Stunned Myocardium Syndrome

[Stunned Myocardium Syndrome]

Adriana Martinz1, César Guardia2

1. Obstetricia Crítica, Maternidad del Hospital Santo Tomás; 2. Obstetricia, Maternidad del Hospital Santo Tomás;

Published: 2021-06-30

Abstract

La miocardiopatía por estrés, también conocida como “síndrome de miocardio aturdido” es una disfunción ventricular que simula un infarto agudo del miocardio, pero sin evidencia de coronariopatía obstructiva o ruptura de placa ateromatosa. Generalmente se presenta como consecuencia de situación de estrés, por lo que las complicaciones propias de un embarazo, por ejemplo, un cuadro de shock séptico o una hemorragia post parto, podrían desencadenar esta condición. La presente revisión busca brindar una actualización del tema, así como enfocar el cuadro en la paciente obstétrica en base a la evidencia disponible a la fecha.


Abstract

Stress cardiomyopathy, also known as "stunned myocardial syndrome" is a ventricular dysfunction that simulates an acute myocardial infarction, but without evidence of obstructive coronary artery disease or atheromatous plaque rupture. It generally occurs as a result of a stressful situation, so the complications of a pregnancy, for example, a picture of septic shock or postpartum hemorrhage, could trigger this condition. This review seeks to provide an update on the subject, as well as to focus the picture on the obstetric patient based on the evidence available to date.

References

[1] Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373(10):929–938. doi: 10.1056/NEJMoa1406761.

[2] Minatoguchi M, Itakura A, Takagi E, Nishibayashi M, Kikuchi M, Ishihara O. Takotsubo cardiomyopathy after cesarean: a case report and published work review of pregnancy-related cases. J Obstet Gynaecol Res. 2014;40(6):1534–1539. doi: 10.1111/jog.12437

[3] Sato, H, Taiteishi, et al. Takotsubo-type cardiomyopathy due to multivessel spasm. In: Clinical aspect of myocardial injury: From ischemia to heart failure, Kodama, K, Haze, K, Hon, M (Eds), Kagakuhyouronsha, Tokyo 1990. p.56.

[4] Nayeri A, Rafla-Yuan E, Farber-Eger E, Blair M, Ziaeian B, Cadeiras M, et al. Pre-existing psychiatric illness is associated with increased risk of recurrent Takotsubo cardiomyopathy. Psychosomatics. 2017.

[5] Kakihana, Y., Ito, T., Nakahara, M., Yamaguchi, K., & Yasuda, T. (2016). Sepsis-induced myocardial dysfunction: pathophysiology and management. Journal of Intensive Care, 4(1). doi:10.1186/s40560-016-0148-1

[6] Suzuki T, Nemoto C, Ikegami Y, Yokokawa T, Tsukada Y, Abe Y, et al. Development of Takotsubo cardiomyopathy with severe pulmonary edema before a cesarean section. J Anesth. 2014;28(1):121–124. doi: 10.1007/s00540-013-1677-6

[7] Kurowski V, Kaiser A, von Hof K, Killermann DP, Mayer B, Hartmann F, Schunkert H, Radke PW. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest. 2007 Sep;132(3):809-16. doi: 10.1378/chest.07-0608. Epub 2007 Jun 15. PMID: 17573507.

[8] Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation. 2008 Dec 16;118(25):2754-62. doi: 10.1161/CIRCULATIONAHA.108.767012. PMID: 19106400; PMCID: PMC4893309.

[9] Minatoguchi M, Itakura A, Takagi E, Nishibayashi M, Kikuchi M, Ishihara O. Takotsubo cardiomyopathy after cesarean: a case report and published work review of pregnancy-related cases. J Obstet Gynaecol Res. 2014 Jun;40(6):1534-9. doi: 10.1111/jog.12437. PMID: 24888912.

[10] Amin HZ, Amin LZ, Pradipta A. Takotsubo Cardiomyopathy: A Brief Review. J Med Life. 2020 Jan-Mar;13(1):3-7. doi: 10.25122/jml-2018-0067. PMID: 32341693; PMCID: PMC7175432.

[11] Spinelli L, Trimarco V, Di Marino S, Marino M, Iaccarino G, Trimarco B. L41Q polymorphism of the G protein coupled receptor kinase 5 is associated with left ventricular apical ballooning syndrome. Eur J Heart Fail. 2010 Jan;12(1):13-6. doi: 10.1093/eurjhf/hfp173. PMID: 20023040.

[12] Jeong H, Lee S, Jeong C, Lee J, Jeong S, Chung S, Yoo K. Inverted takotsubo-like left ventricular dysfunction with pulmonary oedema developed after caesarean delivery complicated by massive haemorrhage in a severe preeclamptic parturient with a prolonged painful labour. Case Rep Anesthesiol. 2011;2011:164720. doi: 10.1155/2011/164720. Epub 2011 Dec 26. PMID: 22606381; PMCID: PMC3350152.

[13] Bhattacharyya PJ, Attri PK, Farooqui W. Takotsubo cardiomyopathy in early term pregnancy: a rare cardiac complication of SARS-CoV-2 infection. BMJ Case Rep. 2020 Sep 28;13(9):e239104. doi: 10.1136/bcr-2020-239104. PMID: 32988978; PMCID: PMC7523204.

[14] Oindi FM, Sequeira E, Sequeira HR, Mutiso SK. Takotsubo cardiomyopathy in pregnancy: a case report and literature review. BMC Pregnancy Childbirth. 2019 Mar 12;19(1):89. doi: 10.1186/s12884-019-2233-7. PMID: 30866848; PMCID: PMC6416971.

[15] Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008 Mar;155(3):408-17. doi: 10.1016/j.ahj.2007.11.008. Epub 2008 Jan 31. PMID: 18294473.

[16] Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG. Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA. 2011 Jul 20;306(3):277-86. doi: 10.1001/jama.2011.992. PMID: 21771988.

[17] Arany Z, Elkayam U. Peripartum Cardiomyopathy. Circulation. 2016 Apr 5;133(14):1397-409. doi: 10.1161/CIRCULATIONAHA.115.020491. PMID: 27045128.

[18] Kloner, R. A. (2020). Stunned and Hibernating Myocardium: Where Are We Nearly 4 Decades Later? Journal of the American Heart Association, 9(3). doi:10.1161/jaha.119.015502

[19] Nunes, M. C. P., Beaton, A., Acquatella, H., Bern, C., Bolger, A. F., … Echeverría, L. E. (2018). Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement From the American Heart Association. Circulation, 138(12). doi:10.1161/cir.0000000000000599

[20] Braunwald E, Kloner RA. The stunned myocardium: Prolonged, post-ischemic ventricular dysfunction. Circulation. 1982;66:1146-1149

[21] Rajan Jain , John Deveikis, Byron G Thompson, Management of patients with stunned myocardium associated with subarachnoid hemorrhage, AJNR Am J Neuroradiol 2004 Jan;25(1):126-9

[22] Society of Critical Care Medicine and the European Society of Intensive Care Medicine, Surviving sepsis campaign, Crit Care Med 2017; 45:486–552

[23] Przyklenk K, Kloner RA Calcium antagonists and the stunned myocardium, J Cardiovasc Pharmacol 1991;18 Suppl 10:S93-101.

[24] Przyklenk, K. (2001). Pharmacologic treatment of the stunned myocardium: the concepts and the challenges. Coronary Artery Disease, 12(5), 363–369. doi:10.1097/00019501-200108000-00005

×