Takotsubo syndrome

Cardiovascular Takotsubo cardiomyopathy [SEDA-33, 313] has been described after local application of adrenaline during nasal surgery in two cases cardiovascular MRI scans showed myocardial vasodilatation, capillary leak, and regional edema [1" ]. Reports linking takotsubo syndrome to the use of adrenaline during anaphylaxis have been reviewed... 

Indirect effects of drugs on catecholamines have ako resulted in takotsubo syndrome. In one case there was transient typical ballooning of the left ventricular apex during systole following the use of cocaine, thought to have been due to inhibition of catecholamine reuptake [22ft]. A 43-year-old woman who took an overdose of venlafaxine, an inhibitor of serotonin and noradrenaline reuptake, developed a takotsubo cardiomyopathy and there was an increase in urinary normetadrenaline (normetanephrine) concentration [23 ]. 

Catecholamines do not improve function in the apical ballooning syndrome and may make it worse. In 11 patients cm infusion of low-dose dobutamine did not improve the akinetic wcdl motion, despite the hypercontractile basal left ventricular wcdl, and despite the fact that the syndrome is reversible [29 ]. In other cases, takotsubo syndrome was worsened by infusion of catecholamines (in one case adrenaline, dobutamine, and noradrenaline and in another dopamine) and improved when the catecholamines were withdrawn [30, 31 ] beta-blockade was beneficial... 

Volz HC, Erbel C, Berentelg J, Katus HA, Frey N. Reversible left ventricular dysfunction resembling Takotsubo syndrome after self-injection of adrenaline. Can J Cardiol 2009 25(7) e261-2. 

Margey R, Diamond P, McCann H, Sugrue D. Dobutamine stress echo-induced apical ballooning (takotsubo) syndrome. Eur J Echocardiogr 2009 10(3) 395-9. 

Vasconcelos Filho FJ, Gomes CA, Queiroz OA, Barreto JE. Dobutamine stress echocardiography-induced broken heart syndrome (takotsubo syndrome). Arq Bras Cardiol 2009 93(1) e5-7. 

Mid-ventricular takotsubo syndrome (see also p. 313) has also been described in a 75-year-old woman taking anagrelide [139" ]. The authors hypothesized that accumulation of anagrelide, a phosphodiesterase type II inhibitor, had caused major inotropic stimulation and sympathetic hyperactivation in a vulnerable myocardium. 

Kajander OA, Virtanen MP, Sclarovsky S, Nikus KC. Iatrogenic inverted takotsubo syndrome following intravenous adrenaline itq ections for an allergic reaction. Int J Cardiol 2013 165(l) e3-5. 

Cardiovascular Takotsubo cardiomyopathy [SEDA-33, 313] has been attributed to high-dose dopamine in a 78-year-old woman who had acute coronary syndrome. Her blood pressure was low and the intraventricular pressure was high during dopamine infusion she improved when the dopamine was gradually withdrawn and carvedilol was added [60" ]. 

Stress cardiomyopathy (takotsubo cardiomyopathy, broken heart syndrome , or gebrochenes Herz Syndrom ) was first described in Japan in the early 1990s [E] and has been reviewed [2 ]. Tako tsubo means octopus trap in Japanese. 

Litvinov IV, Kotowycz MA, Wassmann S. Iatrogenic epinephrine-induced reverse Takotsubo cardiomyopathy direct evidence supporting the role of catecholamines in the pathophysiology of the broken heart syndrome Clin Res Cardiol 2009 98(7) 457-62. 

Shah BN, Simpson lA, Rakhit DJ. Takotsubo (apical ballooning) syndrome in the recovery period following dobutamine stress echocardiography a first report. Eur J Echocardiogr 2011 12(1) E5. 

Drug withdrawal Transient left ventricular ballooning syndrome (takotsubo cardiomyopathy) occurs mostly in post-menopausal women in response to stressful events and beta-blockers are used to treat it. Abrupt withdrawal of beta-blockade can result in a hyperadrenergic syndrome that can lead to takotsubo cardiomyopathy, even in the absence of a stressful precipitating event [14 ]. 

Soufras GD, Kounis NG. Adrenaline administration for anaphylaxis and the risk of takotsubo and Kounis syndrome. Int J Cardiol 2013 166(2) 281-2. 

Cardiovascular A 64-year-old woman treated for macular degeneration with intraocular injections of bevacizumab presented with chest pain, nausea and vomiting. After an initial diagnosis of acute coronary syndrome and anticoagulation treatment with intravenous heparin, she remained stable without chest pain or shortness of breath and with no evidence of arrhythmias. This may be the first report of an association between intraocular bevacizumab and reversible myocardial dysfunction with a pattern similar to stress-induced cardiomyopathy (also called Takotsubo cardiomyopathy or apical ballooning), although clear evidence for a causal relationship is lacking [97 ]. 

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