Case report
Cardiac thrombus and conduction disorder in takotsubo cardiomyopathy
Miocardiopatia de takotsubo complicada com trombo apical e alterações da condução
Read
6375
Timeswas read the article
1771
Total PDF
4604
Total HTML
Share statistics
array:24 [ "pii" => "S2174204912001158" "issn" => "21742049" "doi" => "10.1016/j.repce.2012.06.001" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "118" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2011" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2012;31:513-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3660 "formatos" => array:3 [ "EPUB" => 144 "HTML" => 2864 "PDF" => 652 ] ] "itemSiguiente" => array:19 [ "pii" => "S217420491200116X" "issn" => "21742049" "doi" => "10.1016/j.repce.2012.06.002" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "119" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2012;31:517-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4536 "formatos" => array:3 [ "EPUB" => 177 "HTML" => 3584 "PDF" => 775 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Fulminant myocarditis associated with pandemic H1N1 influenza A virus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "517" "paginaFinal" => "520" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Miocardite fulminante associada ao vírus influenza A pandémico H1N1" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1436 "Ancho" => 966 "Tamanyo" => 273912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Intermediate (A) and high (B) magnification of myocardium with multifocal infiltrates composed mostly of lymphocytes but also some neutrophils, macrophages, plasma cells and eosinophils, associated with myocyte necrosis and ischemia.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Cabral, Maria J. Brito, Marta Conde, Mário Oliveira, Gonçalo C. Ferreira" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Cabral" ] 1 => array:2 [ "nombre" => "Maria J." "apellidos" => "Brito" ] 2 => array:2 [ "nombre" => "Marta" "apellidos" => "Conde" ] 3 => array:2 [ "nombre" => "Mário" "apellidos" => "Oliveira" ] 4 => array:2 [ "nombre" => "Gonçalo C." "apellidos" => "Ferreira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491200116X?idApp=UINPBA00004E" "url" => "/21742049/0000003100000078/v1_201308021407/S217420491200116X/v1_201308021407/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2174204912000979" "issn" => "21742049" "doi" => "10.1016/j.repce.2012.05.002" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "121" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2012;31:509-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4594 "formatos" => array:3 [ "EPUB" => 147 "HTML" => 3810 "PDF" => 637 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Anomalous origin of the right coronary artery and acute myocardial infarction: Cause or coincidence?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "509" "paginaFinal" => "512" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Origem anómala da coronária direita e enfarte agudo do miocárdio: causa ou coincidência?" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1807 "Ancho" => 2667 "Tamanyo" => 375806 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">64-slice cardiac CT: (A) (maximum-intensity projection reconstruction) and (B) (volume-rendered reconstruction) show anomalous origin of the right coronary artery in the mid segment of the left anterior descending artery; (C) (volume-rendered reconstruction) shows the right coronary artery coursing anterior to the great vessels; (D) (volume-rendered reconstruction) shows reduced epicardial blood flow in the posterior and inferior walls due to absence of posterolateral and posterior descending arteries.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nuno Antunes, Ana Meireles, Catarina Gomes, Miguel Vieira, Diana Anjo, Mario Santos, Pinheiro Vieira, Isabel Sá, Henrique Carvalho, Severo Torres" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Nuno" "apellidos" => "Antunes" ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Meireles" ] 2 => array:2 [ "nombre" => "Catarina" "apellidos" => "Gomes" ] 3 => array:2 [ "nombre" => "Miguel" "apellidos" => "Vieira" ] 4 => array:2 [ "nombre" => "Diana" "apellidos" => "Anjo" ] 5 => array:2 [ "nombre" => "Mario" "apellidos" => "Santos" ] 6 => array:2 [ "nombre" => "Pinheiro" "apellidos" => "Vieira" ] 7 => array:2 [ "nombre" => "Isabel" "apellidos" => "Sá" ] 8 => array:2 [ "nombre" => "Henrique" "apellidos" => "Carvalho" ] 9 => array:2 [ "nombre" => "Severo" "apellidos" => "Torres" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204912000979?idApp=UINPBA00004E" "url" => "/21742049/0000003100000078/v1_201308021407/S2174204912000979/v1_201308021407/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Cardiac thrombus and conduction disorder in takotsubo cardiomyopathy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "513" "paginaFinal" => "516" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Sofia Correia, Nuno Moreno, Alexandra Gonçalves, Vítor Araújo, Teresa Pinho, Rui André Rodrigues, Filipe Macedo, Maria Júlia Maciel" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Ana Sofia" "apellidos" => "Correia" "email" => array:1 [ 0 => "sofiakorreia@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Nuno" "apellidos" => "Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Alexandra" "apellidos" => "Gonçalves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Vítor" "apellidos" => "Araújo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Teresa" "apellidos" => "Pinho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Rui André" "apellidos" => "Rodrigues" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Filipe" "apellidos" => "Macedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Maria Júlia" "apellidos" => "Maciel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital de São João, E.P.E., Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital Padre Américo, Vale do Sousa (Centro Hospitalar Tâmega e Sousa, E.P.E.), Penafiel, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Miocardiopatia de takotsubo complicada com trombo apical e alterações da condução" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 587 "Ancho" => 1800 "Tamanyo" => 141482 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Results of cardiac catheterization. Left ventriculography at end-systole (A) and end-diastole (B) demonstrating typical apical ballooning and double outline apex suggestive of apical thrombus. Results of selective coronary angiography of the left main coronary artery (C) showing no significant stenosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Takotsubo cardiomyopathy (TC), or transient left ventricular apical ballooning syndrome, was first recognized in Japan in 1991.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is characterized by self-limited left ventricular mid and apical akinesia, usually precipitated by profound physical or emotional trauma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> The natural history of TC appears to be benign, requiring supportive therapy until the ventricular dysfunction has resolved,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> but occasionally it has been identified as a precipitant of serious arrhythmias.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6–8</span></a> Ventricular dyskinesia combined with increased sympathetic activation which alters the coagulation cascade may explain the apical thrombus formation sporadically reported in these patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> We present a case of TC associated with apical thrombus and complete heart block. To our knowledge this is the first report of an association of these two complications simultaneously in the same patient.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 78-year-old woman with unremarkable cardiac and medical history was admitted to our hospital because of dyspnea, chest discomfort and dizziness lasting for a week, since she had been physically assaulted by her husband. On physical examination, she was hemodynamically stable and rales were detected in both lungs. The ECG showed complete heart block with wide QRS complexes (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A transthoracic echocardiogram revealed severe left ventricular (LV) systolic dysfunction with akinesia of the mid-apical segments and hyperkinesis of the basal segments. Assuming a possible previous infarction with post-infarction angina and severe conduction abnormalities, cardiac catheterization was performed and temporary transvenous pacing was instituted. The coronary angiography excluded significant coronary vascular disease: 40% stenosis of the mild left anterior descending artery (LAD) and 50% of the distal circumflex coronary artery (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). The left ventriculography demonstrated typical “apical ballooning” and an apical thrombus (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>, <a class="elsevierStyleCrossRef" href="#sec0030">video 1</a>). Contrast echocardiography confirmed the presence of apical thrombus and hypocoagulation therapy was initiated (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient's clinical evolution was favorable, however the LV dysfunction, wall motion abnormalities and AV conduction abnormalities did not improve significantly during the week after admission. Troponin level was maximum at admission (0.79<span class="elsevierStyleHsp" style=""></span>ng/ml). Due to the lack of LV function improvement a temporary coronary occlusion could not be ruled out as the cause of apical ballooning. To better clarify the diagnosis cardiac magnetic resonance imaging was performed, almost two weeks after admission, and showed global (ejection fraction: 50%) and regional (hypokinesis of the 17th segment, lateral and inferior apical segments) improvement of LV function. There was no apical thrombus or delayed enhancement, consistent with the diagnosis of TC (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The echocardiography performed at this time confirmed the resolution of LV systolic function and wall-motion abnormalities. However, the complete AV block persisted and, consequently, a dual-chamber pacemaker was implanted (<a class="elsevierStyleCrossRef" href="#fig0025">Figure 5</a>). Pacemaker check at one year identified persistent complete heart block but the patient was asymptomatic.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">This case demonstrates that complete AV block associated with takotsubo cardiomyopathy may persist after improvement of left ventricular wall motion, and pacemaker implantation may be needed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The physiopathology of TC remains unclear, as does the involvement of the conduction system. It is still not known if in these cases the conduction system is primarily involved or if it suffers the consequence of an acutely distorted cardiac structure. It seems that the remodeling of the ventricle after the acute TC phase recovers within weeks, while the conduction system may take years to recover.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> Further follow-up of this patient will help determine whether the conduction disorder is permanent or will resolve over time.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Authorship</span><p id="par0055" class="elsevierStylePara elsevierViewall">Ana Sofia Correia and Nuno Moreno contributed equally to the paper.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres251837" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec239435" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres251836" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec239436" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Authorship" ] 8 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-09-18" "fechaAceptado" => "2011-11-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec239435" "palabras" => array:3 [ 0 => "Takotsubo cardiomyopathy" 1 => "Complete heart block" 2 => "Apical thrombus" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec239436" "palabras" => array:3 [ 0 => "Miocardiopatia de takotsubo" 1 => "Bloqueio aurículo-ventricular completo" 2 => "Trombo apical" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Takotsubo cardiomyopathy is a reversible form of left ventricular dysfunction with an apparently benign natural history after left ventricular recovery. Rarely there are complications such as arrhythmias and apical thrombus. We describe a case of takotsubo cardiomyopathy complicated with apical thrombus and persistent complete atrioventricular block after improvement of left ventricular wall motion.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A miocardiopatia de takotsubo constitui uma forma transitória e aparentemente benigna de disfunção ventricular esquerda. Raramente cursa com complicações como arritmias e trombos apicais. Descrevemos um caso de miocardiopatia de takotsubo complicada com trombo apical e bloqueio aurículo-ventricular completo persistente após a normalização da contractilidade do ventrículo esquerdo.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0050" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 570 "Ancho" => 1995 "Tamanyo" => 312541 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Electrocardiography at presentation. Complete heart block with wide QRS escape rhythm (left bundle branch block aberration, 59<span class="elsevierStyleHsp" style=""></span>bpm).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 587 "Ancho" => 1800 "Tamanyo" => 141482 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Results of cardiac catheterization. Left ventriculography at end-systole (A) and end-diastole (B) demonstrating typical apical ballooning and double outline apex suggestive of apical thrombus. Results of selective coronary angiography of the left main coronary artery (C) showing no significant stenosis.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 575 "Ancho" => 1500 "Tamanyo" => 89413 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Contrast echocardiography. Left ventricle at end-systole (A) and end-diastole (B) in apical 4-chamber view, showing typical “apical ballooning” and apical thrombus.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 713 "Ancho" => 1000 "Tamanyo" => 90367 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cardiac magnetic resonance imaging in 4-chamber view showing absence of apical thrombus or delayed enhancement.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 893 "Ancho" => 1945 "Tamanyo" => 421319 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Electrocardiography two weeks after presentation: sustained complete heart block (QRS escape rhythm without left bundle branch block aberration) and evolutionary changes in T-wave morphology with inversion and QTc prolongation.</p>" ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mpg" "ficheroTamanyo" => 1540096 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Dote" 1 => "H. Sato" 2 => "H. Tateishi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cardiol" "fecha" => "1991" "volumen" => "21" "paginaInicial" => "203" "paginaFinal" => "214" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1841907" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Gianni" 1 => "F. Dentali" 2 => "A.M. Grandi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehl032" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "1523" "paginaFinal" => "1529" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16720686" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical features of takotsubo cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y.J. Akashi" 1 => "K. Nakazawa" 2 => "M. Sakakibara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "QJM" "fecha" => "2003" "volumen" => "96" "paginaInicial" => "563" "paginaFinal" => "573" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12897341" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K.A. Bybee" 1 => "T. Kara" 2 => "A. Prasad" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2004" "volumen" => "141" "paginaInicial" => "858" "paginaFinal" => "865" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15583228" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apical thrombus associated with Takotsubo Cardiomyopathy in a young woman" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.D. Ricardo Tobar" 1 => "M.D. Renee Rotzak" 2 => "M.D. Yoseph Rozenman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8175.2008.00826.x" "Revista" => array:6 [ "tituloSerie" => "Echocardiography" "fecha" => "2009" "volumen" => "26" "paginaInicial" => "575" "paginaFinal" => "580" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19438699" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of the arrhythmogenicity of stress-induced “Takotsubo cardiomyopathy” from the time course of the 12-lead surface electrocardiogram" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Matsuoka" 1 => "S. Okubo" 2 => "E. Fujii" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2003" "volumen" => "92" "paginaInicial" => "230" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12860233" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complete atrioventricular block associated with takotsubo cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Inoue" 1 => "H. Kanaya" 2 => "T. Matsubara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circ J" "fecha" => "2009" "volumen" => "73" "paginaInicial" => "589" "paginaFinal" => "592" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19075523" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo cardiomyopathy: a novel “proarrhythmic” disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.A. Nault" 1 => "A. Baranchuk" 2 => "C.S. Simpson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anadolu Kardyiol Derg" "fecha" => "2007" "volumen" => "7" "numero" => "Suppl. 1" "paginaInicial" => "101" "paginaFinal" => "103" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003100000078/v1_201308021407/S2174204912001158/v1_201308021407/en/main.assets" "Apartado" => array:4 [ "identificador" => "9919" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003100000078/v1_201308021407/S2174204912001158/v1_201308021407/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204912001158?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 5 | 10 |
| 2024 October | 41 | 35 | 76 |
| 2024 September | 53 | 20 | 73 |
| 2024 August | 49 | 25 | 74 |
| 2024 July | 32 | 28 | 60 |
| 2024 June | 29 | 24 | 53 |
| 2024 May | 46 | 15 | 61 |
| 2024 April | 30 | 26 | 56 |
| 2024 March | 68 | 23 | 91 |
| 2024 February | 28 | 21 | 49 |
| 2024 January | 24 | 22 | 46 |
| 2023 December | 22 | 24 | 46 |
| 2023 November | 40 | 25 | 65 |
| 2023 October | 26 | 10 | 36 |
| 2023 September | 27 | 21 | 48 |
| 2023 August | 23 | 23 | 46 |
| 2023 July | 27 | 6 | 33 |
| 2023 June | 19 | 20 | 39 |
| 2023 May | 34 | 28 | 62 |
| 2023 April | 22 | 4 | 26 |
| 2023 March | 33 | 20 | 53 |
| 2023 February | 34 | 14 | 48 |
| 2023 January | 21 | 16 | 37 |
| 2022 December | 36 | 17 | 53 |
| 2022 November | 37 | 23 | 60 |
| 2022 October | 25 | 18 | 43 |
| 2022 September | 21 | 20 | 41 |
| 2022 August | 25 | 22 | 47 |
| 2022 July | 30 | 29 | 59 |
| 2022 June | 19 | 24 | 43 |
| 2022 May | 20 | 23 | 43 |
| 2022 April | 28 | 31 | 59 |
| 2022 March | 23 | 27 | 50 |
| 2022 February | 23 | 28 | 51 |
| 2022 January | 19 | 17 | 36 |
| 2021 December | 18 | 24 | 42 |
| 2021 November | 37 | 29 | 66 |
| 2021 October | 40 | 40 | 80 |
| 2021 September | 21 | 21 | 42 |
| 2021 August | 25 | 26 | 51 |
| 2021 July | 22 | 19 | 41 |
| 2021 June | 19 | 19 | 38 |
| 2021 May | 28 | 42 | 70 |
| 2021 April | 19 | 33 | 52 |
| 2021 March | 44 | 9 | 53 |
| 2021 February | 46 | 9 | 55 |
| 2021 January | 25 | 8 | 33 |
| 2020 December | 20 | 5 | 25 |
| 2020 November | 30 | 16 | 46 |
| 2020 October | 37 | 13 | 50 |
| 2020 September | 49 | 9 | 58 |
| 2020 August | 25 | 6 | 31 |
| 2020 July | 42 | 13 | 55 |
| 2020 June | 42 | 8 | 50 |
| 2020 May | 37 | 10 | 47 |
| 2020 April | 34 | 12 | 46 |
| 2020 March | 35 | 11 | 46 |
| 2020 February | 39 | 18 | 57 |
| 2020 January | 41 | 8 | 49 |
| 2019 December | 24 | 7 | 31 |
| 2019 November | 28 | 6 | 34 |
| 2019 October | 42 | 4 | 46 |
| 2019 September | 18 | 12 | 30 |
| 2019 August | 16 | 5 | 21 |
| 2019 July | 46 | 9 | 55 |
| 2019 June | 19 | 8 | 27 |
| 2019 May | 40 | 11 | 51 |
| 2019 April | 23 | 17 | 40 |
| 2019 March | 92 | 7 | 99 |
| 2019 February | 54 | 9 | 63 |
| 2019 January | 30 | 6 | 36 |
| 2018 December | 35 | 8 | 43 |
| 2018 November | 104 | 15 | 119 |
| 2018 October | 210 | 13 | 223 |
| 2018 September | 41 | 10 | 51 |
| 2018 August | 40 | 3 | 43 |
| 2018 July | 30 | 8 | 38 |
| 2018 June | 67 | 5 | 72 |
| 2018 May | 68 | 5 | 73 |
| 2018 April | 68 | 21 | 89 |
| 2018 March | 65 | 6 | 71 |
| 2018 February | 30 | 3 | 33 |
| 2018 January | 72 | 4 | 76 |
| 2017 December | 37 | 6 | 43 |
| 2017 November | 31 | 11 | 42 |
| 2017 October | 29 | 12 | 41 |
| 2017 September | 35 | 14 | 49 |
| 2017 August | 28 | 23 | 51 |
| 2017 July | 21 | 11 | 32 |
| 2017 June | 37 | 23 | 60 |
| 2017 May | 37 | 6 | 43 |
| 2017 April | 39 | 1 | 40 |
| 2017 March | 27 | 9 | 36 |
| 2017 February | 40 | 6 | 46 |
| 2017 January | 33 | 3 | 36 |
| 2016 December | 39 | 12 | 51 |
| 2016 November | 32 | 4 | 36 |
| 2016 October | 36 | 3 | 39 |
| 2016 September | 36 | 6 | 42 |
| 2016 August | 10 | 2 | 12 |
| 2016 July | 12 | 3 | 15 |
| 2016 June | 4 | 1 | 5 |
| 2016 May | 15 | 3 | 18 |
| 2016 April | 10 | 7 | 17 |
| 2016 March | 17 | 9 | 26 |
| 2016 February | 16 | 3 | 19 |
| 2016 January | 11 | 7 | 18 |
| 2015 December | 15 | 0 | 15 |
| 2015 November | 15 | 4 | 19 |
| 2015 October | 16 | 8 | 24 |
| 2015 September | 24 | 5 | 29 |
| 2015 August | 13 | 4 | 17 |
| 2015 July | 8 | 1 | 9 |
| 2015 June | 13 | 7 | 20 |
| 2015 May | 12 | 0 | 12 |
| 2015 April | 23 | 5 | 28 |
| 2015 March | 6 | 1 | 7 |
| 2015 February | 16 | 2 | 18 |
| 2015 January | 15 | 3 | 18 |
| 2014 December | 22 | 6 | 28 |
| 2014 November | 7 | 1 | 8 |
| 2014 October | 12 | 3 | 15 |
| 2014 September | 17 | 0 | 17 |
| 2014 August | 17 | 6 | 23 |
| 2014 July | 26 | 6 | 32 |
| 2014 June | 30 | 4 | 34 |
| 2014 May | 29 | 3 | 32 |
| 2014 April | 24 | 2 | 26 |
| 2014 March | 29 | 9 | 38 |
| 2014 February | 41 | 7 | 48 |
| 2014 January | 34 | 10 | 44 |
| 2013 December | 30 | 5 | 35 |
| 2013 November | 31 | 6 | 37 |
| 2013 October | 32 | 9 | 41 |
| 2013 September | 24 | 10 | 34 |
| 2013 August | 36 | 13 | 49 |
| 2013 July | 42 | 15 | 57 |
| 2013 June | 24 | 7 | 31 |
| 2013 May | 29 | 8 | 37 |
| 2013 April | 45 | 17 | 62 |
| 2013 March | 20 | 10 | 30 |
| 2013 February | 37 | 16 | 53 |
| 2013 January | 32 | 11 | 43 |
| 2012 December | 28 | 7 | 35 |
| 2012 November | 16 | 6 | 22 |
| 2012 October | 3 | 2 | 5 |
| 2012 September | 3 | 3 | 6 |
Show all
