Images in Intensive Medicine
Comprehensive echocardiographic assessment of takotsubo cardiomyopathy case due to opioids withdrawal
Valoración ecocardiográfica integral en un caso de miocardiopatía de takotsubo por privación de opiáceos
I. Keituqwa Yáñez
, S. Nicolás Franco, A. Arcís Conesa
Corresponding author
Unidad de Cuidados Intensivos y Electroestimulación Cardiaca, Hospital General Universitario Rafael Méndez, Lorca, Murcia, Spain
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"apellidos" => "Blanco Huelga" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569119300634" "doi" => "10.1016/j.medin.2019.02.005" "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/S0210569119300634?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719302048?idApp=WMIE" "url" => "/21735727/0000004300000009/v1_201911280636/S2173572719302048/v1_201911280636/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Intensive Medicine</span>" "titulo" => "Comprehensive echocardiographic assessment of takotsubo cardiomyopathy case due to opioids withdrawal" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "591" "paginaFinal" => "592" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Keituqwa Yáñez, S. Nicolás Franco, A. Arcís Conesa" "autores" => array:3 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Keituqwa Yáñez" "email" => array:1 [ 0 => "ivankeituqwa@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Nicolás Franco" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Arcís Conesa" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Cuidados Intensivos y Electroestimulación Cardiaca, Hospital General Universitario Rafael Méndez, Lorca, Murcia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valoración ecocardiográfica integral en un caso de miocardiopatía de takotsubo por privación de opiáceos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 838 "Ancho" => 1667 "Tamanyo" => 525342 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 49-year-old woman with a history of intravenous drug abuse in the past and treated with buprenorphine presented due to diarrhea and abdominal pain. She had suspended buprenorphine 36<span class="elsevierStyleHsp" style=""></span>h ago. In the emergency room she developed typical sudden onset chest pain with manifestations of heart failure with arterial hypotension. The chest X-rays showed lung edema (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The laboratory tests indicated troponin I elevation (1.7<span class="elsevierStyleHsp" style=""></span>μg/l; reference range 0–0.5), with increased NT-proBNP (17,480<span class="elsevierStyleHsp" style=""></span>pg/ml). The ECG tracing is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was admitted to intensive care, and echocardiography (<a class="elsevierStyleCrossRef" href="#sec0010">video 1</a>) with strain assessment evidenced severe hypokinesia of the middle and apical segments, with an ejection fraction of 38% and diminished global longitudinal strain (−12.4%), associated to loss of the physiological apical gradient (in normal strain the apical segments show greater values than at middle and basal level – the normal global longitudinal strain being −20%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2%) in the polar map (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). The echocardiographic parametric quantitative myocardial perfusion study with echocontrast (SonoVue®) is shown in <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>A. The condition was treated as acute coronary syndrome without ST-segment elevation, with volume depletion and inotropic therapy with levosimendan. Coronary angiography after 36<span class="elsevierStyleHsp" style=""></span>h revealed no obstructive coronary disease (<a class="elsevierStyleCrossRef" href="#sec0010">video 2</a>). The troponin I peak was 4.9<span class="elsevierStyleHsp" style=""></span>μg/l. After 72<span class="elsevierStyleHsp" style=""></span>h the patient was hemodynamically stable and without signs of heart failure. The echocardiogram showed normalization of the segmental alterations, with an ejection fraction of 55% (<a class="elsevierStyleCrossRef" href="#sec0010">video 3</a>). The strain polar map indicated recovery of the apical gradient but with a slightly decreased global longitudinal strain (−14.2%; <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). The parametric quantitative myocardial perfusion study showed improved septoapical perfusion (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>B). The ECG tracing obtained at that time is shown in <a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Keituqwa Yáñez I, Nicolás Franco S, Arcís Conesa A. Valoración ecocardiográfica integral en un caso de miocardiopatía de takotsubo por privación de opiáceos. Med Intensiva. 2019;43:591–592.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0020" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:8 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 443 "Ancho" => 600 "Tamanyo" => 19469 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 838 "Ancho" => 1667 "Tamanyo" => 525342 ] ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 878 "Ancho" => 1667 "Tamanyo" => 186695 ] ] ] 3 => array:6 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 728 "Ancho" => 1667 "Tamanyo" => 99973 ] ] ] 4 => array:6 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 843 "Ancho" => 1667 "Tamanyo" => 534111 ] ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 1842505 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 6 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 1602611 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 7 => array:5 [ "identificador" => "upi0015" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc3.mp4" "ficheroTamanyo" => 941380 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc3.flv" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc3.m4v" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004300000009/v1_201911280636/S2173572719301985/v1_201911280636/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000009/v1_201911280636/S2173572719301985/v1_201911280636/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719301985?idApp=WMIE" ]
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