The therapy is guided by the patient’s clinical presentation and hemodynamic status. [ncbi.nlm.nih.gov]

• Dyspnea

  A 101 years-old woman was admitted to our Emergency Department (ED) for acute dyspnea which onset nearly two hours before presentation. She had been on hydrochlorothyazyde-amiloride therapy due to mild hypertension. [ncbi.nlm.nih.gov]

• Chest Pain

  Our patient had typical substernal chest pain induced with exercise and was relieved by sublingual nitroglycerin in the Emergency Department. The pain started after 2 h of intensive Zumba workout. [ncbi.nlm.nih.gov]

  pain, and st segment elevation A transient left ventricular apical dysfunction or ballooning accompanied by electrocardiographic (ecg) t wave inversions. [icd9data.com]

• Tachycardia

  The day after his SS symptoms disappeared, the patient's blood pressure decreased, and he developed tachycardia. [ncbi.nlm.nih.gov]

  Her tachycardia was diagnosed as the short-coupled variant of idiopathic VF, and an implantable cardioverter defibrillator was implanted. [doi.org]

• Retrosternal Chest Pain

  A 72-year-old woman with asthma attack and retrosternal chest pain was presented to our emergency unit. She had used albuterol spray ten-times before admission due to accentuated dyspnea. [ncbi.nlm.nih.gov]

  Skip to content learn bedside ultrasound, one week at a time This is a 50 year old female who presents with sudden onset retrosternal chest pain that began just after she heard of her sister’s death. [ultrasoundoftheweek.com]

• Systolic Murmur

  On auscultation, there may be a late-peaking systolic murmur due to left ventricular outflow tract obstruction. There also may be symptoms and signs of transient ischemic attack or stroke like presentation due to embolization from apical thrombus. [ncbi.nlm.nih.gov]

  Dynamic left ventricular outflow tract obstruction in acute coronary syndromes: an important cause of new systolic murmur and cardiogenic shock. Mayo Clin Proc. 1999 ; 74 (9): 901 –906. [doi.org]

• Chest Pain Radiating to the Back

  Case 4 A 75-year-old woman was admitted with acute chest pain radiating to her back. This was found to be due to an acute type B localised thoracic aortic dissection. The ECG showed left bundle branch block. Troponin T was 1.2μg/l and CK was 300U/l. [doi.org]

• Ulcer

  A 68-year-old woman with a history of bipolar disorder was admitted to another hospital with a gastric ulcer. [ncbi.nlm.nih.gov]

  Although all patients had less than 50% stenosis on angiograms, intravascular ultrasound showed ulcerated atherosclerotic lesions in each patient’s LAD. [doi.org]

• Hirsutism

  On review of her history, our patient was noted to be taking spironolactone 125 mg once daily for hirsutism for the past year. Our patient denied any family history of cardiac disease or heart failure. [ncbi.nlm.nih.gov]

Workup raised suspicion for non-accidental trauma. Despite progression to brain death, the severely decreased ventricular function and apical akinesis of the left ventricle improved within 40 hours of admission. [ncbi.nlm.nih.gov]

(See Presentation and Workup .) [3] Electrocardiogram of a patient with takotsubo cardiomyopathy demonstrating ST-segment elevation in anterior and inferior leads. [emedicine.medscape.com]

• Right Axis Deviation

  Electrocardiogram showed right axis deviation, poor R-wave progression, and diffuse ST-segment elevation in the anterior leads, and cardiomegaly was observed by roentgenogram. [ncbi.nlm.nih.gov]

  Her admission resting ECG showed right axis deviation, right bundle branch block and widespread deep T wave inversion. Troponin I levels were raised at 4.26μg/l. [doi.org]

• Poor R Wave Progression

  Electrocardiogram showed right axis deviation, poor R-wave progression, and diffuse ST-segment elevation in the anterior leads, and cardiomegaly was observed by roentgenogram. [ncbi.nlm.nih.gov]

  This demonstrates resolution of ST-segment elevation, and now with diffuse T-wave inversion and poor R-wave progression. [emedicine.medscape.com]

• ST Elevation

  Despite this ST elevation persisted; however the coronary angiogram was negative for obstructive coronary artery disease. [ncbi.nlm.nih.gov]

  Clinically it is characterised by the acute onset of chest pain and is associated with ECG changes such as ST elevation, ST depression or deep T wave inversion which mimic an acute coronary syndrome. [doi.org]

• T Wave Abnormality

  abnormalities or Q waves 5 (Figure 5 ⇓ ). [doi.org]

  ST-segment elevation was reported in 81.6% of the patients, T wave abnormalities in 64.3%, and Q waves in 31.8%. Cardiac biomarkers were usually mildly elevated, as reported in 86.2% of the patients. [academic.oup.com]

• Flattened T Wave

  Electrocardiographic findings were as follows: inverted or flattened T waves (100%); QTc prolongation >0.45 seconds (90.0%); ST segment elevation (60.0%); and ST segment depression (20.0%). [ncbi.nlm.nih.gov]

Treatment / Management Since initial presentation of Takotsubo cardiomyopathy is similar to acute coronary syndrome, initial treatment involves aspirin, beta blocker, ACE inhibitor, a lipid-lowering agent, and coronary angiography to rule out obstructive [ncbi.nlm.nih.gov]

[…] infarction (heart attack) ruled out, the aspirin regimen may be discontinued, and treatment becomes that of supporting the patient. [35] While medical treatments are important to address the acute symptoms of takotsubo cardiomyopathy, further treatment [en.wikipedia.org]

Prognosis of takotsubo cardiomyopathy is generally favorable, but serious complications can occur, especially in the early stage. In this review, we summarize the current knowledge on the clinical management of takotsubo cardiomyopathy. [ncbi.nlm.nih.gov]

Prognosis of takotsubo cardiomyopathy is generally favorable, but serious complications can occur, especially in the early stage. [doi.org]

Data on longterm follow-up is pending and further studies will be necessary to clarify the etiology and reach consensus in acute and longterm management of TLVABS. [ncbi.nlm.nih.gov]

Verifica in corso… Pubblicazione: New York : McGraw Hill Education, [2017] ©2017 Edizione/Formato: Libro a stampa : English : Fifty-sixth edition Vedi tutte le edizioni e i formati Sommario: Provides information on the signs, symptoms, epidemiology, etiology [worldcat.org]

"Epidemiology and pathophysiology of Takotsubo syndrome" (PDF). Nature Reviews Cardiology. 12 (7): 387–97. doi : 10.1038/nrcardio.2015.39. PMID 25855605. ^ a b Gianni M, Dentali F, et al. (December 2006). [en.wikipedia.org]

Epidemiology The real incidence of Takotsubo cardiomyopathy is uncertain. [ncbi.nlm.nih.gov]

[…] hyperthyroidism, hypoparathyroidism, pheochromocytoma, hypoglycemia Metabolic disorders Glycogen-storage diseases, carnitine deficiency, fatty acid oxidation defects, mucopolysaccharidoses Malformation syndromes Cri-du-chat (cat-cry) syndrome Viral myocarditis Epidemiologic [emedicine.medscape.com]

The underlying pathophysiological mechanism is still unclear but possible causes have been proposed mainly catecholamine cardiotoxicity, followed by metabolic disturbance, coronary microvascular impairment, and multivessel epicardial coronary artery vasospasm [ncbi.nlm.nih.gov]

The pathophysiology of the disorder remains to be elucidated but may involve catecholamine excess and vasospasm. [doi.org]

Excess catecholamines have been postulated as a contributing mechanism to the disease, therefore, catecholamines were avoided to prevent further myocardial injury. [ncbi.nlm.nih.gov]

Transgender health & disease prevention -- e10. Appendix: Therapeutic drug monitoring & laboratory reference intervals. [worldcat.org]