array:24 [
  "pii" => "S2173572717300693"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2016.10.006"
  "estado" => "S300"
  "fechaPublicacion" => "2017-05-01"
  "aid" => "1002"
  "copyright" => "Elsevier España, S.L.U. and SEMICYUC"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Med Intensiva. 2017;41:260"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1437
    "formatos" => array:3 [
      "EPUB" => 169
      "HTML" => 728
      "PDF" => 540
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173572717300589"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2016.12.002"
    "estado" => "S300"
    "fechaPublicacion" => "2017-05-01"
    "aid" => "1017"
    "copyright" => "Elsevier España, S.L.U. and SEMICYUC"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Med Intensiva. 2017;41:261"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2091
      "formatos" => array:3 [
        "EPUB" => 185
        "HTML" => 1345
        "PDF" => 561
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Author&#39;s reply"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "261"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Respuesta de los autores"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Garc&#237;a-Delgado, I&#46; Navarrete-S&#225;nchez"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Garc&#237;a-Delgado"
            ]
            1 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Navarrete-S&#225;nchez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:2 [
      "en" => array:9 [
        "pii" => "S0210569116302546"
        "doi" => "10.1016/j.medin.2016.10.011"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116302546?idApp=WMIE"
      ]
      "es" => array:9 [
        "pii" => "S0210569117300025"
        "doi" => "10.1016/j.medin.2016.12.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117300025?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300589?idApp=WMIE"
    "url" => "/21735727/0000004100000004/v1_201705111033/S2173572717300589/v1_201705111033/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173572717300577"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2016.05.003"
    "estado" => "S300"
    "fechaPublicacion" => "2017-05-01"
    "aid" => "935"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Med Intensiva. 2017;41:257-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6529
      "formatos" => array:3 [
        "EPUB" => 209
        "HTML" => 5379
        "PDF" => 941
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "Hydroxychloroquine&#44; a potentially lethal drug"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "257"
          "paginaFinal" => "259"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "La hidroxicloroquina&#44; un f&#225;rmaco potencialmente letal"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "C&#46; Merino Argum&#225;nez, I&#46; S&#225;ez de La Fuente, Z&#46; Molina Collado, D&#46; Su&#225;rez Pita, B&#46; Mestre G&#243;mez, J&#46;A&#46; Sanchez Izquierdo"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Merino Argum&#225;nez"
            ]
            1 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "S&#225;ez de La Fuente"
            ]
            2 => array:2 [
              "nombre" => "Z&#46;"
              "apellidos" => "Molina Collado"
            ]
            3 => array:2 [
              "nombre" => "D&#46;"
              "apellidos" => "Su&#225;rez Pita"
            ]
            4 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Mestre G&#243;mez"
            ]
            5 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Sanchez Izquierdo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569116300985"
        "doi" => "10.1016/j.medin.2016.05.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116300985?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300577?idApp=WMIE"
    "url" => "/21735727/0000004100000004/v1_201705111033/S2173572717300577/v1_201705111033/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:19 [
      "pii" => "S2173572717300589"
      "issn" => "21735727"
      "doi" => "10.1016/j.medine.2016.12.002"
      "estado" => "S300"
      "fechaPublicacion" => "2017-05-01"
      "aid" => "1017"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Med Intensiva. 2017;41:261"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2091
        "formatos" => array:3 [
          "EPUB" => 185
          "HTML" => 1345
          "PDF" => 561
        ]
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
        "titulo" => "Author&#39;s reply"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:1 [
            "paginaInicial" => "261"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Respuesta de los autores"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Garc&#237;a-Delgado, I&#46; Navarrete-S&#225;nchez"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Garc&#237;a-Delgado"
              ]
              1 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Navarrete-S&#225;nchez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:2 [
        "en" => array:9 [
          "pii" => "S0210569116302546"
          "doi" => "10.1016/j.medin.2016.10.011"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116302546?idApp=WMIE"
        ]
        "es" => array:9 [
          "pii" => "S0210569117300025"
          "doi" => "10.1016/j.medin.2016.12.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "es"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117300025?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300589?idApp=WMIE"
      "url" => "/21735727/0000004100000004/v1_201705111033/S2173572717300589/v1_201705111033/en/main.assets"
    ]
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Electrocardiograms in a diabetic patient with takotsubo syndrome after heart surgery for atrial myxoma"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "260"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "John E&#46; Madias"
        "autores" => array:1 [
          0 => array:4 [
            "nombre" => "John E&#46;"
            "apellidos" => "Madias"
            "email" => array:1 [
              0 => "madiasj&#64;nychhc&#46;org"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "The Icahn School of Medicine at Mount Sinai&#44; New York&#44; NY&#44; United States"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Division of Cardiology&#44; Elmhurst Hospital Center&#44; Elmhurst&#44; NY&#44; United States"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Electrocardiogramas en un paciente diab&#233;tico con s&#237;ndrome de tako-tsubo tras cirug&#237;a card&#237;aca para mixoma auricular"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSmallCaps">I</span> read&#44; through &#8220;Google translate&#8221;&#44; the report by Garc&#237;a-Delgado et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> published on line ahead of print&#44; on September 17&#44; 2016 in the <span class="elsevierStyleItalic">Journal</span>&#44; about the 68 year-old woman with atrial myxoma&#44; for which she underwent surgery&#44; and who suffered takotsubo syndrome &#40;TTS&#41; in the post-operative period&#44; complicated by cadiogenic shock non-responding to vasoactive drugs&#44; which required veno-arterial extracorporeal membrane oxygenation support&#46; It has been recently reported that patients with TTS have a low prevalence of diabetes mellitus &#40;DM&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> but this does not imply that all patients with DM are &#8220;protected&#8221; from developing TTS&#46; The present patient had noninsulin-dependent DM&#44; and it would be of interest to know whether her DM was of long duration and whether she had DM-induced peripheral neuropathy&#44; to which the &#8220;protective&#8221; influence on TTS has been attributed&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Also the present patient was admitted with atrial fibrillation&#44; underwent surgery for atrial myxoma&#44; had hypoxemia post-operatively&#44; all factors&#44; which will be expected to &#8220;overwhelm&#8221; the hypothetical &#8220;protective&#8221; effect for the emergence of TTS exerted by DM&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The electrocardiogram &#40;ECG&#41; A of Figure 2 of the article&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> reveals attenuation of the amplitude of the QRS complexes &#40;attQRS&#41; of ECG A in comparison with the ECG of Figure B&#44; which could be either because of TTS&#44; in keeping with a recent report&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> or due to the postoperative volume overload&#44; both of which cause attQRS&#46; The attQRS in TTS is attributed to the associated myocardial edema&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> and the attQRS in patients with cardiogenic shoch or postoperative state is attributed to the low electrical impedance of the passive body volume conductor&#44; engendered by a high body edematous state&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Accordingly&#44; it will be of interest to compare all the ECGs obtained in this patient from her admission to her discharge&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:3 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:2 [
          "identificador" => "xack281650"
          "titulo" => "Acknowledgements"
        ]
        2 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "pii&#58; S0210-5691&#40;16&#41;30152-8&#46; doi&#58; 10&#46;1016&#47;j&#46;medin&#46;2016&#46;07&#46;007&#46; &#91;Epub ahead of print&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extracorporeal membrane oxygenation support for Takotsubo syndrome and long QT after cardiac surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Garc&#237;a-Delgado"
                            1 => "D&#46; Garc&#237;a-Huertas"
                            2 => "I&#46; Navarrete-S&#225;nchez"
                            3 => "L&#46; Olivencia-Pe&#241;a"
                            4 => "J&#46;M&#46; Garrido"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low prevalence of diabetes mellitus in patients with Takotsubo syndrome&#58; a plausible &#8216;protective&#8217; effect with pathophysiologic connotations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;E&#46; Madias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/2048872615570761"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J Acute Cardiovasc Care"
                        "fecha" => "2016"
                        "volumen" => "5"
                        "paginaInicial" => "164"
                        "paginaFinal" => "170"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25673782"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transient attenuation of the amplitude of the QRS complexes in the diagnosis of Takotsubo syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;E&#46; Madias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/2048872613504311"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J Acute Cardiovasc Care"
                        "fecha" => "2014"
                        "volumen" => "3"
                        "paginaInicial" => "28"
                        "paginaFinal" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24562801"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anasarca-mediated attenuation of the amplitude of electrocardiogram complexes&#58; a description of a heretofore unrecognized phenomenon"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;E&#46; Madias"
                            1 => "R&#46; Bazaz"
                            2 => "H&#46; Agarwal"
                            3 => "M&#46; Win"
                            4 => "L&#46; Medepalli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2001"
                        "volumen" => "38"
                        "paginaInicial" => "756"
                        "paginaFinal" => "764"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11527629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack281650"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0020" class="elsevierStylePara elsevierViewall">No financial support was received for this work&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004100000004/v1_201705111033/S2173572717300693/v1_201705111033/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "64604"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004100000004/v1_201705111033/S2173572717300693/v1_201705111033/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300693?idApp=WMIE"
]
Share
Journal Information
Vol. 41. Issue 4.
Pages 260 (May 2017)
Share
Share
Download PDF
More article options
Vol. 41. Issue 4.
Pages 260 (May 2017)
Letter to the Editor
Full text access
Electrocardiograms in a diabetic patient with takotsubo syndrome after heart surgery for atrial myxoma
Electrocardiogramas en un paciente diabético con síndrome de tako-tsubo tras cirugía cardíaca para mixoma auricular
Visits
5340
John E. Madiasa,b
a The Icahn School of Medicine at Mount Sinai, New York, NY, United States
b Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States
Related content
Med Intensiva. 2017;41:26110.1016/j.medine.2016.12.002
M. García-Delgado, I. Navarrete-Sánchez
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text
Dear Editor,

I read, through “Google translate”, the report by García-Delgado et al.,1 published on line ahead of print, on September 17, 2016 in the Journal, about the 68 year-old woman with atrial myxoma, for which she underwent surgery, and who suffered takotsubo syndrome (TTS) in the post-operative period, complicated by cadiogenic shock non-responding to vasoactive drugs, which required veno-arterial extracorporeal membrane oxygenation support. It has been recently reported that patients with TTS have a low prevalence of diabetes mellitus (DM),2 but this does not imply that all patients with DM are “protected” from developing TTS. The present patient had noninsulin-dependent DM, and it would be of interest to know whether her DM was of long duration and whether she had DM-induced peripheral neuropathy, to which the “protective” influence on TTS has been attributed.2 Also the present patient was admitted with atrial fibrillation, underwent surgery for atrial myxoma, had hypoxemia post-operatively, all factors, which will be expected to “overwhelm” the hypothetical “protective” effect for the emergence of TTS exerted by DM.2

The electrocardiogram (ECG) A of Figure 2 of the article,1 reveals attenuation of the amplitude of the QRS complexes (attQRS) of ECG A in comparison with the ECG of Figure B, which could be either because of TTS, in keeping with a recent report,3 or due to the postoperative volume overload, both of which cause attQRS. The attQRS in TTS is attributed to the associated myocardial edema,3 and the attQRS in patients with cardiogenic shoch or postoperative state is attributed to the low electrical impedance of the passive body volume conductor, engendered by a high body edematous state.4 Accordingly, it will be of interest to compare all the ECGs obtained in this patient from her admission to her discharge.

Conflicts of interest

None.

Acknowledgements

No financial support was received for this work.

References
[1]
M. García-Delgado, D. García-Huertas, I. Navarrete-Sánchez, L. Olivencia-Peña, J.M. Garrido.
Extracorporeal membrane oxygenation support for Takotsubo syndrome and long QT after cardiac surgery.
Med Intensiva, (2016),
pii: S0210-5691(16)30152-8. doi: 10.1016/j.medin.2016.07.007. [Epub ahead of print]
[2]
J.E. Madias.
Low prevalence of diabetes mellitus in patients with Takotsubo syndrome: a plausible ‘protective’ effect with pathophysiologic connotations.
Eur Heart J Acute Cardiovasc Care, 5 (2016), pp. 164-170
[3]
J.E. Madias.
Transient attenuation of the amplitude of the QRS complexes in the diagnosis of Takotsubo syndrome.
Eur Heart J Acute Cardiovasc Care, 3 (2014), pp. 28-36
[4]
J.E. Madias, R. Bazaz, H. Agarwal, M. Win, L. Medepalli.
Anasarca-mediated attenuation of the amplitude of electrocardiogram complexes: a description of a heretofore unrecognized phenomenon.
J Am Coll Cardiol, 38 (2001), pp. 756-764
Copyright © 2016. Elsevier España, S.L.U. and SEMICYUC
Download PDF
Idiomas
Medicina Intensiva (English Edition)
Article options
Tools