Takotsubo cardiomyopathy is a rare and newly described clinical entity characterized by transient left ventricular apical ballooning and left ventricular apical dyskinesis in the absence of angiographic evidence of significant coronary vessel disease found predominantly in post-menopausal women. It was first documented in the USA in 2004, and it has previously been described only in Japanese and Caucasian patients.
A 77-year-old Native Hawaiian woman was admitted to the hospital for severe bradycardia. To the best of our knowledge, this is the first time that normal ventricular function has been documented by echocardiography just prior to the development of the syndrome of transient left ventricular apical ballooning.
Retrospective review of the reported patient's medical record, cardiac angiography and ventriculography, echocardiography, and ECGs.
The patient reported manifested all of the diagnostic criteria for transient left ventricular apical ballooning syndrome proposed by the Mayo Clinic. The finding of normal cardiac morphology and contractility by echocardiography two days prior to diagnosis shows that this syndrome develops rapidly. The case reported here is the first time that transient left ventricular apical ballooning syndrome has been documented in a Native Hawaiian patient in a tropical location, suggesting that transient left ventricular apical ballooning likely occurs across all ethnic and geographical lines.
"The underlying mechanism is unclear, but it seems mainly related to an excess of catecholamine release . Pacemaker implantation even if uncomplicated may be sufficiently stressful in individual patients to precipitate this syndrome as previously described in some cases      . In our patient, as in the previously reported cases, no other perioperative stressful events other than implantation itself were identified that could explain the clinical syndrome, typically characterized by chest pain, ST segment elevation on ECG, transient LV wall motion abnormalities with takotsubo-like shape at ventriculography, slight cardiac enzymes increase, and absence of significant coronary lesions, according to current accepted criteria  . "
[Show abstract][Hide abstract] ABSTRACT: Apical ballooning syndrome, also called takotsubo cardiomyopathy, has been recently reported. It may mimic acute myocardial infarction and is typically observed in postmenopausal women after stressful events. A 75-year-old female after permanent dual chamber pacemaker implant complained of chest pain with repolarization alterations suggesting acute myocardial ischemia. Echocardiography showed a left ventricle with akinesia of the apical portions and reduced global systolic function. The patient was treated with antithrombotic agents and intravenous nitrates. No coronary lesions were found at angiography. At ventriculography, a typical takotsubo-like shape of the left ventricle was observed. The clinical and echocardiographic picture normalized at discharge.
"As described in two prior reports   the patient discussed above represents the development of TTC in the setting of pacemaker placement. This patient had a normal EF and LV wall motion on echocardiogram the morning of the procedure, after which he experienced severe respiratory distress and chest pain post-implantation with a marked decrease in EF and akinesis of the LV apical and inferior walls. "
[Show abstract][Hide abstract] ABSTRACT: Left apical ballooning syndrome, also known as Takotsubo cardiomyopathy (TTC), characterized by transient left ventricular dysfunction is increasingly recognized worldwide. Predominantly affecting females, this condition mimics myocardial infarction and often occurs in the setting of emotional or physical stress. We report the case of a 77-year-old male who was admitted to the hospital for complete heart block and developed TTC after pacemaker implantation. To our knowledge, this is the first report of TTC development after pacemaker implantation in a male.
Journal of Cardiology Cases 06/2011; 3(3). DOI:10.1016/j.jccase.2011.03.001
[Show abstract][Hide abstract] ABSTRACT: A 78-year-old woman presented to our emergency room because of complete atrioventricular block. The patient experienced significant psychophysical stress during pacemaker implantation due to fear of operation. Acute lung edema occurred four hours after permanent pacemaker implantation. Coronary angiography showed no significant coronary artery stenosis and left ventriculography revealed typical abnormal wall motion of takotsubo cardiomyopathy. Three weeks later, follow-up echocardiography showed recovery of left ventricular wall motion abnormality. This case demonstrates that cardiologists should include takotsubo cardiomyopathy in the list of potential complications of permanent pacemaker implantation, especially in postmenopausal women.
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