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Cardiac stunning

Shams Y-Hassan, Rodney De Palma
Takotsubo syndrome (TS), an increasingly recognized acute cardiac disease entity, is characterized by a unique pattern of circumferential and typically regional left ventricular wall motion abnormality resulting in a conspicuous transient ballooning of the left ventricle during systole. The mechanism of the disease remains elusive. However, the sudden onset of acute myocardial stunning in a systematic pattern extending beyond a coronary artery territory; the history of a preceding emotional or physical stress factor in two thirds of cases; the signs of sympathetic denervation at the regions of left ventricular dysfunction on sympathetic scintigraphy; the finding of myocardial edema and other signs consistent with (catecholamine-induced) myocarditis shown by cardiac magnetic resonance imaging; and the contraction band necrosis on histopathological examination all argue strongly for the involvement of the cardiac sympathetic nervous system in the pathogenesis of TS...
November 9, 2016: International Journal of Cardiology
Helen J Jefferies, Risto Tertti, Saara Wittfooth, James O Burton, Kaj Metsärinne, Kim Pettersson, Christopher W McIntyre
Introduction Repetitive dialysis-induced cardiac injury is associated with elevated troponin levels, inflammation, and longitudinal reduction in cardiac function. Pathogenic autoantibodies to cardiac troponins (cTnAAb) produce inflammatory cardiomyopathy in murine models. This study aimed to explore the possibility that analogous autoimmune processes might occur in hemodialysis (HD) patients, by initially investigating cTnAAb prevalence, and exploring potential links with HD-induced myocardial stunning. Methods In 130 prevalent HD patients from two centers (Derby, UK; Turku, Finland), cTnAAb (immunoassay) and cardiac troponins were quantified...
November 20, 2016: Hemodialysis International
Jose A Morfin, Richard J Fluck, Eric D Weinhandl, Sheru Kansal, Peter A McCullough, Paul Komenda
Hemodialysis (HD) treatment can be difficult to tolerate. Common complications are intradialytic hypotension (IDH) and long time to recovery after an HD session. IDH, as defined by nadir systolic blood pressure < 90mmHg and intradialytic decline > 30mmHg, occurs in almost 8% of HD sessions. IDH may be caused by aggressive ultrafiltration in response to interdialytic weight gain, can lead to myocardial stunning and cardiac arrhythmias, and is associated with increased risk for death. Long recovery time after a treatment session is also common...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Mélanie Girardey, Laurence Jesel, Umberto Campia, Nathan Messas, Sébastien Hess, Alessio Imperiale, Cyrille Blondet, Annie Trinh, Patrick Ohlmann, Olivier Morel
BACKGROUND: Although the relationship between malignancies and catecholamine-induced myocardial stunning remains largely speculative, it has been suggested that the presence of cancer may lower the threshold for stress stimuli and/or may aggravate cardiac adrenoreceptor sensitivity. We sought to investigate whether associations exist between a previous or current diagnosis of malignancy, diagnostic parameters during hospitalization and death in takotsubo. METHODS AND RESULTS: The 154 takotsubo patients were retrospectively identified between May 2008 and December 2014...
September 23, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Riccardo Ieva, Graziapia Casavecchia, Matteo Gravina, Antonio Totaro, Armando Ferraretti, Luca Macarini, Matteo Di Biase, Natale Daniele Brunetti
BACKGROUND: The presence of viable stunned myocardium recovering after primary angioplasty is not easy to identify in the early phase of acute myocardial infarction (AMI) by noninvasive bed-side methods. We therefore aimed to assess whether a simple electrocardiogram parameter may be of help in identifying the presence of stunned viable myocardium recovering after reperfusion with primary angioplasty. MATERIALS AND METHODS: A total of 14 consecutive patients with ST-elevation AMI (STEMI) were enrolled in the study and underwent QT duration assessment after admission: the difference between QT corrected (QTc) in the ischaemic areas and QTc values in nonischaemic areas was therefore calculated and compared with the presence and the extension of viable stunned myocardium, assessed by comparing akinetic/dyskinetic areas at admission echocardiography with akinetic/dyskinetic areas and extension of scar at 6-month cardiac magnetic resonance imaging (cMRI)...
October 2016: European Journal of Clinical Investigation
Jessica J Geer, Shweta Shah, Eric Williams, Ayse Akcan Arikan, Poyyapakkam Srivaths
BACKGROUND: Intradialytic hypotension and myocardial stunning are proposed as contributing to the pathogenesis of increased cardiovascular disease burden and death in patients receiving maintenance hemodialysis (HD). Noninvasive cardiac output measurements provide a dynamic, real-time assessment of hemodynamic parameters. We investigated intradialytic changes in hemodynamic parameters in pediatric outpatients receiving chronic HD and determined patient and treatment risk factors associated with such intradialytic changes...
August 23, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Shams Y-Hassan
Heart failure and cardiovascular death are common in patients with chronic kidney disease (CKD) and extremely prevalent in patients undergoing dialysis. It has been shown that the excess of cardiovascular mortality in this patient population is not fully accounted for by the traditional cardiovascular risk factors. Substantial evidence exists for the presence of sympathetic over-activity in patients with dialytic and non-dialytic CKD. Several studies have also been reported on reversible segmental left ventricular wall motion abnormality consistent with myocardial stunning in association with dialysis especially hemodialysis...
November 1, 2016: International Journal of Cardiology
K A Popugaev, A Yu Lubnin, M V Zabelin, A S Samoylov
The autonomic nervous system (ANS) provides homeostasis due to the innervation of the secretory glands, smooth muscle and cardiac muscle. Higher centers of the ANS (primarily the hypothalamus, some centers of the brain stem and limbic system) form a integrative network, which plays a key role in coordinating the functioning of the endocrine, immune system and other parts of the central nervous system. Intracranial centers of the ANS are responsible for the consciousness, behavioral, emotional, and other components of the higher nervous activity...
March 2016: Anesteziologiia i Reanimatologiia
Hernán David Mejía-Rentería, Iván J Núñez-Gil
Takotsubo cardiomyopathy is a syndrome mimicking an acute myocardial infarction in absence of obstructive epicardial coronary artery disease to explain the degree of the wall motion abnormalities. Typically more common in the elderly women, this condition is usually triggered by unexpected emotional or physical stress situations, and is associated with electrocardiogram abnormalities and slight elevation of cardiac biomarkers. The pathophysiological mechanism is not clear yet, but it is believed that a high circulating concentration of catecholamines causes an acute dysfunction of the coronary microcirculation and metabolism of cardiomyocytes, leading to a transient myocardial stunning...
July 26, 2016: World Journal of Cardiology
Tiziano Cassina, Alessandro Putzu, Luisa Santambrogio, Michele Villa, Marc Joseph Licker
BACKGROUND: Active mobilization is a key component in fast-track surgical strategies. Following major surgery, clinicians are often reluctant to mobilize patients arguing that circulatory homeostasis would be impaired as a result of myocardial stunning, fluid shift, and autonomic dysfunction. AIMS: We examined the feasibility and safety of a mobilization protocol 12-24 h after elective cardiac surgery. SETTING AND DESIGN: This observational study was performed in a tertiary nonacademic cardiovascular Intensive Care Unit...
July 2016: Annals of Cardiac Anaesthesia
J E Martin, K Christensen, Y Vizzier-Thaxton, D E F McKeegan
Low atmospheric pressure stunning (LAPS) is a novel approach to poultry stunning involving the application of gradual decompression lasting 280 s according to a prescribed pressure curve. The aim of this study was to determine how behavioural, electroencephalogram (EEG) and electrocardiogram (ECG) responses to LAPS are influenced by illumination of the decompression chamber. A secondary aim was to examine responses to the decompression chamber without LAPS being applied, as such a "sham" control has been absent in previous studies...
October 2016: British Poultry Science
Sang Kim, Samuel DeMaria, Edmond Cohen, George Silvay, Jeron Zerillo
We report the case of successful resuscitation after prolonged cardiac arrest during orthotopic liver transplantation. After reperfusion, the patient developed ventricular tachycardia, complicated by intracardiac clot formation and massive hemorrhage. Transesophageal echocardiography demonstrated stunned and nonfunctioning right and left ventricles, with developing intracardiac clots. Treatment with heparin, massive transfusion and prolonged cardiopulmonary resuscitation ensued for 51 minutes. Serial arterial blood gases demonstrated adequate oxygenation and ventilation during cardiopulmonary resuscitation...
September 2016: Seminars in Cardiothoracic and Vascular Anesthesia
Markku S Nieminen, Michael Buerke, Alain Cohen-Solál, Susana Costa, István Édes, Alexey Erlikh, Fatima Franco, Charles Gibson, Vojka Gorjup, Fabio Guarracino, Finn Gustafsson, Veli-Pekka Harjola, Trygve Husebye, Kristjan Karason, Igor Katsytadze, Sundeep Kaul, Matti Kivikko, Giancarlo Marenzi, Josep Masip, Simon Matskeplishvili, Alexandre Mebazaa, Jacob E Møller, Jadwiga Nessler, Bohdan Nessler, Argyrios Ntalianis, Fabrizio Oliva, Emel Pichler-Cetin, Pentti Põder, Alejandro Recio-Mayoral, Steffen Rex, Richard Rokyta, Ruth H Strasser, Endre Zima, Piero Pollesello
Acute heart failure and/or cardiogenic shock are frequently triggered by ischemic coronary events. Yet, there is a paucity of randomized data on the management of patients with heart failure complicating acute coronary syndrome, as acute coronary syndrome and cardiogenic shock have frequently been defined as exclusion criteria in trials and registries. As a consequence, guideline recommendations are mostly driven by observational studies, even though these patients have a particularly poor prognosis compared to heart failure patients without signs of coronary artery disease...
September 1, 2016: International Journal of Cardiology
Petter Schiller, Per Vikholm, Laila Hellgren
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has experienced an increased use in acute cardiac failure. There are some reports on negative effects of VA-ECMO on cardiac function, such as left ventricular (LV) dilatation and cardiac stun, but the support in the literature is scarce. This study investigates the effects of experimental VA-ECMO on LV function in both peripheral and central cannulation. Ten pigs were randomized to VA-ECMO by either peripheral cannulation through the femoral vessels or central cannulation in the right atrium and ascending aorta...
September 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Joana Faleiro Oliveira, Susana Rebelo Pacheco, Marta Moniz, Pedro Nunes, Clara Abadesso, Mónica Rebelo, Helena Loureiro, Helena Almeida
Takotsubo syndrome (TTS) is an acquired transient type of systolic dysfunction which mimics myocardial infarction clinically and electrocardiographically. TTS is also known as stress cardiomyopathy, broken heart syndrome, apical ballooning, reversible acute heart failure, neurogenic stunned myocardium or acute catecholamine cardiomyopathy. This case report describes an uncommon presentation of myocardial stunning after an anesthetic procedure. A 14-year-old girl with a history of pineal cyst and hemiplegic migraine was admitted for control brain magnetic resonance imaging...
June 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Meng-Ta Tsai, Wei-Chuan Tsai, Jun-Neng Roan, Chwan-Yau Luo
UNLABELLED: It is an unfortunate fact that pacing-induced heart failure after cardiac surgery is frequently ignored by medical professionals. A 60-year-old woman with chronic atrial fibrillation with a single-lead right ventricular permanent pacemaker for a prolonged ventricular pause underwent mitral valve replacement 6 months later for severe stenosis (NYHA functional class III). The patient's pacing rate was increased from the preoperative level of 60 beats per minute (bpm) to 70 bpm in order to facilitate weaning from the cardiopulmonary bypass...
July 2015: Acta Cardiologica Sinica
Jessica E Martin, Karen Christensen, Yvonne Vizzier-Thaxton, Malcolm A Mitchell, Dorothy E F McKeegan
A novel approach to pre-slaughter stunning of chickens has been developed in which birds are rendered unconscious by progressive hypobaric hypoxia. Termed Low Atmospheric Pressure Stunning (LAPS), this approach involves application of gradual decompression lasting 280s according to a prescribed curve. We examined responses to LAPS by recording behaviour, electroencephalogram (EEG) and electrocardiogram (ECG) in individual male chickens, and interpreted these with regard to the welfare impact of the process...
September 1, 2016: Physiology & Behavior
Virginia Perez, Veronica D'Annunzio, Laura B Valdez, Tamara Zaobornyj, Silvina Bombicino, Tamara Mazo, Nadia Longo Carbajosa, Mariela M Gironacci, Alberto Boveris, Junichi Sadoshima, Ricardo J Gelpi
AIM: We evaluated the effect of thioredoxin1 (Trx1) system on postischemic ventricular and mitochondrial dysfunction using transgenic mice overexpressing cardiac Trx1 and a dominant negative (DN-Trx1) mutant (C32S/C35S) of Trx1. Langendorff-perfused hearts were subjected to 15 min of ischemia followed by 30 min of reperfusion (R). We measured left ventricular developed pressure (LVDP, mmHg), left ventricular end diastolic pressure (LVEDP, mmHg), and t63 (relaxation index, msec). Mitochondrial respiration, SERCA2a, phospholamban (PLB), and phospholamban phosphorylation (p-PLB) Thr17 expression (Western blot) were also evaluated...
July 10, 2016: Antioxidants & Redox Signaling
Max J Hilz
Autonomic dysfunction is common but frequently overlooked in multiple sclerosis (MS) patients. The case of a Tako-Tsubo cardiomyopathy on which this commentary is based shows that centrally triggered autonomic dysfunction may be the first life-threatening manifestation of MS.
May 2016: Multiple Sclerosis: Clinical and Laboratory Research
Jennifer E Gilda, Qian Xu, Margaret E Martinez, Susan T Nguyen, P Bryant Chase, Aldrin V Gomes
The C-terminal region of cardiac troponin I (cTnI) is known to be important in cardiac function, as removal of the last 17 C-terminal residues of human cTnI has been associated with myocardial stunning. To investigate the C-terminal region of cTnI, three C-terminal deletion mutations in human cTnI were generated: Δ1 (deletion of residue 210), Δ3 (deletion of residues 208-210), and Δ5 (deletion of residues 206-210). Mammalian two-hybrid studies showed that the interactions between cTnI mutants and cardiac troponin C (cTnC) or cardiac troponin T (cTnT) were impaired in Δ3 and Δ5 mutants when compared to wild-type cTnI...
July 1, 2016: Archives of Biochemistry and Biophysics
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