathy, but the precise etiologic basis still remains unclear.
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              Acute heart failure syndromes: current state and framework for future research.

              Liviu Klein, Luigi Tavazzi, … (2005)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Intern Med
                Journal ID (iso-abbrev): Intern. Med
                Title: Internal Medicine
                Publisher: The Japanese Society of Internal Medicine
                ISSN (Print): 0918-2918
                ISSN (Electronic): 1349-7235
                Publication date (Electronic): 1 August 2017
                Publication date (Print): 15 August 2017
                Volume: 56
                Issue: 16
                Pages: 2159-2164
                Affiliations
                [1 ]Division of Intensive Care Unit, Kumamoto Central Hospital, Japan
                [2 ]Division of Cardiovascular Medicine, Kumamoto Central Hospital, Japan
                [3 ]Division of Radiology, Kumamoto Central Hospital, Japan
                [4 ]Division of Cardiovascular Medicine, Jinnouchi Hospital, Japan
                [5 ]Collaborative Research Institute of Innovation for Cardiovascular Diseases, Kyushu University Center for Disruptive Cardiovascular Medicine, Japan
                Author notes

                Correspondence to Dr.　Hitoshi Sumida, hitsumida@ 123456me.com

                Article
                DOI: 10.2169/internalmedicine.8323-16
                PMC ID: 5596277
                PubMed ID: 28781307
                SO-VID: 6f9fc8f7-5705-4c84-aa7a-6af84e79907f
                Copyright © Copyright © 2017 by The Japanese Society of Internal Medicine
                License:

                The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit ( https://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 25 September 2016
                Date accepted : 11 January 2017
                Categories
                Subject: Case Report

                Keywords: circulatory shock,right heart failure,stress (takotsubo) cardiomyopathy,cardiac magnetic resonance,echocardiography,mechanical support
                Data availability:
                Keywords: circulatory shock, right heart failure, stress (takotsubo) cardiomyopathy, cardiac magnetic resonance, echocardiography, mechanical support

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