Cath Lab Digest - January 2008 - (Page 27)

27 hopes of learning more about this interesting disorder. been reported in 5–10% of patients with Takotsubo cardiomyopathy.4,13,14 ■ The author can be contacted at bmcculloch@jps.net Pathophysiology The pathophysiology of Takotsubo cardiomyopathy is not clearly understood at present. Several theories of the pathophysiology have been postulated, including multi-vessel coronary vasospasm and myocarditis.4 Stress is thought to be a significant risk factor for its development and currently, the leading theory is that catecholamines trigger the left ventricular abnormalities. High levels of circulating catecholamines have been measured in patients with Takotsubo cardiomyopathy.11 References 1. Wittstein IS. The broken heart syndrome. Cleveland Clinic Journal of Medicine 2007;74: s17–s22. 2. Abe Y, Kondo M, Matsuoka R, et al. Assessment of clinical features in transient left ventricular apical ballooning. JACC 2003;41(5): 737–742. 3. Seth PS, Aurigemma GP, Drasnow JM, et al. A Syndrome of Transient Left Ventricular Apical Wall Motion Abnormality in the Absence of Coronary Disease: A Perspective from the United States. Cardiology 2003;100: 61–66. 4. Prasad A. Apical ballooning syndrome: An important differential diagnosis of acute myocardial infarction. Circulation 2007;115: e56–e59. 5. Mitsuma W, Kodama M, Ito M, et al. Serial electrocardiographic findings in women with takotsubo cardiomyopathy. Am J Cardiol 2007;100:106–109. 6. Bybee KA, Kara T, Prasad A, et al. Systematic review: Transient left ventricular apical ballooning: A syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med 2004; 141:858–865. 7. Abdulla I & Ward MR. Takotsubo cardiomyopathy: How stress can mimic acute coronary occlusion. MJA 2007;187(6): 357–360. 8. Reuss CS, Lester SJ, Hurst RT, et al. Isolated left ventricular basal ballooning phenotype of transient cardiomyopathy in young women. Am J Cardiol 2007;99:1451–1453. 9. McCulloch BJ. Transient left ventricular apical ballooning. Crit Care Nurse 2007;27(6):20–27. 10. Park JH, Kang SJ, Song KW, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the Treatment At this time, there are no published evidence-based guidelines for the treatment of Takotsubo cardiomyopathy. 4 Most patients are managed empirically for acute coronary syndrome. The treatment is supportive and may include aspirin, beta blockers, ACE inhibitors, diuretics, inotropes, vasopressors, anti-coagulants and intra-aortic balloon counterpulsation.12 Complications Reported complications include left heart failure, cardiogenic shock, acute mitral regurgitation, arrhythmias, left ventricular thrombus and left ventricular free wall rupture.6 The prognosis for Takotsubo cardiomyopathy is usually favorable, with an inpatient mortality rate of 1–2%. Though rare, recurrence has medical ICU. Chest 2005;128:296–302. 11. Askashi YJ, Nakazawa K, Sakakibara M, et al. The clinical features of takotsubo cardiomyopathy. Q J Med 2003;96:563–573. 12. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 2005;111:472–479. 13. Parodi G, Del Pace S, Carrabba N, et al. Incidence, clinical findings, and outcomes of women with left ventricular apical ballooning syndrome. Am J Cardiol 2007;99: 182–185. 14. Guttormsen B, Nee L, Makielski JC, Keevil JG. Transient left ventricular apical ballooning: A review of the literature. Wisconsin Medical Journal 2006;105: 49–54. Table 1. Reported Triggers of Takotsubo Cardiomyopathy Unexpected death of a close family member or close family friend; anniversary of the death of a close family member Witnessing an accident; being in an accident; being the victim of a violent crime Loss of job; loss of life savings, being in court Severe arguments Lightening strikes, earthquakes, hypothermia Acute medical illnesses: stroke, epilepsy, pneumothorax, severe pain Surgical procedures: hip surgery, eye surgery, cholecystectomy Source: McCulloch BJ. Transient left ventricular apical ballooning. Crit Care Nurse 2007;27(6):20-27. Table 2. Mayo Clinic Criteria for Takotsubo Cardiomyopathy Transient akinesis or dyskinesis of the left ventricular apical and mid-ventricular segments with regional wall motion abnormalities extending beyond a single epicardial vascular distribution. Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture. New electrocardiographic abnormalities (either ST segment elevation or T wave inversion. Absence of recent significant head trauma, intracranial hemorrhage, pheochromocytoma, obstructive epicardial coronary artery disease, myocarditis, or hypertrophic cardiomyopathy. Source: Bybee KA, Kara T, Prasad A, et al. Systematic review: Transient left ventricular apical ballooning: A syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med 2004;141:858-865. http://modulardevices.com http://modulardevices.com

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Cath Lab Digest - January 2008 Central Baptist Hospital Contrast Media Use in High-Risk Patients An Ergonomic Survey of Cath Lab Repetitive Stress Injuries Contents Clinical Editor’s Corner Takotsubo Cardiomyopathy, a.k.a., Transient Left Ventricular Apical Ballooning Syndrome: An Acute Coronary Syndrome Imposter Searching for the Key to D2B STEMI Intervention News STEMI Interventions: Commentary The Massachusetts Stent Study The Value of Educating Staff Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab SICP* Chapter Updates The Society of Invasive Cardiovascular Professionals Holds an RCIS Review Course at New Cardiovascular Horizons 18:20 To Denver — One Student’s First Clinical Experience CEU Education Center Meetings Calendar What Do You Think? Clinical & Industry News Classifieds The Ten-Minute Interview with…Heather Vardon, RN Advertisers Index

Cath Lab Digest - January 2008

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