Takotsubo cardiomyopathy - Revision history

Rossdonaldson1: /* External Links */

2023-10-18T15:32:57Z

External Links

← Older revision		Revision as of 15:32, 18 October 2023
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	==External Links==		==External Links==
	[[Cardiomyopathy (Main)]]		*[[Cardiomyopathy (Main)]]

	==References==		==References==

Cmb23: /* Management */

2023-10-08T21:46:23Z

Management

← Older revision		Revision as of 21:46, 8 October 2023
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	*Management of differs from usual [[cardiogenic shock]]<ref>Masoud H. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management. International Cardiovascular Forum Journal. 2016; 5:33-35.</ref>		*Management of differs from usual [[cardiogenic shock]]<ref>Masoud H. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management. International Cardiovascular Forum Journal. 2016; 5:33-35.</ref>
	**[[IVF]]		**[[IVF]]
	**With LVOT obstruction, avoid volume depletion and vasodilator therapy (similar to [[hypertrophic cardiomyopathy]] management)		**With LVOT obstruction, avoid volume depletion and vasodilator therapy such as nitroglycerine (similar to [[hypertrophic cardiomyopathy]] management)
	**~~Avoid use of catecholamine based inotropic meds~~		**Inotropic medications may worsen hypotension whereas pure vasoconstriction with phenylephrine can improve MAPs
	**Consider [[beta blockers]] and [[ACE inhibitors]], which reduce recurrence		**Consider [[beta blockers]] and [[ACE inhibitors]], which reduce recurrence
	**Intra-aortic balloon pump or [[ECMO]] in refractory cases		**Intra-aortic balloon pump or [[ECMO]] in refractory cases

ClaireLewis: /* Clinical Features */

2019-09-26T17:05:44Z

Clinical Features

← Older revision		Revision as of 17:05, 26 September 2019
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	==Clinical Features==		==Clinical Features==
	*Mimics [[Acute ~~Coronary Syndrome~~]]		*Mimics [[Acute coronary syndrome]]
	*[[Chest ~~Pain~~]]		*[[Chest pain]]
	*[[Dyspnea]]		*[[Dyspnea]]
	*[[Cardiogenic ~~Shock~~]] and sudden [[CHF]]		*[[Cardiogenic shock]] and sudden [[CHF]]
	*Lethal [[arrhythmia]] (e.g. [[VTach]]/[[VF]], [[PEA]])		*Lethal [[arrhythmia]] (e.g. [[VTach]]/[[VF]], [[PEA]])

ClaireLewis at 17:05, 26 September 2019

2019-09-26T17:05:23Z

← Older revision		Revision as of 17:05, 26 September 2019
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	==Clinical Features==		==Clinical Features==
	*Mimics [[Acute Coronary Syndrome]]		*Mimics [[Acute Coronary Syndrome]]
	*Chest Pain		*[[Chest Pain]]
	*Dyspnea		*[[Dyspnea]]
	*[[Cardiogenic Shock]] and sudden [[CHF]]		*[[Cardiogenic Shock]] and sudden [[CHF]]
	*Lethal arrhythmia (e.g. VT/VF, PEA)		*Lethal [[arrhythmia]] (e.g. [[VTach]]/[[VF]], [[PEA]])

	==Differential Diagnosis==		==Differential Diagnosis==
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	**May mimic STEMI		**May mimic STEMI
	**Frequently affects the anterior distribution and to a lesser extent inferior distribution		**Frequently affects the anterior distribution and to a lesser extent inferior distribution
	*~~Echocardiogram~~		*[[Echocardiography]]
	**Systolic Dysfunction (with ejection fraction dropping from normal to <25-35%)		**Systolic Dysfunction (with ejection fraction dropping from normal to <25-35%)
	**Reduced contractility not explained by single vessel disease		**Reduced contractility not explained by single vessel disease
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	==Management==		==Management==
	*Treat as STEMI until ruled out		*Treat as STEMI until ruled out
	*Anticoagulation may be required until wall motion abnormalities resolve		*[[Anticoagulation]] may be required until wall motion abnormalities resolve
	*Monitor QTc intervals and arrhythmias		*Monitor QTc intervals and arrhythmias
	**Stop all QT prolonging drugs		**Stop all QT prolonging drugs
	**~~Replace~~ magnesium ~~levels~~		**Replete [[magnesium sulfate\|magnesium]]
	*Management of differs from usual [[cardiogenic shock]]<ref>Masoud H. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management. International Cardiovascular Forum Journal. 2016; 5:33-35.</ref>		*Management of differs from usual [[cardiogenic shock]]<ref>Masoud H. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management. International Cardiovascular Forum Journal. 2016; 5:33-35.</ref>
	**IVF		**[[IVF]]
	**With LVOT obstruction, avoid volume depletion and vasodilator therapy (similar to [[hypertrophic cardiomyopathy]] management)		**With LVOT obstruction, avoid volume depletion and vasodilator therapy (similar to [[hypertrophic cardiomyopathy]] management)
	**Avoid use of catecholamine based inotropic meds		**Avoid use of catecholamine based inotropic meds
	**Consider ~~Beta Blockers~~ and ACE ~~Inhibitors~~, which reduce recurrence		**Consider [[beta blockers]] and [[ACE inhibitors]], which reduce recurrence
	**Intra-aortic balloon pump or ECMO in refractory cases		**Intra-aortic balloon pump or [[ECMO]] in refractory cases

	==Prognosis==		==Prognosis==

Rossdonaldson1: Text replacement - "Troponin" to "Troponin"

2019-07-01T21:11:53Z

Text replacement - "*Troponin" to "*Troponin"

← Older revision		Revision as of 21:11, 1 July 2019
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	==Evaluation==		==Evaluation==
	[[File:Takotsubo ventriculography.gif\|thumbnail\|LV apical ballooning during systole]]		[[File:Takotsubo ventriculography.gif\|thumbnail\|LV apical ballooning during systole]]
	*Troponin may elevated or normal, but not usually as high as with traditional STEMI		*[[Troponin]] may elevated or normal, but not usually as high as with traditional STEMI
	*[[ECG]]		*[[ECG]]
	**May mimic STEMI		**May mimic STEMI

SLuckettG: /* Evaluation */

2019-02-28T00:33:46Z

Evaluation

← Older revision		Revision as of 00:33, 28 February 2019
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	==Evaluation==		==Evaluation==
	[[File:Takotsubo ventriculography.gif\|thumbnail\|LV apical ballooning during systole]]		[[File:Takotsubo ventriculography.gif\|thumbnail\|LV apical ballooning during systole]]
	*Troponin ~~frequently~~ elevated		*Troponin may elevated or normal, but not usually as high as with traditional STEMI
	*[[ECG]]		*[[ECG]]
	**May mimic STEMI		**May mimic STEMI

SLuckettG: /* Background */

2019-02-28T00:32:38Z

Background

← Older revision		Revision as of 00:32, 28 February 2019
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	*AKA transient apical ballooning syndrome or stress-induced cardiomyopathy		*AKA transient apical ballooning syndrome or stress-induced cardiomyopathy
	*Bulging out of LV apex with preserved function of the base looks like an octopus pot or "tako tsubo" in Japanese		*Bulging out of LV apex with preserved function of the base looks like an octopus pot or "tako tsubo" in Japanese
			**Recent recognition of additional subtypes: reverse Takotsubo (basal ballooning), mid-ventricular type, localized type
	*85% of cases caused by stressful event before symptoms (death of loved one, fear, argument, asthma, surgery, stroke, etc.)<ref> Sharkey, S., Lesser, J., & Maron, B. (2011). Takotsubo (stress) cardiomyopathy. American Heart Association.</ref>		*85% of cases caused by stressful event before symptoms (death of loved one, fear, argument, asthma, surgery, stroke, etc.)<ref> Sharkey, S., Lesser, J., & Maron, B. (2011). Takotsubo (stress) cardiomyopathy. American Heart Association.</ref>
	**Proposed mechanisms include vasospasm and abnormal response to catecholamine surge		**Proposed mechanisms include vasospasm, microvascular dysfunction, and abnormal myocyte response to catecholamine surge
	**As high as 28% in ICU patients due to severe physical stress<ref>Park JH, Kang SJ, Song JK, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest 2005;128:296-302.</ref>		**As high as 28% in ICU patients due to severe physical stress<ref>Park JH, Kang SJ, Song JK, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest 2005;128:296-302.</ref>

SLuckettG: /* Prognosis */

2019-02-28T00:28:21Z

Prognosis

← Older revision		Revision as of 00:28, 28 February 2019
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	==Prognosis==		==Prognosis==
	Ejection Fraction returns to normal (at least >50%) in nearly all cases		*Ejection Fraction returns to normal (at least >50%) in nearly all cases
			*Some patients experience recurrence

	==Disposition==		==Disposition==

Bobzmac at 20:34, 7 January 2018

2018-01-07T20:34:12Z

← Older revision		Revision as of 20:34, 7 January 2018
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	**Reduced contractility not explained by single vessel disease		**Reduced contractility not explained by single vessel disease
	**Apical Ballooning on US		**Apical Ballooning on US
	[[File:apicalballooning.gif\|thumbnail\|[http://www.thepocusatlas.com/~~echocardiography~~/ ~~Apical Ballooning]~~]]		[[File:apicalballooning.gif\|thumbnail\|Apical Ballooning<ref>http://www.thepocusatlas.com/left-ventricle-1</ref>]]

	*Ventriculography		*Ventriculography

Bobzmac: /* Evaluation */

2017-10-25T01:41:07Z