Letter to the Editor Received: January 26, 2015 Accepted: January 26, 2015 Published online: May 6, 2015
Cardiology 2015;131:160 DOI: 10.1159/000376571
‘Bronchogenic Stress Cardiomyopathy’, a Subset of Takotsubo Syndrome John E. Madias Icahn School of Medicine at Mount Sinai, New York, N.Y., and the Division of Cardiology, Elmhurst Hospital Center, Elmhurst, N.Y., USA
It appears that the authors recorded an admission ECG and they are reporting on marked changes in the subsequent ECGs, featured in figure 1 of the article [1]. It is also possible that the authors recorded more ECGs to evaluate for resolution of the noted ECG abnormalities. Recently transient attenuation of the QRS voltage (AQRS) was described in association with TTS [2]. The authors could provide important information by providing data on the AQRS, and its possible resolution, by comparing changes in all available (including old ECGs prior to the index admission) serial ECGs for these patients. It is also conceivable that frequent and early implementation of echocardiograpy [3], and what is currently termed ‘focused ultrasound’, implementing hand-held echocardiograpy devices [4], by many members of the intensive respiratory care unit, will further enhance our efforts to diagnose more patients with bronchogenic stress cardiomyopathy, and earlier in their clinical course.
© 2015 S. Karger AG, Basel 0008–6312/15/1313–0160$39.50/0 E-Mail [email protected] www.karger.com/crd
Conflicts of Interest
The author does not have any competing interests to disclose.
References 1 Rajwani A, Adam Z, Hall JA: Bronchogenic stress cardiomyopathy: a case series. Cardiology 2015;130:106–111. 2 Madias JE: Transient attenuation of the amplitude of the QRS complexes in the diagnosis of Takotsubo syndrome. Eur Heart J Acute Cardiovasc Care 2014;3:28–36. 3 Madias JE: Appropriate implementation of echocardiography in Takotsubo syndrome: earlier and more frequently. Echocardiography 2013;30:1123–1125. 4 Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ: Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013;26:567–581.
John E. Madias, MD Division of Cardiology, Elmhurst Hospital Center 79-01 Broadway Elmhurst, NY 11373 (USA) E-Mail madiasj @ nychhc.org
Downloaded by: Weizmann Inst. of Science 149.126.78.33 - 1/27/2016 8:09:06 AM
The interesting contribution of Rajwani et al. [1], published in a recent issue of Cardiology, describing 5 cases of patients who developed Takotsubo syndrome (TTS) in the setting of an admission with acute exacerbation of their chronic obstructive pulmonary disease treated with high-dose bronchodilator therapy, termed by the authors ‘bronchogenic stress cardiomyopathy’, is a call to action for all clinicians caring for patients in the intensive respiratory care unit. The authors remarked on the ‘insidious symptomatology’, ‘notable absence of chest pain’, and ‘progressive or relapsing dyspnea’, ‘which made it difficult to distinguish from the preceding or accompanying acute respiratory illness’, highlighting the existence of a novel bronchogenic subgroup of TTS; they also emphasized the importance of the electrocardiogram (ECG) for the detection of the TTS when the ‘clinical course of an acute exacerbation of chronic airway disease appears atypical’ [1].
Cardiology 2015;131:160 DOI: 10.1159/000376571
‘Bronchogenic Stress Cardiomyopathy’, a Subset of Takotsubo Syndrome John E. Madias Icahn School of Medicine at Mount Sinai, New York, N.Y., and the Division of Cardiology, Elmhurst Hospital Center, Elmhurst, N.Y., USA
It appears that the authors recorded an admission ECG and they are reporting on marked changes in the subsequent ECGs, featured in figure 1 of the article [1]. It is also possible that the authors recorded more ECGs to evaluate for resolution of the noted ECG abnormalities. Recently transient attenuation of the QRS voltage (AQRS) was described in association with TTS [2]. The authors could provide important information by providing data on the AQRS, and its possible resolution, by comparing changes in all available (including old ECGs prior to the index admission) serial ECGs for these patients. It is also conceivable that frequent and early implementation of echocardiograpy [3], and what is currently termed ‘focused ultrasound’, implementing hand-held echocardiograpy devices [4], by many members of the intensive respiratory care unit, will further enhance our efforts to diagnose more patients with bronchogenic stress cardiomyopathy, and earlier in their clinical course.
© 2015 S. Karger AG, Basel 0008–6312/15/1313–0160$39.50/0 E-Mail [email protected] www.karger.com/crd
Conflicts of Interest
The author does not have any competing interests to disclose.
References 1 Rajwani A, Adam Z, Hall JA: Bronchogenic stress cardiomyopathy: a case series. Cardiology 2015;130:106–111. 2 Madias JE: Transient attenuation of the amplitude of the QRS complexes in the diagnosis of Takotsubo syndrome. Eur Heart J Acute Cardiovasc Care 2014;3:28–36. 3 Madias JE: Appropriate implementation of echocardiography in Takotsubo syndrome: earlier and more frequently. Echocardiography 2013;30:1123–1125. 4 Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ: Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013;26:567–581.
John E. Madias, MD Division of Cardiology, Elmhurst Hospital Center 79-01 Broadway Elmhurst, NY 11373 (USA) E-Mail madiasj @ nychhc.org
Downloaded by: Weizmann Inst. of Science 149.126.78.33 - 1/27/2016 8:09:06 AM
The interesting contribution of Rajwani et al. [1], published in a recent issue of Cardiology, describing 5 cases of patients who developed Takotsubo syndrome (TTS) in the setting of an admission with acute exacerbation of their chronic obstructive pulmonary disease treated with high-dose bronchodilator therapy, termed by the authors ‘bronchogenic stress cardiomyopathy’, is a call to action for all clinicians caring for patients in the intensive respiratory care unit. The authors remarked on the ‘insidious symptomatology’, ‘notable absence of chest pain’, and ‘progressive or relapsing dyspnea’, ‘which made it difficult to distinguish from the preceding or accompanying acute respiratory illness’, highlighting the existence of a novel bronchogenic subgroup of TTS; they also emphasized the importance of the electrocardiogram (ECG) for the detection of the TTS when the ‘clinical course of an acute exacerbation of chronic airway disease appears atypical’ [1].
