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Broken heart syndrome triggered by an obstructive goiter not associated with thyrotoxicosis.
MedLine Citation:
PMID:  23842757     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Takotsubo cardiomyopathy (TC) is described as transient ventricular dysfunction following emotional or physical trauma. A few reports have described patients with TC in association with various circumstances of thyrotoxicosis. We report an unusual case of TC in a patient with a large retrosternal goiter and normal thyroid function. We speculate that TC was triggered by compromise of tracheal flow induced by the goiter.
CLINICAL FEATURE: A 68-yr-old woman without primary heart disease presented with cardiorespiratory collapse requiring ventilatory and cardiovascular support, including placement of an intra-aortic balloon pump. She was diagnosed with a severe form of TC based on characteristic echocardiography findings and clinical course. Within less than a week, her myocardial function completely normalized. The patient was later found to have a large retrosternal goiter compressing her trachea, though her thyroid function was normal. A total thyroidectomy was eventually performed, and she made a full recovery. Subsequently, the patient was found to have a positive JAK2 mutation for a myeloproliferative disorder.
CONCLUSIONS: Takotsubo cardiomyopathy may be regarded as the final common pathway of cardiac dysfunction triggered by various stress conditions, in this case, a large retrosternal goiter not associated with thyrotoxicosis and likely exacerbated by severe leukocytosis related to a myeloproliferative disorder.
Authors:
Roupen Hatzakorzian; Helen Bui; Thomas Schricker; Steven B Backman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-7-11
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthesie     Volume:  60     ISSN:  1496-8975     ISO Abbreviation:  Can J Anaesth     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-7-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  808-812     Citation Subset:  -    
Affiliation:
Department of Anesthesia and Critical Care, Royal Victoria Hospital, McGill University Health Centre, 687 Pine Avenue West S5.05, Montreal, QC, H3A 1A1, Canada, roupenhatz@hotmail.com.
Vernacular Title:
Syndrome du cœur brisé déclenché par un goitre obstructif non associé à une thyrotoxicose.
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