Background: Tako-tsubo cardiomyopathy occurs typicallly after an intrinsic adrenergic hyperstimulation triggered by a psychological or physically stressful event. Exceptionally, it may be caused by an exogenous hypera...Background: Tako-tsubo cardiomyopathy occurs typicallly after an intrinsic adrenergic hyperstimulation triggered by a psychological or physically stressful event. Exceptionally, it may be caused by an exogenous hyperadrenergism. We report the case of an 85 year old man, hypertensive, with a history of ischemic stroke. He consulted for signs of heart failure with recurrent dizziness two weeks which was explained by an atrioventricular block. Initial echocardiography showed left ventricular ejection fraction to 60% with no wall motion abnormalities. The patient received iso-prenaline (0.02 mcg/kg/mn) for 20 hours before the implantation of a single chamber pacemaker. At 24 hours of admission an acute pulmonary edema occurred. The control echocardiography showed impaired left ventricular ejection fraction of 25% with apical ballooning and akinesis was also found on ventricu-lography. Coronary angiography showed no significant coronary lesions. Troponin level was elevated to 2 ng/ml. The pulmonary edema was then controlled. Subsequent clinical and echocardiographic were favo- rable after two weeks which was consistent with the diagnosis of tako-tsubo cardiomyopathy. Conclusion: This case illustrates an example of tako-tsubo syndrome induced by an exogenous catecholergic stimulation (isoprenaline) combined with an endogenous release after a pacemaker implantation which confirmed the physiopathological hypothesis of a catecholamine-mediated stunning in tako-tsubo cardiomyopathy.展开更多
Background: In Takotsubo cardiomyopathy (TCM), left ventricular dysfunction is usually reversible within a few weeks. Complete recovery can however be very rapid. We report the case of Mrs. TA, a 53 year old patient w...Background: In Takotsubo cardiomyopathy (TCM), left ventricular dysfunction is usually reversible within a few weeks. Complete recovery can however be very rapid. We report the case of Mrs. TA, a 53 year old patient who had a history of hypertension treated with atenolol and captopril. She was admitted with the diagnosis of non ST segment elevation myo-cardial infarction. The electrocardiogram showed anterior sub and the troponinI level was 3.48 mg/l. Echo-cardiography revealed a left ventricular (LV) ballooning and LV ejection fraction was 36%. A recent emotional stress was mentioned. TCM was suspected and emergency angiography showed apical ballooning with a normal coronary angiogram. There was a complete recovery in 72 hours with a normalization of regional and global LV function at echocardiography and angiography. Conclusion: There is a large variability in TCM evolution aspects probably due to a variable physiopathological mechanism which remains to be clarified.展开更多
文摘Background: Tako-tsubo cardiomyopathy occurs typicallly after an intrinsic adrenergic hyperstimulation triggered by a psychological or physically stressful event. Exceptionally, it may be caused by an exogenous hyperadrenergism. We report the case of an 85 year old man, hypertensive, with a history of ischemic stroke. He consulted for signs of heart failure with recurrent dizziness two weeks which was explained by an atrioventricular block. Initial echocardiography showed left ventricular ejection fraction to 60% with no wall motion abnormalities. The patient received iso-prenaline (0.02 mcg/kg/mn) for 20 hours before the implantation of a single chamber pacemaker. At 24 hours of admission an acute pulmonary edema occurred. The control echocardiography showed impaired left ventricular ejection fraction of 25% with apical ballooning and akinesis was also found on ventricu-lography. Coronary angiography showed no significant coronary lesions. Troponin level was elevated to 2 ng/ml. The pulmonary edema was then controlled. Subsequent clinical and echocardiographic were favo- rable after two weeks which was consistent with the diagnosis of tako-tsubo cardiomyopathy. Conclusion: This case illustrates an example of tako-tsubo syndrome induced by an exogenous catecholergic stimulation (isoprenaline) combined with an endogenous release after a pacemaker implantation which confirmed the physiopathological hypothesis of a catecholamine-mediated stunning in tako-tsubo cardiomyopathy.
文摘Background: In Takotsubo cardiomyopathy (TCM), left ventricular dysfunction is usually reversible within a few weeks. Complete recovery can however be very rapid. We report the case of Mrs. TA, a 53 year old patient who had a history of hypertension treated with atenolol and captopril. She was admitted with the diagnosis of non ST segment elevation myo-cardial infarction. The electrocardiogram showed anterior sub and the troponinI level was 3.48 mg/l. Echo-cardiography revealed a left ventricular (LV) ballooning and LV ejection fraction was 36%. A recent emotional stress was mentioned. TCM was suspected and emergency angiography showed apical ballooning with a normal coronary angiogram. There was a complete recovery in 72 hours with a normalization of regional and global LV function at echocardiography and angiography. Conclusion: There is a large variability in TCM evolution aspects probably due to a variable physiopathological mechanism which remains to be clarified.
