Journal of Yeungnam Medical Science

Case reports

Reverse Takotsubo cardiomyopathy with left bundle branch block after anesthesia induction in a patient with subarachnoid hemorrhage: a case report: Eun Kyung Choi, Jong-Hoon Kim, Minhyun Kim; J Yeungnam Med Sci. 2022;39(2):172-178. Published online October 25, 2021; DOI: https://doi.org/10.12701/yujm.2021.01354

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Cardiac dysfunction after subarachnoid hemorrhage (SAH) is described as Takotsubo or reverse Takotsubo cardiomyopathy that shows transient left ventricular wall motion abnormalities with electrocardiogram (ECG) changes. ST change followed by T inversion is a common ECG finding complicated with these disorders, left bundle branch block (LBBB) may be a potential ECG pattern which is seen. In this case, we describe the clinical profile and outcomes of a patient with LBBB and reverse Takotsubo cardiomyopathy after anesthetic induction, which was scheduled as an emergent external ventricular drainage after SAH. This is the first report of an LBBB pattern in reverse Takotsubo cardiomyopathy.

Citations

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Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review
Dorottya Szántó, Péter Luterán, Judit Gál, Endre V. Nagy, Béla Fülesdi, Csilla Molnár
Reviews in Cardiovascular Medicine.2023;[Epub] CrossRef

Catastrophic catecholamine-induced cardiomyopathy rescued by extracorporeal membrane oxygenation in recurrent malignant pheochromocytoma: Daniel Min; Yeungnam Univ J Med. 2019;36(3):254-259. Published online May 22, 2019; DOI: https://doi.org/10.12701/yujm.2019.00213

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Abstract PDF

Pheochromocytoma (PCC) is a rare catecholamine-producing tumor with the incidence in hypertension of 0.1-0.6%. PCC crisis is an endocrine emergency that can lead to hemodynamic disturbance and organ failure such as catecholamine-induced cardiomyopathy. The circulatory collapse caused by it often requires mechanical support. The author reports an unusual case in which a patient who previously underwent surgery for malignant PCC developed catecholamine-induced cardiomyopathy, and successfully recovered using extracorporeal membrane oxygenation.

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Successful Use of Extracorporeal Life Support and Continuous Renal Replacement Therapy in the Treatment of Cardiogenic Shock Induced by Tumor Lysis Syndrome in a Pediatric Patient With Lymphoma: A Case Report
Zhulin Wang, Fang Zhang, Long Xiang, Yinyu Yang, Wei Wang, Biru Li, Hong Ren
Frontiers in Medicine.2022;[Epub] CrossRef
Clinical characteristics and outcomes of pheochromocytoma crisis: a literature review of 200 cases
Y. Ando, Y. Ono, A. Sano, N. Fujita, S. Ono, Y. Tanaka
Journal of Endocrinological Investigation.2022; 45(12): 2313. CrossRef
Catecholamine-induced cardiomyopathy: an endocrinologist’s perspective
Aman Kumar, Joseph M Pappachan, Cornelius James Fernandez
Reviews in Cardiovascular Medicine.2021;[Epub] CrossRef

Original Article

Meta-analysis on risk stratification of malignant ventricular tachyarrhythmic events in arrhythmogenic right ventricular cardiomyopathy: Young Eun Roh, Hyun Ji Jang, Min Jung Cho; Yeungnam Univ J Med. 2017;34(2):208-215. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.208

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Abstract PDF: BACKGROUND
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a cardiomyopathy characterized by predominant right ventricular fibro-fatty replacement, right ventricular dysfunction and ventricular arrhythmias. It is a rare but important cause of sudden cardiac death in children and young adults. A meta-analysis on risk stratification of major ventricular tachyarrhythmic events indicating the need for implantable cardioverter defibrillator therapy in ARVC was performed. METHODS: The pubmed database was searched from its inception to May 2015. Of the 433 citations identified, 12 were included in this meta-analysis. Data regarding major ventricular tachyarrhythmic events were retrieved in 817 subjects from the studies. For the variables, a combined odds ratio (OR) was calculated using a fixed-effects meta-analysis. RESULTS: Extensive right ventricular dysfunction (OR, 2.44), ventricular late potential (OR, 1.66), inducible ventricular tachyarrhythmia during electrophysiology study (OR, 3.67), non-sustained ventricular tachycardia (OR, 3.78), and history of fatal event/sustained VT (OR, 5.66) identified as significant risk factors (p < 0.0001). CONCLUSION: This meta-analysis shows that extensive right ventricular dysfunction, ventricular late potential, inducible ventricular tachyarrhythmia during electrophysiological study, non-sustained ventricular tachycardia, and history of sustained ventricular tachycardia/fibrillation are consistently reported risk factors of major ventricular tachyarrhythmic events indicating implantable cardioverter defibrillator therapy in patients with ARVC.

Case Reports

A patient with stress induced cardiomyopathy that occurred after cessation of hormone replacement therapy for panhypopituitarism.: Seoung Wan Nam, Jun Won Lee, Jeong Han Sim, Hyun Sung Pack, Changjo Im, Jung Soo Lim, Sung Gyun Ahn; Yeungnam Univ J Med. 2016;33(2):125-129. Published online December 31, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.2.125

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Abstract PDF: Stress induced cardiomyopathy (SC) is characterized by transient left ventricular (LV) dysfunction in the absence of coronary artery disease. We report on a patient with panhypopituitarism who developed SC resulting from withdrawal of hormonal replacement therapy (HRT). A 52-year-old male visited our hospital for progressively worsening dyspnea. The patient had discontinued HRT 7 days ago, which had been administered for 18 months after transsphenoidal adenomectomy for pituitary macroadenoma. Initial electrocardiogram showed marked sinus bradycardia. Transthoracic echocardiography showed apical ballooning with an LV ejection fraction of 25%. No significant obstructive lesions were observed on coronary angiography. With a clinical diagnosis of SC associated with panhypopituitarism, HRT was restarted, including glucocorticoid and thyroxine, along with standard heart failure management. His LV function had normalized at 2-month follow-up. He remains asymptomatic and administration of beta-blocker and angiotensin converting enzyme inhibitor were discontinued He currently only requires HRT.

Development of Steroid Myopathy during Polymyositis Treatment.: Ji Hoon Lee, Shin Young Hyun, Choong Ki Kim, Su Hwan Lee, A Ra Choi, Seong Woo Kim, Sung Hye Park, Chan Hee Lee; Yeungnam Univ J Med. 2011;28(2):173-179. Published online December 31, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.2.173

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Abstract PDF: Polymyositis is diffuse, inflammatory myopathy with proximal-muscle weakness due to lymphocyte infiltration to the muscle layer. The exact cause of the muscle weakness is unclear but may be related with an immunologic mechanism. Using high-dose steroid is the treatment of choice for polymyositis. It is difficult to distinguish steroid-resistant polymyositis from steroid myopathy, however, in the course of high-dose steroid therapy. These authors encountered a steroid myopathy patient during polymyositis treatment with high-dose steroid. A 57-year-old woman was diagnosed with polymyositis and was treated with high-dose steroid. Her condition was initially improved, but in the course of the treatment, her symptom was aggravated without increasing the muscle enzymes. Her muscle weakness was improved by reducing the steroid dosage.

Apical Hypertrophic Cardiomyopathy with Apical Aneurysm and Thrombus Diagnosed by Contrast Echocardiography.: Kyu Hwan Park, Geu Ru Hong, Jong Ho Nam, Min Kyu Kang, Su Mi Kim, Seong Yoon Jung, Ji Hoon Na; Yeungnam Univ J Med. 2010;27(2):133-138. Published online December 31, 2010; DOI: https://doi.org/10.12701/yujm.2010.27.2.133

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Abstract PDF: Apical hypertrophic cardiomyopathy is rare disease and a variant of hypertrophic cardiomyopathy with prevalence of 1 in 500 in the general population. Apical hypertrophic cardiomyopathy with apical aneurysm and intramural thrombus is extremely rare. We report a case of apical hypertrophic cardiomyopathy progressing to left ventricular apical aneurysm with intramural thrombus diagnosed by contrast echocardiography.

Anesthesia for Cesarean Section in a Parturient with Dilated Cardiomyopathy: A Case Report.: Sae Yeon Kim, Su Jeong Heo, Sun Ok Song; Yeungnam Univ J Med. 2010;27(1):52-56. Published online June 30, 2010; DOI: https://doi.org/10.12701/yujm.2010.27.1.52

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Abstract PDF: Idiopathic peripartum cardiomyopathy is an uncommon malady disease. Making the diagnosis is often difficult and it is always necessary to exclude other prior heart disease and other causes of left ventricular dysfunction in pregnant women. Heart failure in these women ensues when the cardiovascular demands of normal pregnancy are further amplified when the common complications of pregnancy complications superimposed upon these underlying conditions that cause compensated ventricular hypertrophy. This may be aggravated by making a late diagnosis and providing inappropriate treatment. We experienced a 38-year-primigravida who has diagnosed with idiopathic peripartum cardiomyopathy and underwent elective cesarean section with general anesthesia.

A Case of Glycogen Storage Disease with Hypertrophic Cardiomyopathy.: Dong Hee Kim, Sang Wook Kang, Won Jong Park, Kyoung Ae Jang, Joon Hyuk Choi, Woong Kim, Sang Hee LEE, Geu Ru Hong; Yeungnam Univ J Med. 2006;23(2):252-257. Published online December 31, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.2.252

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Abstract PDF: Glycogen storage diseases are a heterogeneous group of metabolic disorder affecting multiple organ system: liver, skeletal muscle, heart and brain. Clinical features include: short status, hepatomegaly, hypoglycemia, dyslipidemia and rare involvement of the myocardium except in the case of type III, glycogen storage diseases with hypertrophic cardiomyopathy in adult, which is extremely rare. We treated a case of hypertrophic cardiomyopathy with hepatomegaly that was unknown etiology. The patient was diagnosed as having glycogen storage disease. This 46-year old women was transferred with dyspnea on exertion and abnormal LFTs. She was diagnosed with hypertrophic cardiomyopathy by echocardiography but there was no specific cause for hypertrophic cardiomyopathy. A liver biopsy was performed. The result showed glycogen storage disease possible type III, IV or IX. In conclusion, patients with hypertrophic cardiomyopathy of unknown etiology and abnormal LFTs should be evaluated for glycogen storage disease.

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