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    "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>"
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Letter to the Editor
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
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
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      "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"
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    "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>"
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Article information
ISSN: 21735727
Original language: English
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Medicina Intensiva (English Edition)