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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2018, Number 4

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An Med Asoc Med Hosp ABC 2018; 63 (4)

Takotsubo reverse associated to cardiogenic shock in a young woman

Fuentes GAJ, Ochoa MX, Rojas GCA, Aisa ÁA

Language: Spanish
References: 22
Page: 293-298
PDF size: 267.25 Kb.


ABSTRACT

Takotsubo syndrome is associated with transient myocardial dysfunction, characterized by «apical ballooning», a consequence of marked akinesia of the apical segments. It has less frequent clinical variants that differ in epidemiological characteristics and in the pattern of involvement in myocardial contractility. These atypical forms have not been thoroughly studied due to their low incidence. Although there are multiple reports where these patterns have been identified, their definitive management has not been defined. We present the case of a 38-year-old woman with diagnosis of fragile X syndrome and primary ovarian failure, who presented with acute pulmonary edema of sudden onset and cardiogenic shock. She was diagnosed with inverse takotsubo syndrome by echocardiographic study in which it was observed hypokinesia of the basal and middle segments of all cardiac the walls, with contractility conserved in apical segments and severe systolic failure. The management consisted of minimal administration of vasopressors and ventilatory management with positive pressure. The clinical, radiological and gasometric improvement was evident after 48 hours.


REFERENCES

  1. Sato H, Tateishi H, Uchida T, Dote K, Ishihara M, Sasaki K. Takotsubo-like left ventricular dysfunction due to multivessel coronary spasm. Clinical Aspect of Myocardial Injury: from Ischemia to Heart Failure. Tokyo: Kagakuhyoronsha Publishing Co.; 1990: pp. 56-64.

  2. Ghadri JR, Cammann VL, Napp LC, Jurisic S, Diekmann J, Bataiosu DR et al. Differences in the clinical profile and outcomes of typical and atypical takotsubo syndrome: data from the international takotsubo registry. JAMA Cardiol. 2016; 1 (3): 335-340.

  3. Arandia-Guzmán J, Antezana-Llaveta G, Zarate-Carrillo A. Miocardiopatía inducida por estrés o síndrome de Takotsubo: a propósito de un caso. Gac Med Bol. 2018; 41 (1): 71-74.

  4. Barbaryan A, Bailuc SL, Patel K, Raqeem MW, Thakur A, Mirrakhimov AE. An emotional stress as a trigger for reverse takotsubo cardiomyopathy: a case report and literature review. Am J Case Rep. 2016; 17: 137-142.

  5. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med. 2015; 373 (10): 929-938.

  6. Angelini P. Reverse, or inverted, transient Takotsubo cardiomyopathy: terms and status of an open discussion. Tex Heart Inst J. 2013; 40 (1): 60-63.

  7. Song BG, Chun WJ, Park YH, Kang GH, Oh J, Lee SC et al. The clinical characteristics, laboratory parameters, electrocardiographic, and echocardiographic findings of reverse or inverted takotsubo cardiomyopathy: comparison with mid or apical variant. Clin Cardiol. 2011; 34 (11): 693-699.

  8. Ennezat PV, Pesenti-Rossi D, Aubert JM, Rachenne V, Bauchart JJ, Auffray JL et al. Transient left ventricular basal dysfunction without coronary stenosis in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo). Echocardiography. 2005; 22 (7): 599-602.

  9. Simões MV, Marin-Neto JA, Maciel BC. Variable regional left ventricular dysfunction in takotsubo cardiomyopathy syndrome. Echocardiography. 2007; 24 (8): 893; author reply 894.

  10. Ramaraj R, Movahed MR. Reverse or inverted takotsubo cardiomyopathy (reverse left ventricular apical ballooning syndrome) presents at a younger age compared with the mid or apical variant and is always associated with triggering stress. Congest Heart Fail. 2010; 16 (6): 284-286.

  11. Ramaraj R. Stress cardiomyopathy: aetiology and management. Postgrad Med J. 2007; 83 (982): 543-546.

  12. Kumai T, Inamasu J, Watanabe E, Sugimoto K, Hirose Y. Differences between Takotsubo cardiomyopathy and reverse Takotsubo cardiomyopathy associated with subarachnoid hemorrhage. Int J Cardiol Heart Vasc. 2016; 11: 99-103.

  13. Chattopadhyay S, John J. Tako-Tsubo and reverse Tako-Tsubo cardiomyopathy: temporal evolution of the same disease? Eur Heart J. 2009; 30 (23): 2837.

  14. Ehl NF, Zurek M, Rickli H, Maeder MT. “Double takotsubo”: first description of the sequence of classical followed by inverted type in a young woman. Int J Cardiol. 2014; 174 (2): e36-e37.

  15. Ceccacci A, Mancone M, Calcagno S, De Vincentis G, Sardella G, Fedele F. Role of MIBG scintigraphy in reverse Tako-tsubo cardiomyopathy: Confirming a pathophysiologic hypothesis. Int J Cardiol. 2016; 223: 54-55.

  16. Kim DH, Bang DW, Park HK. Atypical basal type takotsubo cardiomyopathy: MDCT findings correlated with echocardiography. Int J Cardiol. 2010; 141 (2): e28-e30.

  17. Bomann S, Davies IO. ED echo of reverse Tako-tsubo cardiomyopathy: a rare and misleading finding. Am J Emerg Med. 2012; 30 (9): 2088.e3-5.

  18. Huddleston LB, Visootsak J, Sherman SL. Cognitive aspects of fragile X syndrome. Wiley Interdiscip Rev Cogn Sci. 2014; 5 (4): 501-508.

  19. Mila M, Mallolas J. Síndrome del cromosoma X frágil: menopausia precoz. Diagnóstico preimplantacional y preconcepcional. Rev Neurol. 2001; 33 (Supl 1): S20-S23.

  20. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008; 155 (3): 408-417.

  21. Olechowski B, Corbett SJ, Shah BN. Reverse Tako-tsubo cardiomyopathy: a clinical entity mimicking acute coronary syndrome. Postgrad Med J. 2015; 91 (1076): 355-356.

  22. Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ et al. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J. 2018; 39 (22): 2032-2046.




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