Drug-Induced Takotsubo Cardiomyopathy, a Form of Presentation of Heart Failure
Keywords:
cardiomyopathy, stress, takotsubo, epinephrine, catecholamines.Abstract
Introduction: Stress cardiomyopathy is a clinical syndrome in the context of a stunned myocardium, triggered by acute situations such as stress or an excessive catecholaminergic response, either endogenous or exogenous, leading to left ventricular dysfunction that may evolve to acute heart failure. We describe a case of stress cardiomyopathy attributed to the administration of epinephrine during an intraoperative otorhinolaryngology procedure.
Case presentation: A 23-year-old woman with a history of generalized anxiety disorder, who was medicated with escitalopram, was admitted for scheduled otorhinolaryngologic surgery (septoplasty plus turbinoplasty). In the immediate postoperative period, she presented with tachyarrhythmia associated with marked respiratory distress and clinical signs of shock. Acute pulmonary edema of cardiac origin was indicated by positive cardiac biomarkers, as well as by an echocardiogram with severe left ventricular systolic dysfunction and an ejection fraction of 24%.
Conclusion: Cardiomyopathies constitute the spectrum of different diseases affecting the myocardium, leading to the development of heart failure. They are currently classified into three main groups: hypertrophic, restrictive and dilated cardiomyopathy. The latter, in turn, includes within its broad etiology, stress cardiomyopathies, which is characterized mainly by sudden systolic dysfunction of the left ventricle, accompanied by transient dyskinesia of some segments of the ventricular wall.
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References
Medina de Chazal H, Del Buono MG, Keyser-Marcus L, Ma L, Moeller FG, Berrocal D, et al. Stress Cardiomyopathy Diagnosis and Treatment. J Am Coll Cardiol. 2018;72(16):1955-71. DOI: http://dx.doi.org/10.1016/j.jacc.2018.07.072
Wittstein IS, Schulman SP, Bivalacqua TJ. Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress. N Engl J Med. 2005;10;352(6):539-48. DOI: http://dx.doi.org/10.1016/j.accreview.2005.05.028
Kido K, Guglin M. Drug-Induced Takotsubo Cardiomyopathy. J Cardiovasc Pharmacol Ther. 2017;22(6):552-63. DOI: http://dx.doi.org/10.1177/1074248417708618
Samuels MA. The Brain–Heart Connection. Circulation. 2007;3;116(1):77-84. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.678995
Rawish E, Stiermaier T, Santoro F, Brunetti N, Eitel I. Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 1—Pathophysiology and Diagnosis. J Clin Med. 2021;10(3):479. DOI: http://dx.doi.org/10.3390/jcm10030479
Gómez AR, Herrera S, Ochoa J, Velásquez JG. Miocardiopatía por estrés: serie de casos. Rev Colomb Cardiol. 2015;22(2):97-101. DOI: http://dx.doi.org/10.1016/j.rccar.2014.10.009
Seferović PM, Polovina M, Bauersachs J, Arad M, Ben Gal T, Lund LH, et al. Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019;21(5):553-76. DOI: http://dx.doi.org/10.1002/ejhf.1461
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;3;373(10):929-38. DOI: http://dx.doi.org/10.1056/NEJMoa1406761
Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, et al. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology: Current state of knowledge on Takotsubo syndrome. Eur J Heart Fail. 2016;18(1):8-27. DOI: shttps://dx.doi.org/10.1002/ejhf.424
Samul-Jastrzębska J, Roik M, Wretowski D, Łabyk A, Ślubowska A, Bizoń A, et al. Evaluation of the InterTAK Diagnostic Score in differentiating Takotsubo syndrome from acute coronary syndrome. A single center experiences. Cardiol J. 2021;28(3):416-22. DOI: http://dx.doi.org/10.5603/CJ.a2019.0086
Ghadri JR, Cammann VL, Jurisic S, Seifert B, Napp LC, Diekmann J, et al. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry: Diagnostic score for takotsubo syndrome. Eur J Heart Fail. 2017;19(8):1036-42. DOI: https://dx.doi.org/10.1002/ejhf.683
Singh K, Carson K, Shah R, Sawhney G, Singh B, Parsaik A, et al. Meta-Analysis of Clinical Correlates of Acute Mortality in Takotsubo Cardiomyopathy. Am J Cardiol. 2014;113(8):1420-8. DOI: http://dx.doi.org/10.1016/j.amjcard.2014.01.419
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. DOI: https://dx.doi.org/10.1093/eurheartj/ehab368
Sharkey SW. A Clinical Perspective of the Takotsubo Syndrome. Heart Fail Clin. 2016;12(4):507-20. DOI: http://dx.doi.org/10.1016/j.hfc.2016.06.003
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Copyright (c) 2024 Erika María Martínez Carreño, Andres Eduardo Yoli Garrido, Luis Alfredo Blanco Castiblanco, Marina Esther Pedrosa Algarin
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