1 / 11

The Broken Heart Syndrome

The Broken Heart Syndrome. Primary Care Conference May 30, 2007 Gregory L. Sheehy, M.D. Case Report. AC is a 64 year old woman History of right breast cancer, 1990 s/p mastectomy, chemotherapy and radiation) complicated by recurrent RUE lymphedema/lymphangitis. Type 2 DM HTN

Download Presentation

The Broken Heart Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. The Broken Heart Syndrome Primary Care Conference May 30, 2007 Gregory L. Sheehy, M.D.

  2. Case Report • AC is a 64 year old woman • History of right breast cancer, 1990 • s/p mastectomy, chemotherapy and radiation) complicated by recurrent RUE lymphedema/lymphangitis. • Type 2 DM • HTN • Uric acid nephropathy • Obesity

  3. Case Report-Medications • Glyburide 1.25 mg daily • Metformin 1000 mg bid • Phenoxymethyl penicillin 1000 mg bid • Lisinopril 10/HCTZ 12.5 mg daily • Metoprolol XL 100 mg daily • Gemfibrozil 600 mg bid • Aspirin 81 mg daily • Allopurinol 300 mg daily

  4. Case report-May 26, 2006 • Because of risk factors (age, hypercholesterolemia, hypertension, diabetes, family history) a radionucleotide stress test was performed and was negative

  5. Case report-December 14, 2006 • AC calls office, speaks with triage nurse • Patient is reported to be hysterical, crying, sobbing and begging for a sedative • Her 35 year old son was just found dead in bed • Alprazolam 0.25 mg 1-2 tablets q 8hrs prn called to local pharmacy

  6. Case report- December 15, 2006 • AC awakes from sleep early morning hours with right chest pain • She then develops dyspnea, diaphoresis, lightheadedness • EMS called • On paramedic arrival, patient in acute distress, SBP 70s • Patient transferred to UW ER, vital signs similar, IVF and dopamine initiated

  7. Case report-data • Electrocardiogram revealed mild ST elevation in lateral leads (see copy) • Initial troponin 1.5 (<0.3) with peak of 4.4 approximately 20 hours later • Echocardiogram showed “mild to moderate” reduction in systolic function with a an ejection fraction of 40% and an akinetic apex • Emergency cardiac cath demonstrated diffuse nonocclusive coronary artery disease • Near complete recovery in 48-72 hours

  8. What is “The Broken Heart Syndrome”? • Other names: • Stress induced cardiomyopathy • Transient apical ballooning • Takotsubo Cardiomyopathy • A definition: • “Transient apical left ventricular dysfunction that mimics myocardial infarction, but in the absence of significant coronary artery disease.” UpToDate, 2007

  9. Broken Heart Syndrome • First described in Japan… “Takotsubo” is an octopus trap (see diagram)1 • More common in women than men • Onset typically triggered by an acute medical illness or intense emotional/physical stress (death in the family, domestic abuse, financial catastrophy, natural disaster) 1). Tsuchihashi K et al, J Am Coll Cardiol 2001; 38(1): 11-8

  10. Broken Heart Syndrome • Pathogenesis…still uncertain • Catecholamine excess1 • Coronary artery spasm • Myocardial stunning • “Aborted myocardial infarction” (transient thrombosis and dissolution)2 1).Wittstein et al, NEJM 2005; 352(6): 539-48. 2). Ibanez et al, Mayo Clinic Proceedings, 2006; 81(6): 732-35.

  11. Broken Heart Syndrome • Is this syndrome more common than we realize?1 • The good news- recovery is relatively rapid and complete 1). Park et al. Stress Induced Cardiomyopathy in an ICU, Chest 2005; 128: 296.

More Related