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{{Stress cardiomyopathy}}
{{Stress cardiomyopathy}}
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{{CMG}}; {{AE}}{{DN}} {{AKK}}


{{SK}} Takotsubo cardiomyopathy; Tako-tsubo syndrome; Left Ventricular Apical Ballooning Syndrome; Ampulla-Shaped Cardiomyopathy; Broken Heart Syndrome; transient apical dysfunction
{{SK}} Takotsubo cardiomyopathy; Tako-tsubo syndrome; left ventricular apical ballooning syndrome; LVABS; ampulla-shaped cardiomyopathy; broken heart syndrome; transient apical dysfunction; stress-induced cardiomyopathy; SIC
== [[Stress cardiomyopathy overview|Overview]] ==
==[[ Stress cardiomyopathy historical perspective| Historical Perspective]]==


== Overview ==
== [[Stress cardiomyopathy classification|Classification]] ==
Stress cardiomyopathy is a cardiac syndrome characterized by a reversible transient apical ventricular dysfunction.


==Diagnosis==
== [[Stress cardiomyopathy pathophysiology|Pathophysiology]] ==


== [[Stress cardiomyopathy causes|Causes]] ==


===Cardiac Catheterization===
== [[Stress cardiomyopathy differential diagnosis|Differentiating Stress Cardiomyopathy from other Diseases]] ==
Coronary angiography usually demonstrates normal coronary arteries or mild coronary atherosclerosis. The left ventriculogram usually reveals characteristic regional wall motion abnormalities which involve the mid and usually the apical segments.  There is sparing of the basal systolic function, and the wall motion abnormality extends beyond the distribution of any one single coronary artery.


[[Image:Takotsubo left ventriculogram.jpg|center|thumb|Left ventriculogram during [[systole]] displaying the characteristic apical ballooning with apical motionlessness in a patient with Takotsubo cardiomyopathy.]]
== [[Stress cardiomyopathy epidemiology and demographics|Epidemiology and Demographics]] ==
==[[Stress cardiomyopathy risk factors | Risk Factors]]==


The diagnosis is made by the pathognomic wall motion abnormalities, in which the base of the left ventricle is contracting normally or are hyperkinetic while the remainder of the left ventricle is akinetic or dyskinetic.  This is accompanied by the lack of significant coronary artery disease that would explain the wall motion abnormalities.
== [[Stress cardiomyopathy natural history, complications and prognosis|Natural History, Complications and Prognosis]] ==


===The Various Patterns of Wall Motion Abnormalities===
== Diagnosis ==
It should be that the wall motion abnormalities are not always anteroapical.
[[Stress cardiomyopathy criteria| Diagnostic Criteria]] |
[[Stress cardiomyopathy history and symptoms|History and Symptoms]] | [[Stress cardiomyopathy physical examination|Physical Examination]] | [[Stress cardiomyopathy laboratory findings|Laboratory Findings]] | [[Stress cardiomyopathy electrocardiogram|Electrocardiogram]] | [[Stress cardiomyopathy chest x ray | Chest X Ray]] | [[Stress cardiomyopathy CT| CT]] | [[Stress cardiomyopathy MRI|MRI]] | [[Stress cardiomyopathy echocardiography or ultrasound|Echocardiography]] | [[Stress cardiomyopathy other imaging findings| Other Imaging Findings]] |  [[Stress cardiomyopathy other diagnostic studies|Other Diagnostic Studies]]


<div align="center">
== Treatment ==
<gallery heights="175" widths="175">
Image:Takotsubo Diagram.jpg|Different end-systolic left ventricular (LV) silhouettes.
</gallery>
</div>
A, <ref>Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol. 2003;41:737-742.</ref>; B, <ref>San Roman Sanchez D, Medina O, Jimenez F, Rodriguez JC, Nieto V. Dynamic intraventricular obstruction in acute myocardial infarction. Echocardiography. 2001;18:515-518.</ref>; C, <ref>Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352:539-548.</ref>; D, <ref>Rivera JM, Locketz AJ, Fritz KD, et al. “Broken heart syndrome” after separation (from OxyContin). Mayo Clin Proc. 2006;81:825-828.</ref>; E, <ref>Desmet WJ, Adriaenssens BF, Dens JA.  Apical ballooning of the left ventricle: first series in white patients. Heart. 2003;89:1027-1031.</ref>; and F, <ref>Reyburn AM, Vaglio JC Jr.  Transient left ventricular apical ballooning syndrome. Mayo Clin Proc. 2006;81:824.</ref>. There is wide heterogeneity among the different patterns, varying from a relatively small akinetic apical area in C to a wide global akinesia in D and E. <ref>Ibanez B. Takotsubo Syndrome: A Bayesian Approach to Interpreting Its Pathogenesis Mayo Clin Proc. 2006; 81: 732-735</ref>


===Mayo Criteria===
[[Stress cardiomyopathy medical therapy|Medical Therapy]] | [[Stress cardiomyopathy surgery|Surgery]] | [[Stress cardiomyopathy primary prevention|Primary Prevention]] | [[Stress cardiomyopathy secondary prevention|Secondary Prevention]] | [[Stress cardiomyopathy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Stress cardiomyopathy future or investigational therapies|Future or Investigational Therapies]]
Mayo Clinic Criteria for Apical Ballooning Syndrome.  All 4 must be present <ref name="pmid17283269">{{cite journal |author=Prasad A |title=Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction |journal=Circulation |volume=115 |issue=5 |pages=e56–9 |year=2007 |pmid=17283269 |doi=10.1161/CIRCULATIONAHA.106.669341}}</ref>:


#Transient hypokinesis, akinesis or dyskinesis of the left ventricular mid-segments with or without apical involvement. The regional wall motion abnormalities extend beyond a single epicardial vascular distribution. A stressful trigger is often, but not always present
== Case Studies ==
#Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture.
#New electrocardiographic abnormalities (either ST-segment elevation and/or T- wave inversion) or modest elevation in cardiac [[troponin]].
#Absence of [[pheochromocytoma]] and [[myocarditis]]


==Treatment==
: [[Stress cardiomyopathy case study one|Case #1]]
The treatment of stress cardiomyopathy is supportive as the condition is reversible.  Initial treatment should be similar to that of an acute coronary syndrome with therapy directed at relieving myocardial ischemia with administration of aspirin, intravenous heparin and [[beta blockers]].  Once a diagnosis of stress cardiomyopathy has been confirmed and an acute coronary syndrome excluded, consideration should be given to continuing beta-blocker therapy empirically since catecholamines are suspected of contributing to the syndrome.  Diuretics are effective for the treatment of congestive heart failure.  [[Angiotensin converting enzyme inhibitors]] may be used if the diagnosis is uncertain, until there is complete recovery of systolic function.  Insofar as the left ventricular function and apical wall motion return to normal within days or weeks, long-term anti-coagulation does not appear to be necessary.


==References==
{{Reflist|2}}
[[de:Stress-Kardiomyopathie]]
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Latest revision as of 16:29, 14 July 2020

Stress cardiomyopathy
Schematic representation of Takotsubo cardiomyopathy (A) compared to the situation in a normal person (B).
ICD-9 429.83
DiseasesDB 33976
MeSH 054549

Stress cardiomyopathy Microchapters

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Overview

Historical Perspective

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Epidemiology and Demographics

Risk Factors

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Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

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CT

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Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

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Cost-Effectiveness of Therapy

Unstable angina/non ST elevation myocardial infarction in Stress (Takotsubo) Cardiomyopathy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2] Arzu Kalayci, M.D. [3]

Synonyms and keywords: Takotsubo cardiomyopathy; Tako-tsubo syndrome; left ventricular apical ballooning syndrome; LVABS; ampulla-shaped cardiomyopathy; broken heart syndrome; transient apical dysfunction; stress-induced cardiomyopathy; SIC

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Stress Cardiomyopathy from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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