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Takotsubo Syndrome and Acute Myocardial Infarction: Causal Links

Published:November 17, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.11.005
      Thanks to Dr Madias for his instructive comments
      • Madias J.E.
      Could takotsubo syndrome trigger type I myocardial infarction?.
      entitled “could takotsubo syndrome (TS) trigger type 1 myocardial infarction” on our recently published report in the American Journal of Cardiology entitled “A missed penalty kick triggered coronary death in the husband and broken heart syndrome in the wife.”
      • Y-Hassan S.
      • Feldt K.
      • Stalberg M.
      A missed penalty kick triggered coronary death in the husband and broken heart syndrome in the wife.
      I greatly appreciated Dr Madias awareness of another case, which we regrettably have unnoticed, of TS in an 82-year-old Italian woman watching a football game where the results frustrated and angered the patient who blamed for the loss the Italian national team coach, Marcello Lippi. Kim et al
      • Kim S.J.
      • Morelli R.
      Lippi-induced cardiomyopathy.
      reported that case as “Lippi-induced cardiomyopathy.” Dr Madias has in addition raised an interesting hypothesis, which is whether the acute myocardial infarction in our patient's husband triggered by the stressful football game followed by a fierce argument has been facilitated by initial TS. Madias proposed that “the disrupted systolic motion of the left ventricular myocardium, with normokinetic/hyperkinetic myocardial territories abutting akinetic myocardial regions, could have led to a rupture of a coronary plaque in the left anterior descending coronary artery and coronary thrombotic occlusion resulting in acute myocardial infarction.” Because of the patient's critical clinical condition, left ventriculography was not performed during coronary angiography and angioplasty. Nevertheless, echocardiography 13 hours and 2 days after the angioplasty revealed hyopkinesia in the anterior, septal, and apical segments; the contractions in the inferior and lateral wall were normal. Consequently, the left ventricular wall motion abnormality pattern was not consistent with TS in that patient. However, the hypothesis proposed by Madias is appealing and warrants further research. On the other hand, there is evidence and reports that acute coronary syndrome including spontaneous coronary artery dissection (SCAD) may trigger TS. We have recently reported on a series of 20 patients with acute coronary syndrome having left ventricular wall motion abnormality pattern consistent with TS.
      • Y-Hassan S.
      Takotsubo syndrome triggered by acute coronary syndrome in a cohort of 20 patients: an often missed diagnosis.
      Postischemic myocardial stunning is actually a form of TS and was the starting point of TS.
      • Y-Hassan S.
      Post-ischemic myocardial stunning was the starting point of takotsubo syndrome: restitution is justified after falling down on.
      Madias hypothesis could be interesting in the discussion of the causal link between SCAD and TS. Noteworthy, SCAD and TS afflict predominantly women and both conditions can be induced by an emotional or extreme physical stress factors; thus, for us, an unknown common pathogenesis for both disease entities could be a possibility.
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      References

        • Madias J.E.
        Could takotsubo syndrome trigger type I myocardial infarction?.
        Am J Cardiol. 2015; 116: 1951
        • Y-Hassan S.
        • Feldt K.
        • Stalberg M.
        A missed penalty kick triggered coronary death in the husband and broken heart syndrome in the wife.
        Am J Cardiol. 2015; 116: 1639-1642
        • Kim S.J.
        • Morelli R.
        Lippi-induced cardiomyopathy.
        Hellenic J Cardiol. 2011; 52: 91-92
        • Y-Hassan S.
        Takotsubo syndrome triggered by acute coronary syndrome in a cohort of 20 patients: an often missed diagnosis.
        Int J Cardiol Res. 2015; 02: 28-33
        • Y-Hassan S.
        Post-ischemic myocardial stunning was the starting point of takotsubo syndrome: restitution is justified after falling down on.
        Int J Cardiol. 2015; 198: 174-175

      Linked Article

      • Could Takotsubo Syndrome Trigger Type I Myocardial Infarction?
        American Journal of CardiologyVol. 116Issue 12
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          I read the interesting report by Y-Hassan et al,1 published online ahead of print, on September 3, 2015, in the American Journal of Cardiology, about a 64-year-old woman who suffered midventricular Takotsubo syndrome (TTS) with subsequent full recovery, after the defeat of the Chilean national football (soccer) team by the Brazilian national team during the FIFA 2014 World Championship. The inception of her illness was 75 minutes after the onset of cardiac arrest of her husband who had an acute myocardial infarction (AMI), 2 hours after the completion of the game, and died from anoxic encephalopathy 3 days later.
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