International Journal of Cardiology 176 (2014) e101
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Association between chronic obstructive pulmonary disease and tako tsubo cardiomyopathy — A case report S. Peters St. Elisabeth Hospital Salzgitter, Liebenhaller Str. 20, 38259 Salzgitter, Germany
a r t i c l e
i n f o
Article history: Received 11 July 2014 Accepted 27 July 2014 Available online 4 August 2014 Keywords: Chronic obstructive pulmonary disease Tako tsubo cardiomyopathy Apical ballooning Cortisol
A 72-years-old female patient with known chronic obstructive lung disease was admitted to a hospital with progressive dyspnoea and angina since eight weeks. Exacerbated chronic obstructive pulmonary disease was supposed. In the ECG sinus rhythm and progressive loss of R wave amplitude in precordial leads were evident. Transthoracic echocardiography revealed akinesia of the apical region of the left ventricle and reduced left ventricular function. Laboratory findings revealed isolated troponin enzyme rise. Coronary angiography evidenced normal coronary arteries and apical ballooning of the left ventricle with reduction of left ventricular function (EF 42%). In addition to bronchorelaxation a therapy with aspirin, ramipril, low-dose betablocker and spironolacton was initiated. After a week with cardioprotective therapy the control echocardiography revealed
E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2014.07.255 0167-5273/© 2014 Published by Elsevier Ireland Ltd.
an almost complete normalisation of left ventricular function and a relief of dyspnoea. An association of tako tsubo cardiomyopathy and chronic obstructive pulmonary disease is described in the literature [1]. Exacerbated chronic obstructive lung disease leads to stress-related cardiomyopathy and an increase of dyspnoea and angina equivalent to the use of increasing doses of β2 agonists. The inhibitory influence of cortisol on catecholamine release together with stress response, personality and psychiatric profile must be postulated in developing tako tsubo cardiomyopathy [2]. The patient was advised to continue cardioprotective medication for 3 up to 6 months and when to stop aldosteron antagonist bearing the risk of hyperkalemia. The combination of ACE inhibitor, anti platelet therapy and low-dose beta blocker should be continued in fear of recurrent episodes of tako tsubo cardiomyopathy with chronic respiratory disease. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] Manfredini R, Fabbian F, Giorgi AD, et al. Heart and lung, a dangerous liaison — takotsubo cardiomyopathy and respiratory diseases: a systematic review. World J Cardiol 2014;6:338–44. [2] Kastaun S, Schwarz NP, Juenemann M, et al. Cortisol awakening and stress response, personality and psychiatric profiles in patients with takotsubo cardiomyopathy. Heart 2014. http://dx.doi.org/10.1136/heartjnl-2014-305745.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Association between chronic obstructive pulmonary disease and tako tsubo cardiomyopathy — A case report S. Peters St. Elisabeth Hospital Salzgitter, Liebenhaller Str. 20, 38259 Salzgitter, Germany
a r t i c l e
i n f o
Article history: Received 11 July 2014 Accepted 27 July 2014 Available online 4 August 2014 Keywords: Chronic obstructive pulmonary disease Tako tsubo cardiomyopathy Apical ballooning Cortisol
A 72-years-old female patient with known chronic obstructive lung disease was admitted to a hospital with progressive dyspnoea and angina since eight weeks. Exacerbated chronic obstructive pulmonary disease was supposed. In the ECG sinus rhythm and progressive loss of R wave amplitude in precordial leads were evident. Transthoracic echocardiography revealed akinesia of the apical region of the left ventricle and reduced left ventricular function. Laboratory findings revealed isolated troponin enzyme rise. Coronary angiography evidenced normal coronary arteries and apical ballooning of the left ventricle with reduction of left ventricular function (EF 42%). In addition to bronchorelaxation a therapy with aspirin, ramipril, low-dose betablocker and spironolacton was initiated. After a week with cardioprotective therapy the control echocardiography revealed
E-mail address: [email protected].
http://dx.doi.org/10.1016/j.ijcard.2014.07.255 0167-5273/© 2014 Published by Elsevier Ireland Ltd.
an almost complete normalisation of left ventricular function and a relief of dyspnoea. An association of tako tsubo cardiomyopathy and chronic obstructive pulmonary disease is described in the literature [1]. Exacerbated chronic obstructive lung disease leads to stress-related cardiomyopathy and an increase of dyspnoea and angina equivalent to the use of increasing doses of β2 agonists. The inhibitory influence of cortisol on catecholamine release together with stress response, personality and psychiatric profile must be postulated in developing tako tsubo cardiomyopathy [2]. The patient was advised to continue cardioprotective medication for 3 up to 6 months and when to stop aldosteron antagonist bearing the risk of hyperkalemia. The combination of ACE inhibitor, anti platelet therapy and low-dose beta blocker should be continued in fear of recurrent episodes of tako tsubo cardiomyopathy with chronic respiratory disease. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] Manfredini R, Fabbian F, Giorgi AD, et al. Heart and lung, a dangerous liaison — takotsubo cardiomyopathy and respiratory diseases: a systematic review. World J Cardiol 2014;6:338–44. [2] Kastaun S, Schwarz NP, Juenemann M, et al. Cortisol awakening and stress response, personality and psychiatric profiles in patients with takotsubo cardiomyopathy. Heart 2014. http://dx.doi.org/10.1136/heartjnl-2014-305745.
