Introduction: Anaphylactic reaction represent a not uncommon life-threatening emergency. The allergic syndrome may involve multiple target organs, including skin, respiratory, gastrointestinal, and cardiovascular systems. Tako-Tsubo cardiomyopathy (TTC) is a reversible clinical condition mimicking an acute myocardial infarction (AMI). Typical presentation involves chest pain and/or dyspnea, transient ST-segment elevation on the electrocardiogram (ECG), with modest increase in cardiac troponin. Multifactorial pathophysiologic mechanisms are likely to be involved, but the most accepted pathogenic hypothesis indicates abrupt elevation of circulating catecholamine, triggered by emotional and/or physical stress. The aim of this review was to evaluate if anaphylaxis may represent a stressful valid trigger for TTC. Methods: We systematically explored the most important medical information sources, to identify the different triggering causes. The following keywords were searching: takotsubo cardiomyopathy, stress-induced cardiomyopathy, apical ballooning syndrome in combination with allergic reaction, anaphylactic shock, and anaphylaxis. We also collected a set of data, including author, year of publication, patients' sex and age, triggers of allergic reaction and outcome. Results: Out of a total of 1958 articles found (1443 with the precise MeSH term: Takotsubo cardiomyopathy, we found 26 case reports. The mean age was 47.7 ± 19.2 years, and the great majority of patients were women (76.9%). Drug reactions were reported in 22 patients (84.6%), of whom 10 (45.5%) were treated with therapeutic doses of epinephrine, 5 (22.7%) with general anesthetics, and 3 (13.6%) with antibiotics. Anaphylactic reaction due to intravenous contrast media for computer tomography has been reported only in two cases. Clinical outcome was favorable in most cases, with only 1 fatal event described. Conclusions: TTC may be associated with anaphylactic reactions, mainly due to epinephrine administration during allergic reaction, as results in approximately 45% of reported cases. Thus, allergic reactions may be fully considered a potential trigger of TTC, with a mechanism including both production of inflammatory cytokines and adrenaline treatment.
May allergic syndrome represent valid trigger for Tako-tsubo cardiomyopathy? A systematic review of reported cases.
BOCCAFOGLI, Arrigo;TISEO, Ruana;PORTALUPPI, Francesco;FABBIAN, Fabio;MANFREDINI, Roberto
2014
Abstract
Introduction: Anaphylactic reaction represent a not uncommon life-threatening emergency. The allergic syndrome may involve multiple target organs, including skin, respiratory, gastrointestinal, and cardiovascular systems. Tako-Tsubo cardiomyopathy (TTC) is a reversible clinical condition mimicking an acute myocardial infarction (AMI). Typical presentation involves chest pain and/or dyspnea, transient ST-segment elevation on the electrocardiogram (ECG), with modest increase in cardiac troponin. Multifactorial pathophysiologic mechanisms are likely to be involved, but the most accepted pathogenic hypothesis indicates abrupt elevation of circulating catecholamine, triggered by emotional and/or physical stress. The aim of this review was to evaluate if anaphylaxis may represent a stressful valid trigger for TTC. Methods: We systematically explored the most important medical information sources, to identify the different triggering causes. The following keywords were searching: takotsubo cardiomyopathy, stress-induced cardiomyopathy, apical ballooning syndrome in combination with allergic reaction, anaphylactic shock, and anaphylaxis. We also collected a set of data, including author, year of publication, patients' sex and age, triggers of allergic reaction and outcome. Results: Out of a total of 1958 articles found (1443 with the precise MeSH term: Takotsubo cardiomyopathy, we found 26 case reports. The mean age was 47.7 ± 19.2 years, and the great majority of patients were women (76.9%). Drug reactions were reported in 22 patients (84.6%), of whom 10 (45.5%) were treated with therapeutic doses of epinephrine, 5 (22.7%) with general anesthetics, and 3 (13.6%) with antibiotics. Anaphylactic reaction due to intravenous contrast media for computer tomography has been reported only in two cases. Clinical outcome was favorable in most cases, with only 1 fatal event described. Conclusions: TTC may be associated with anaphylactic reactions, mainly due to epinephrine administration during allergic reaction, as results in approximately 45% of reported cases. Thus, allergic reactions may be fully considered a potential trigger of TTC, with a mechanism including both production of inflammatory cytokines and adrenaline treatment.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
