Midventricular Takotsubo syndrome

A 78-year-old woman with a background of type 2 diabetes mellitus,hyperlipidaemia and hypertension experienced sudden onset severe chest pain while in the emergency department,after a stressful emotional event.The pain lasted for 20-30 min and the patient developed widespread T-wave inversion on 12-lead ECG.

Acute myocardial infarction triggering Takotsubo syndrome, and the need to search for its prevalence

To the Editor The interesting report by Redfors, et aL[1] in the June issue of the Journal of Geriatric Cardiology, about an 88-year-old woman who presented with chest pain, found on echocardiography （ECHO） to have transient left ventricular apical akinesis with a hypercontractile base, and an occluded first diagonal coronary branch with suspected acute plaque rupture, on coronary angiography, treated with a percutaneous coronary intervention, for which the authors concluded that the observed extent of akinesis was disproportionally large for the occluded coronary lesion, letting them to deduce that the acute myocardial infarction （AMI） caused the episode of Takotsubo syndrome （TTS）, reminds me of a similar case of an AMI due to stent thrombosis and a resultant associated TTS.

Age related differences and outcome of patients with Takotsubo syndrome

Background Takotsubo syndrome （TS） is an important cardiac disease that affects predominantly postmenopausal women. This study was conducted to determine the impact of age on the short- and long-term outcome of TS patients. Methods ＆ Results The data from a collective of 114 TS patients with a mean follow-up of 1591 ：E 1079 days was retrospectively analysed. The study population was divided into two groups （≤ 65 and 〉 65 years） so as to evaluate the impact of age on the short- and long-term mortality of TS patients. In-hospital eventslike life-threatening arrhythmias （14.58% vs. 9.09%; P = 0.036）, need for mechanical respiratory support （41.66% vs. 28.78%; P = 0.15） as well as inotropic agent use （22.91% vs. 15.15%; P = 0.29）, although not reaching the statistical cut-of, tended to occur more often in the younger group. Heart failure was more common in the elderly age group （P = 0.03）. The use of multivariate analysis ruled out age as a significant marker of long term mortality （HR： 1.0; 95% CI： 0.9-1.0; P = 0.60）. Conclusions Age does not influence the clinical course of TS in terms of the short- as well as long-term outcome. The study revealed a higher incidence of life threatening arrhythmias in the younger patient age-group and a higher incidence of heart failure among the older group of patients.

Myocardial infarction with ST-segment elevation in old patient with history of takotsubo syndrome

Takotsubo syndrome （TTS） is a rare condition that af- fects mainly aging women. TTS was first reported in 1990r and is characterized by clinical symptoms, ECG changes and regional wall motion abnormalities without changes in the coronary arteries. However, some reports admit the pos- sibility of coexistence of TTS and coronary artery disease. We present a patient who had not had any changes in coro- nary arteries until four years later when she had myocardial infarction associated with right coronary artery narrowing, despite the fact that the risk factors of coronary heart disease were closely monitored.

Association of marital status with takotsubo syndrome(broken heart syndrome)among adults in the United States

BACKGROUND The pathophysiology of takotsubo syndrome(TTS)is not well understood,however,it is often precipitated by psychological or physical stress.Marital status is related to emotional stress,but its associations with TTS are limited.AIM To explored the potential association between marital status and TTS.METHODS We conducted a case-control study using data on patients aged≥40 years with marital status data in the National Hospital Discharge Survey(2006-2010).The International Classification of Diseases Ninth Revision codes were used to identify cases with TTS and other comorbid conditions.Each case was matched to 5 controls by age,sex,year of TTS diagnosis and bed size of hospital.Two sets of controls were selected:Acute myocardial infarction(AMI)controls and noncardiovascular disease(CVD)controls.Conditional logistic regression was used to estimate odds ratios(OR)and 95%confidence intervals(CI)for the association of marital status with TTS.RESULTS The 59 patients with TTS who had information on marital status were matched to 295 controls with AMI and 295 non-CVD controls,resulting in a sample of 649 patients.The average age of cases was 69.7±11 years with 90%being women and 88%reporting White race.In multivariable-adjusted models,compared to singles,patients who were married had lower odds of TTS(OR=0.86,95%CI:0.79–0.93)while those who were widowed(OR=1.14,95%CI:1.05–1.23)or divorced/separated(OR=1.32,95%CI:1.21–1.45)had elevated odds for TTS when compared to non-CVD controls.Similar results were observed when cases were compared to controls with AMI.CONCLUSION In this study,being married was associated with lower odds for TTS while being divorced/separated or widowed was related to elevated odds for TTS.These novel findings that underscore the potential importance of social factors like marital status in the development of TTS need confirmation in larger studies.

Spontaneous coronary artery dissection-associated takotsubo syndrome: A systematic review of case reports

BACKGROUND Spontaneous coronary artery dissection(SCAD)is underdiagnosed and requires comprehensive angiographic findings.Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome(TTS)or exist simultaneously,making it challenging for clinicians to treat and manage.Case reports lack consolidated AIM To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS.METHODS SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed,EMBASE,Scopus,and Google Scholar databases till January 2023.Case reports described demographics,comorbidities,imaging,management,and results.RESULTS Twelve articles about 20 female patients were analyzed.30%of patients(n=6,>60 years)were elderly(mean age 56.2±9.07 years,range 36-70 years).Canada has 9 cases,United States 3,Australia 3,Sweden 2,Japan,Denmark,and France 1.Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS.Nine had hypertension,2 had hyperlipidemia,and 1 had prediabetes.5 patients(25%)smoked.10(50%)troponin-positive myocardial infarction patients reported chest discomfort.11(55%)of 20 instances had TTS/SCAD.12(60%)of 20 patients exhibited ST elevation and 3(15%)had T wave inversion on electrocardiogram.19/20 patients had elevated troponin.9(45%)of 20 people had apical akinesis with TTS ballooning on cardiac imaging.All 20 exhibited echocardiographic wall motion abnormalities.19(95%)of 20 coronary angiography cases had SCAD.10 of 19 SCAD patients had left anterior descending,2 diagonal,and 2 left circumflex coronary artery involvement.7 of 20 patients had left ventricular ejection fraction(LVEF)data.LVEF averaged 38.78±7.35%.5(25%)of the 20 cases underwent dual antiplatelet therapy.Three(15%)of 20 cases experienced occasional ectopic ventricular complexes,Mobitz ll AV block,and paroxysmal atrial fibrillation.All 20 cases recovered and survived.CONCLUSION Given the clinical similarities and challenges in detecting TTS and SCAD,this subset needs more research to raise awareness and reduce morbidity.

Do older patients get takotsubo syndrome differently?

We read with great interest case report of 99-year-old patient with takotsubo syndrome(TTS)presented by Yenerçağ,et al.,[1]especially because four years ago,we described the oldest so far person diagnosed with TTS:a 98-year old woman.[2]During analysis of your article a few comments and questions occurred to us.TTS is usually preceded with a stress factor.[3]Do you know,or can you suspect the TTS cause in this patient?Was she diagnosed with primary or secondary TTS?TTS often occurs in people with ongoing or previous neurological or psychiatric disorder.[4]The patient had history of Alzheimer’s disease.Did she have any new neurological symptoms during described hospitalization?A very good diagnostic test for TTS is NT-proBNP to troponin I ratio.[5]

TAKOTSUBO SYNDROME WITH TRANSIENT COMPLETE ATRIOVENTRICULAR BLOCK

Takotsubo syndrome （transient left ventricular apical ballooning syndrome） is a novel cardiac syndrome of left ventricular apical ballooning involving reversible left ventricular apical ballooning （during systole） of acute onset with chest pain, electrocardiographic changes, and minimal elevation of cardiac enzymes resembling acute myocardial infarction, but without evidence of myocardial ischemia or injury.