I am a nineteen-year-old American girl studying at Carnegie Mellon University.Having lived very closely with othgr women in the housing dorms, I am very
BACKGROUND Patients with myasthenia gravis(MG)are at a higher risk of developing Takotsubo cardiomyopathy(TTC),particularly during a myasthenic crisis.Myasthenic crisis-associated TTC occurs predominantly in women.In ...BACKGROUND Patients with myasthenia gravis(MG)are at a higher risk of developing Takotsubo cardiomyopathy(TTC),particularly during a myasthenic crisis.Myasthenic crisis-associated TTC occurs predominantly in women.In this case report,we present a man with metastasized prostate carcinoma who developed TTC after new-onset MG.CASE SUMMARY An 81-year-old man with non-insulin dependent diabetes mellitus and metastasized prostate carcinoma presented with dyspnea.During primary assessment examination at the emergency department,there was evident blepharoptosis of his right eye.His electrocardiograms were suggestive of an acute anterior wall myocardial infarction,for which he underwent emergency coronary angiography.No obstructive coronary artery disease was found.During the coronary angiography,the patient developed respiratory failure and was admitted to the Intensive Care Unit for non-invasive respiratory support.The following day,diagnostic neostigmine test revealed a myasthenic crisis.Bedside echocardiography revealed left ventricular apical ballooning with a typical appearance of TTC.Despite the potentially reversible character of both MG and TTC,the patient and family requested an end of support in the Intensive Care Unit due to age and chronic malignancy with reduced quality of life in recent months after non-chemo-responding prostate carcinoma.The patient died soon after treatment withdrawal.CONCLUSION Elderly men should be carefully evaluated for TTC when new-onset MG is diagnosed.展开更多
AIM: To review the initial presentation and demonstrate the importance of Takotsubo cardiomyopathy. METHODS: A PubMed search using the terms "Takotsubo cardiomyopathy (TC)" and "apical ballooning syndro...AIM: To review the initial presentation and demonstrate the importance of Takotsubo cardiomyopathy. METHODS: A PubMed search using the terms "Takotsubo cardiomyopathy (TC)" and "apical ballooning syndrome" yield 211 publications. Only those that were relevant were fully reviewed. The gender, age, precipitating stressor, main complaint at presentation, electrocardiogram (ECG) at admission and serum cardiac markers of patients diagnosed with TC, were extracted as available. The data were organized in tables and graphics, and the incidence of the disorder was calculated and analyzed. RESULTS: A total of 250 clinical cases were examined. The predominant gender that was affected was female, with a prevalence of 87.5%. The mean age of presentation was 64±14 years. The cases were divided by age into 10-year intervals. The age interval of 60-69 years showed the highest frequency of TC, accounting for 79 cases. The most common precipitating stressor was physical (50% of cases). Chest pain wasthe primary complaint at presentation (58.8% of cases) followed by dyspnea (30% of cases). The ST segment changes category was the most common (60%), followed by T wave changes (39.6%). Of the 60% of cases with ST segment changes, 12% had concomitant T wave changes. This means that for 27.6% of the cases, the primary abnormality in the ECG was T wave changes; 87.6% of cases with TC had a change in the ST segment, in the T wave or in both. The percentage of ECGs presenting with changes in the anterior wall was 54.4% (35.6% of ST segment elevation +1.6% of ST segment depression +17.2% of T wave inversion). The percentage of patients presenting with changes in the lateral segment of the heart was 46.8%, while the percentage of patients with changes in the inferior heart was 21.6% and the percentage of patients with changes in the apical region was only 16%. The prevalence of elevated creatinine kinase and/or troponin on initial presentation was 89.3%. CONCLUSION: It is essential that every physician consider Takotsubo cardiomyopathy as a possible differential diagnosis when a patient is classified with acute coronary syndrome. To do so, it is necessary to know the clinical presentation of this syndrome in its early stages.展开更多
We present the case of an 86-year-old woman referred to us from Orthopaedics Division after surgical treatment for femur fracture without personal or family history of ischemic cardiopathy. During hospitalization the ...We present the case of an 86-year-old woman referred to us from Orthopaedics Division after surgical treatment for femur fracture without personal or family history of ischemic cardiopathy. During hospitalization the patient had stomach-ache and the electrocardiogram demonstrated ST-segment elevation in anterior leads. The coronarography showed haziness, but no critical stenosis;ventricolography revealed apical ballooning of the left ventricle with severe systolic dysfunction. She was treated with dopamine in renal dose, beta-blockers and warfarin. When she was in fairly good condition, she started physiotherapy for endoprosthesis for the femur fracture. Clinicians should consider takotsubo cardiomyopathy in the differential diagnosis of patients presenting with chest pain, especially in women with a recent history of physical stress.展开更多
文摘I am a nineteen-year-old American girl studying at Carnegie Mellon University.Having lived very closely with othgr women in the housing dorms, I am very
文摘BACKGROUND Patients with myasthenia gravis(MG)are at a higher risk of developing Takotsubo cardiomyopathy(TTC),particularly during a myasthenic crisis.Myasthenic crisis-associated TTC occurs predominantly in women.In this case report,we present a man with metastasized prostate carcinoma who developed TTC after new-onset MG.CASE SUMMARY An 81-year-old man with non-insulin dependent diabetes mellitus and metastasized prostate carcinoma presented with dyspnea.During primary assessment examination at the emergency department,there was evident blepharoptosis of his right eye.His electrocardiograms were suggestive of an acute anterior wall myocardial infarction,for which he underwent emergency coronary angiography.No obstructive coronary artery disease was found.During the coronary angiography,the patient developed respiratory failure and was admitted to the Intensive Care Unit for non-invasive respiratory support.The following day,diagnostic neostigmine test revealed a myasthenic crisis.Bedside echocardiography revealed left ventricular apical ballooning with a typical appearance of TTC.Despite the potentially reversible character of both MG and TTC,the patient and family requested an end of support in the Intensive Care Unit due to age and chronic malignancy with reduced quality of life in recent months after non-chemo-responding prostate carcinoma.The patient died soon after treatment withdrawal.CONCLUSION Elderly men should be carefully evaluated for TTC when new-onset MG is diagnosed.
文摘AIM: To review the initial presentation and demonstrate the importance of Takotsubo cardiomyopathy. METHODS: A PubMed search using the terms "Takotsubo cardiomyopathy (TC)" and "apical ballooning syndrome" yield 211 publications. Only those that were relevant were fully reviewed. The gender, age, precipitating stressor, main complaint at presentation, electrocardiogram (ECG) at admission and serum cardiac markers of patients diagnosed with TC, were extracted as available. The data were organized in tables and graphics, and the incidence of the disorder was calculated and analyzed. RESULTS: A total of 250 clinical cases were examined. The predominant gender that was affected was female, with a prevalence of 87.5%. The mean age of presentation was 64±14 years. The cases were divided by age into 10-year intervals. The age interval of 60-69 years showed the highest frequency of TC, accounting for 79 cases. The most common precipitating stressor was physical (50% of cases). Chest pain wasthe primary complaint at presentation (58.8% of cases) followed by dyspnea (30% of cases). The ST segment changes category was the most common (60%), followed by T wave changes (39.6%). Of the 60% of cases with ST segment changes, 12% had concomitant T wave changes. This means that for 27.6% of the cases, the primary abnormality in the ECG was T wave changes; 87.6% of cases with TC had a change in the ST segment, in the T wave or in both. The percentage of ECGs presenting with changes in the anterior wall was 54.4% (35.6% of ST segment elevation +1.6% of ST segment depression +17.2% of T wave inversion). The percentage of patients presenting with changes in the lateral segment of the heart was 46.8%, while the percentage of patients with changes in the inferior heart was 21.6% and the percentage of patients with changes in the apical region was only 16%. The prevalence of elevated creatinine kinase and/or troponin on initial presentation was 89.3%. CONCLUSION: It is essential that every physician consider Takotsubo cardiomyopathy as a possible differential diagnosis when a patient is classified with acute coronary syndrome. To do so, it is necessary to know the clinical presentation of this syndrome in its early stages.
文摘We present the case of an 86-year-old woman referred to us from Orthopaedics Division after surgical treatment for femur fracture without personal or family history of ischemic cardiopathy. During hospitalization the patient had stomach-ache and the electrocardiogram demonstrated ST-segment elevation in anterior leads. The coronarography showed haziness, but no critical stenosis;ventricolography revealed apical ballooning of the left ventricle with severe systolic dysfunction. She was treated with dopamine in renal dose, beta-blockers and warfarin. When she was in fairly good condition, she started physiotherapy for endoprosthesis for the femur fracture. Clinicians should consider takotsubo cardiomyopathy in the differential diagnosis of patients presenting with chest pain, especially in women with a recent history of physical stress.
