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
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Madias" "autores" => array:1 [ 0 => array:4 [ "nombre" => "John E." "apellidos" => "Madias" "email" => array:1 [ 0 => "madiasj@nychhc.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, New York, NY, United States" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Electrocardiogramas en un paciente diabético con síndrome de tako-tsubo tras cirugía cardíaca para mixoma auricular" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSmallCaps">I</span> read, through “Google translate”, the report by García-Delgado et al.,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> published on line ahead of print, on September 17, 2016 in the <span class="elsevierStyleItalic">Journal</span>, 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),<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The electrocardiogram (ECG) A of Figure 2 of the article,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> 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,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> or due to the postoperative volume overload, both of which cause attQRS. The attQRS in TTS is attributed to the associated myocardial edema,<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, engendered by a high body edematous state.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Accordingly, it will be of interest to compare all the ECGs obtained in this patient from her admission to her discharge.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "xack278991" "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: S0210-5691(16)30152-8. doi: 10.1016/j.medin.2016.07.007. [Epub ahead of print]" "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. García-Delgado" 1 => "D. García-Huertas" 2 => "I. Navarrete-Sánchez" 3 => "L. Olivencia-Peña" 4 => "J.M. 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: a plausible ‘protective’ effect with pathophysiologic connotations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.E. 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.E. 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: a description of a heretofore unrecognized phenomenon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.E. Madias" 1 => "R. Bazaz" 2 => "H. Agarwal" 3 => "M. Win" 4 => "L. 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" => "xack278991" "titulo" => "Acknowledgements" "texto" => "<p id="par0020" class="elsevierStylePara elsevierViewall">No financial support was received for this work.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/02105691/0000004100000004/v1_201704211129/S0210569116302546/v1_201704211129/en/main.assets" "Apartado" => array:4 [ "identificador" => "18743" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105691/0000004100000004/v1_201704211129/S0210569116302546/v1_201704211129/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116302546?idApp=WMIE" ]
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