Document Detail


Stress induced cardiomyopathy presenting as acute coronary syndrome: Tako-Tsubo in Mercogliano, Southern Italy.
MedLine Citation:
PMID:  17939864     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Tako-tsubo syndrome (TTS) in its typical (apical) and atypical (non-apical) forms is being increasingly recognized in the West owing to early systematic coronary angiography in acute coronary syndromes (ACS). AIM OF THE STUDY: To assess the incidence, the clinical characteristics and the outcome of TTS in a single high volume cath lab in Southern Italy over the last 6 years. METHODS: Among 1674 consecutive patients (pts) referred to our coronary care units in the last 6 years (2001-2006) for ACS we selected 6 (0.5%) pts (6 women; age 57 +/- 6 years) who fulfilled the following 4 criteria: 1) transient left ventricular wall motion abnormalities resulting in ballooning at contrast ventricolographic or echocardiographic evaluation; 2) normal coronary artery on coronary angiography performed 5 +/- 9 hours from hospitalization; 3) new electrocardiographic ischemic-like abnormalities (either ST-segment elevation or T-wave inversion) and 4) emotional or physical trigger event. RESULTS: At admission all pts had presumptive diagnosis of ACS and ECG revealed ST elevation in 3 (50%) and T wave inversion with QT elongation in 3 (50%). In the acute phase cardiogenic shock occurred in 2 (33%) and heart failure in 1(16%). Presenting symptoms were chest pain in 6 (100%), dyspnoea in 2 (33%) and lipotimia in 1 (16%). At echocardiographic-ventricolographic assessment, the mechanical dysfunction (ballooning) was apical in all 6 pts ("classic" TTS). In all patients wall motion abnormalities completely reversed within 4.5 +/- 1.5 days. The region of initial recovery was the anterior and lateral wall in 4 cases and the lateral wall in 2 cases. Ejection fraction was 35 +/- 8% in the acute phase and increased progressively at discharge (55 +/- 6%) and at 41 +/- 20 months follow-up (60 +/- 4%, p < 0.001 vs. baseline). All patients remained asymptomatic with minimal (aspirin, beta blockers, antihypertensive and antidislipidemic therapy) treatment. CONCLUSION: Classic TTS is a frequent serendipitous diagnosis after coronary angiography showed "surprisingly" normal findings in a clinical setting mimicking an ACS. Despite its long-term good prognosis life threatening complications in the acute phase can occur.
Authors:
F Cangella; A Medolla; G De Fazio; C Iuliano; N Curcio; L Salemme; G Mottola; Marco Agrusta
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Publication Detail:
Type:  Journal Article     Date:  2007-10-16
Journal Detail:
Title:  Cardiovascular ultrasound     Volume:  5     ISSN:  1476-7120     ISO Abbreviation:  Cardiovasc Ultrasound     Publication Date:  2007  
Date Detail:
Created Date:  2007-11-29     Completed Date:  2008-01-07     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  101159952     Medline TA:  Cardiovasc Ultrasound     Country:  England    
Other Details:
Languages:  eng     Pagination:  36     Citation Subset:  IM    
Affiliation:
Cardiology Department, Montevergine Cardilogy Clinic, Mercogliano, Italy. f.cangella@libero.it
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Contrast Media
Coronary Angiography
Echocardiography
Electrocardiography
Humans
Incidence
Italy / epidemiology
Middle Aged
Retrospective Studies
Statistics, Nonparametric
Stress, Physiological / complications*,  physiopathology
Takotsubo Cardiomyopathy / epidemiology*,  radiography,  radiotherapy,  ultrasonography
Ventricular Dysfunction, Left / epidemiology,  etiology,  radiography,  ultrasonography
Chemical
Reg. No./Substance:
0/Contrast Media
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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