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Takotsubo Cardiomyopathy

Case Presentation for CLSP 4305
by

Mary Gibson

on 26 March 2013

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Transcript of Takotsubo Cardiomyopathy

Takotsubo
Cardiomyopathy One fine day, Penelope was out swimming with her octopus... What is Takotsubo Cardiomyopathy? Treatment & Outcome And it got away! Definition: Serum
Catecholamines Troponin I Myocardial
Infarction Takotsubo
Cardiomyopathy Myocardial
Infarction Takotsubo
Cardiomyopathy Traumatized and shocked at this loss, Penelope started developing chest pain and having trouble breathing. At age 84, Penelope's medical history is remarkably unremarkable, and she has been in relatively good health, she is on no medications, not even estrogen though she is many years post-menopausal.

Upon arrival at the ER, they initiated their chest pain evaluation protocols and drew the following labs... Acute, severe and transient left ventricular heart failure with non-ischemic cardiomyopathy.

Angiogram shows the key wall motion abnormalities in the ventricle causing the symptoms. Pathophysiology: Seems to be precipitated by sudden stress, shock, emotion and/or adrenergic stimulation, with resulting "stunning" of the myocardium by catecholamines such as epinephrine. The ventricle is perhaps most affected as it has a very high proportion of cardiac Beta-2 adrenergic receptors. A "takotsubo"
(octopus pot) Takotsubo Cardiomyopathy Takotsubo Cardiomyopathy in ACTION! Moral of the story... Prevalence: Affects primarily the post-menopausal aged female population, with these women accounting for about 90-95% of cases.

Overall, Takotsubo Cardiomyopathy is diagnosised in approximately 2% of suspected coronary artery syndrome patients. Differential Diagnosis: Patients with Takotsubo Cardiomyopathy present with almost identical symptoms as a myocardial infarction (heart attack).

Rule-out of MI is dependent on angiography results showing no vascular blockage but with prominent ventricular wall motion abnormality, and a minimal troponin increase. Our Case Resolution * Takotsubo cardiomyopathy or "Broken Heart Syndrome" usually affects postmenopausal women after a significant emotional and physical stresses.

* The emotional stressors include grief, extreme anger, fear, and relationship conflicts.

* The main cause of symptoms is severe weakening and akinesis of the left ventricle of the heart muscle. Summary Treatment There is no clear specific treatment or medication available for Takotsubo Cardiomyopathy. Prevention of symptoms in the first place is advised by reducing stress or shock, especially in older women.

Standard heart failure medications such as beta blockers, ACE inhibitors, and diuretics are often part of the recommended supportive treatment until the left ventricular function is restored. Medications * Beta Blockers help reduce the effects of catecholamines such as epinephrine. They also improve heart function.

* ACE inhibitors (angiotensin-converting-enzyme
inhibitor) help improve heart pumping capability and increased the strength of the heart muscle contractions.

* They may give aspirin to patients who also have
atherosclerosis that prevent buildup plaque in the arterial walls. Special Treatment for Complications If a patient develops severe cardiogenic shock, the patient may be treated by placement of an intra-aortic balloon pump for left ventricular support.

—This will help increase coronary blood flow and myocardial oxygen delivery. Cardiogenic Shock short-term anticoagulation may be considered to prevent left ventricular thrombus formation in the akinetic apex. Clot formation With adequate supportive care, Penelope's Takotsubo Cardiomyopathy resolved enough in a few days for her to be discharged, and in follow-up one month later her cardiac function was normal.

The octopus was never found... General Prognosis: Very Good * Left Ventricle function recovers spontaneously, typically within 4 weeks.

* Typically, no significant coronary artery disease or evidence of plaque rupture can be identified and these patients are no more at risk than the rest of the population.

* Less then one percent of hospital mortality Outcome * Troponin-I
* Catecholamines
* Blood gases Follow-up Tests Diagnostic Lab Tests Initial Laboratory Tests Initial Laboratory Tests Group 4:
Mary Gibson
Hanna Melaku
Stacey Bell
Dalika Tiev References Griffin S, Logue B. Takotsubo Cardiomyopathy: A Nurse’s Guide. Accessed 3/22/2013. http://www.aacn.org/WD/CETests/Media/C0953.pdf

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Fairview Diagnostic Laboratories. Web. 25 Mar. 2013.
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Jun-Won, Lee, et al. “Clinical Characteristics and Prognostic Factors of Stress-Induced Cardiomyopathy.” NCBI. 29 June. 2010. Web. 25 Mar. 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893368/

Wittstein IS, et al. Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress. NEJM 2005;352:539-548

Fazio G, Pizzuto C, Novo S, et al. Chronic pharmacological treatment in takotsubo cardiomyopathy. International Journal Of Cardiology [serial online]. June 23, 2008;127(1):121-123. References (cont.) Hansen P. Takotsubo cardiomyopathy: An under-recognized myocardial syndrome. European Journal Of Internal Medicine [serial online]. December 2007;18(8):561-565

By Mayo Clinic Staff. Broken Heart syndrome: Treatment and Drug: Accessed Feb 10, 2011. http://www.mayoclinic.com/health/broken-heart-syndrome/DS01135/DSECTION=treatments-and-drugs

“Stress induced cardiomyopathy presenting as acute coronary syndrome: Tako-Tsubo in Mercogliano, Southern Italy.” Cangella F, Medolla A, et al. http://www.cardiovascularultrasound.com/content/5/1/36

Spyridon K., Socrates P., et al. “Takotsubo Cardiomyopathy: The ‘Broken Heart’ Syndrome”. First Cardiology Department and Radiology Department, Evagelismos Hospital, Athens, Greece Hellenic J Cardiol 2010; 51: 451-457 http://www.hellenicjcardiol.com/archive/full_text/2010/5/2010_5_451.pdf

“The clinical features of takotsubo cardiomyopathy”
Y.J. Akashi, K. Nakazawa, et al. QJM (2003) 96 (8): 563-573. doi: 10.1093/qjmed/hcg096 http://qjmed.oxfordjournals.org/content/96/8/563.full#T5
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