Stress cardiomyopathy other diagnostic studies: Difference between revisions

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==Other Diagnostic Studies==
==Other Diagnostic Studies==
===Coronary Angiography===
Stress cardiomyopathy can mimic an [[acute MI]], mainly [[anterior MI]], since the clinical presentation, [[ECG]] and laboratory findings are similar. Hence, [[coronary angiography]] is considered a great diagnostic modality to differentiate between the two diagnoses. A normal [[angiography]] or absence of substantial [[coronary]] [[stenosis]] supports the diagnosis of stress cardiomyopathy.<ref name="pmid19106400">{{cite journal |vauthors=Akashi YJ, Goldstein DS, Barbaro G, Ueyama T |title=Takotsubo cardiomyopathy: a new form of acute, reversible heart failure |journal=Circulation |volume=118 |issue=25 |pages=2754–62 |year=2008 |pmid=19106400 |pmc=4893309 |doi=10.1161/CIRCULATIONAHA.108.767012 |url=}}</ref><ref name="pmid15276100">{{cite journal |vauthors=Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS |title=Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome |journal=Am. J. Cardiol. |volume=94 |issue=3 |pages=343–6 |year=2004 |pmid=15276100 |doi=10.1016/j.amjcard.2004.04.030 |url=}}</ref><ref name="pmid28041712">{{cite journal |vauthors=Efferth T, Banerjee M, Paul NW |title=Broken heart, tako-tsubo or stress cardiomyopathy? Metaphors, meanings and their medical impact |journal=Int. J. Cardiol. |volume= |issue= |pages= |year=2016 |pmid=28041712 |doi=10.1016/j.ijcard.2016.12.129 |url=}}</ref>


===Cardiac Catheterization===
===Cardiac Catheterization===
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===Myocardial Biopsy===
===Myocardial Biopsy===
Myocardial biopsy, although not necessary for diagnosis, can distinguish between stress cardiomyopathy and [[MI]]. The histological findings on myocardial biopsy in patients with stress cardiomyopathy include:<ref name="pmid19106400">{{cite journal |vauthors=Akashi YJ, Goldstein DS, Barbaro G, Ueyama T |title=Takotsubo cardiomyopathy: a new form of acute, reversible heart failure |journal=Circulation |volume=118 |issue=25 |pages=2754–62 |year=2008 |pmid=19106400 |pmc=4893309 |doi=10.1161/CIRCULATIONAHA.108.767012 |url=}}</ref><ref name="pmid18206521">{{cite journal |vauthors=Brenner ZR, Powers J |title=Takotsubo cardiomyopathy |journal=Heart Lung |volume=37 |issue=1 |pages=1–7 |year=2008 |pmid=18206521 |doi=10.1016/j.hrtlng.2006.12.003 |url=}}</ref>
* Myocardial biopsy, although not necessary for diagnosis, can distinguish between stress cardiomyopathy and [[MI]].  
*[[Inflammatory]] infiltrates, consisting of [[mononuclear lymphocytes]], [[leukocytes]] and [[macrophages]]
* The histological findings on myocardial biopsy in patients with stress cardiomyopathy include:<ref name="pmid19106400">{{cite journal |vauthors=Akashi YJ, Goldstein DS, Barbaro G, Ueyama T |title=Takotsubo cardiomyopathy: a new form of acute, reversible heart failure |journal=Circulation |volume=118 |issue=25 |pages=2754–62 |year=2008 |pmid=19106400 |pmc=4893309 |doi=10.1161/CIRCULATIONAHA.108.767012 |url=}}</ref><ref name="pmid18206521">{{cite journal |vauthors=Brenner ZR, Powers J |title=Takotsubo cardiomyopathy |journal=Heart Lung |volume=37 |issue=1 |pages=1–7 |year=2008 |pmid=18206521 |doi=10.1016/j.hrtlng.2006.12.003 |url=}}</ref>
*[[Myocardial]] [[fibrosis]]
:*[[Inflammatory]] infiltrates, consisting of [[mononuclear lymphocytes]], [[leukocytes]] and [[macrophages]]
*Contraction bands, which may or may not be associated with [[necrosis]]<br>
:*[[Myocardial]] [[fibrosis]]
:*Contraction bands, which may or may not be associated with [[necrosis]]<br>


The combination of inflammatory changes and contraction bands distinguish stress cardiomyopathy from [[coagulative necrosis]] seen in [[MI]].<ref name="pmid19106400">{{cite journal |vauthors=Akashi YJ, Goldstein DS, Barbaro G, Ueyama T |title=Takotsubo cardiomyopathy: a new form of acute, reversible heart failure |journal=Circulation |volume=118 |issue=25 |pages=2754–62 |year=2008 |pmid=19106400 |pmc=4893309 |doi=10.1161/CIRCULATIONAHA.108.767012 |url=}}</ref>
*The combination of inflammatory changes and contraction bands distinguish stress cardiomyopathy from [[coagulative necrosis]] seen in [[MI]].<ref name="pmid19106400">{{cite journal |vauthors=Akashi YJ, Goldstein DS, Barbaro G, Ueyama T |title=Takotsubo cardiomyopathy: a new form of acute, reversible heart failure |journal=Circulation |volume=118 |issue=25 |pages=2754–62 |year=2008 |pmid=19106400 |pmc=4893309 |doi=10.1161/CIRCULATIONAHA.108.767012 |url=}}</ref>


==References==
==References==

Latest revision as of 20:33, 1 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

Coronary angiography and cardiac catheterization are the diagnostic modalities of choice to distinguish between stress cardiomyopathy and acute anterior MI. Normal anatomy of the coronary arteries, along with a reduced ejection fraction supports the diagnosis of stress cardiomyopathy.

Other Diagnostic Studies

Cardiac Catheterization

When patients with stress cardiomyopathy undergo cardiac catheterization, the following findings are usually reported:[1][2][3]

Myocardial Biopsy

  • Myocardial biopsy, although not necessary for diagnosis, can distinguish between stress cardiomyopathy and MI.
  • The histological findings on myocardial biopsy in patients with stress cardiomyopathy include:[4][1]
  • The combination of inflammatory changes and contraction bands distinguish stress cardiomyopathy from coagulative necrosis seen in MI.[4]

References

  1. 1.0 1.1 Brenner ZR, Powers J (2008). "Takotsubo cardiomyopathy". Heart Lung. 37 (1): 1–7. doi:10.1016/j.hrtlng.2006.12.003. PMID 18206521.
  2. Tsai TT, Nallamothu BK, Prasad A, Saint S, Bates ER (2009). "Clinical problem-solving. A change of heart". N. Engl. J. Med. 361 (10): 1010–6. doi:10.1056/NEJMcps0903023. PMID 19726776.
  3. Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS (2004). "Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome". Am. J. Cardiol. 94 (3): 343–6. doi:10.1016/j.amjcard.2004.04.030. PMID 15276100.
  4. 4.0 4.1 Akashi YJ, Goldstein DS, Barbaro G, Ueyama T (2008). "Takotsubo cardiomyopathy: a new form of acute, reversible heart failure". Circulation. 118 (25): 2754–62. doi:10.1161/CIRCULATIONAHA.108.767012. PMC 4893309. PMID 19106400.

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