Case report
Stunned myocardium after an anesthetic procedure in a pediatric patient – case report
Síndrome Takotsubo após procedimento anestésico em idade pediátrica – um caso clínico
Joana Faleiro Oliveiraa,
, Susana Rebelo Pachecoa, Marta Monizb, Pedro Nunesb, Clara Abadessob, Mónica Rebeloc, Helena Loureirob, Helena Almeidab
Corresponding author
a Departamento de Pediatria, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
b Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
c Unidade de Cardiologia Pediátrica, Departamento de Pediatria do Hospital de Santa Maria, CHLN, Lisboa, Portugal
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Rebelo, Helena Loureiro, Helena Almeida" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Joana Faleiro" "apellidos" => "Oliveira" "email" => array:1 [ 0 => "oliveira.joana@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" => "Susana Rebelo" "apellidos" => "Pacheco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Marta" "apellidos" => "Moniz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Pedro" "apellidos" => "Nunes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Clara" "apellidos" => "Abadesso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Mónica" "apellidos" => "Rebelo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Helena" "apellidos" => "Loureiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "Helena" "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Pediatria, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidade de Cardiologia Pediátrica, Departamento de Pediatria do Hospital de Santa Maria, CHLN, Lisboa, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Síndrome Takotsubo após procedimento anestésico em idade pediátrica – um caso clínico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1068 "Ancho" => 3167 "Tamanyo" => 489959 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Electrocardiogram showing sinus tachycardia and ST-segment depression in V4 and V5.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0035" class="elsevierStylePara elsevierViewall">Takotsubo syndrome (TTS) is one of the unclassified cardiomyopathies, nonfamilial form.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> It is an acquired transient type of systolic dysfunction which mimics myocardial infarction clinically and electrocardiographically.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> TTS is also known as stress cardiomyopathy, broken heart syndrome, apical ballooning, reversible acute heart failure, neurogenic stunned myocardium or acute catecholamine cardiomyopathy.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Various pathophysiological mechanisms have been proposed but the most widely accepted is an excess of catecholamines, leading to disruption of contraction and ventricular function,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> which return to baseline values within days or weeks.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> The clinical setting depends on the extent of myocardium affected and associated complications, which can include chest pain, dyspnea, palpitations, diaphoresis, nausea, vomiting or neurological symptoms.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The authors describe a case of TTS in a pediatric patient after an anesthetic procedure, which presented as heart failure and acute pulmonary edema.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0050" class="elsevierStylePara elsevierViewall">A 14-year-old girl with a history of hemiplegic migraine and pineal cyst was admitted for control brain magnetic resonance imaging (MRI). During anesthesia induction with propofol she suffered bradycardia, which was reversed with atropine, followed by ventricular tachyarrhythmia, reversed with lidocaine and precordial thump. Within hours she developed pulmonary edema (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>) and global respiratory failure (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> 156, pCO<span class="elsevierStyleInf">2</span> 57 mmHg) and hypotension (systolic/diastolic blood pressure 89/56 mmHg). The transthoracic echocardiogram showed a dilated left ventricle with global hypokinesia of the mid and basal segments but sparing the apex, resulting in moderate to severe impairment of left ventricular global systolic function and reduced ejection fraction (<30%) (<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2 and 3</a>). The electrocardiogram (ECG) showed persistent sinus tachycardia and nonspecific ST-T wave abnormalities in V4 and V5 (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>). Cardiac biomarkers were elevated (total creatine kinase [CK] 217 UI/l, troponin I 2.42 ng/ml and pro-brain natriuretic peptide [proBNP] 8284 pg/ml). The patient was placed on diuretics and captopril, with dopamine to optimize renal function (maximum 2 μg/kg/min) and digoxin in the first 24 h.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Repeat echocardiography was performed daily, and the patient showed clinical and echocardiographic improvement within 48 h and complete recovery of left ventricular systolic function on day 4. Cardiac biomarkers decreased in the first few days (troponin I 0.69 ng/ml on day 2 and 0.44 ng/ml on day 3; proBNP 2842 pg/ml on day 3), with normalization of total CK and troponin I and a significant fall in proBNP (329 pg/ml) on day 6. Diuretics were discontinued on day 9 and the patient was discharged, medicated with carvedilol. Cardiac MRI showed no alterations such as myocarditis scar or infarct scar, and carvedilol was discontinued. Other diagnostic tests showed normal thyroid function and negative viral serologies for CMV, EBV, HSV-1, HSV-2, HSV-6, parvovirus, adenovirus, influenza A and enterovirus. The patient is being regularly followed in pediatric cardiology consultations.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors describe the case of an adolescent girl who, in the context of emotional stress triggered by anesthesia induction, developed heart failure with acute pulmonary edema, elevation of cardiac biomarkers and nonspecific electrocardiographic alterations, and subsequently completely recovered cardiac function. This presentation is suggestive of TTS, which most commonly occurs between 60 and 75 years of age and is rare at pediatric ages. There are only 28 reported cases in this age-group, some in the context of acute disorders including cancer of the central nervous system or traumatic brain injury.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> However, TTS can also occur without neurological involvement, in the context of systemic disease including celiac disease or infection, ventricular septal defect or ventricular tachycardia, and even with no known triggering factor.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Other triggers, such as emotional or physical stress, have been described in adults.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> According to the literature, there has been one case to date of TTS associated with an anesthetic procedure in an adult<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> and a few cases in pediatric patients in the postoperative period following neurosurgery, which were considered neurogenic.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The first diagnostic criteria were proposed by the Mayo Clinic in 2004,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> and revised in 2010, and are considered the classic criteria. They are as follows: 1) transient hypokinesis, akinesis or dyskinesis of the left ventricular mid segments, with or without apical involvement, with regional wall motion abnormalities extending beyond a single epicardial vascular distribution; a stressful trigger is often, but not always, present; 2) absence of obstructive coronary disease or angiographic evidence of acute plaque rupture; 3) new electrocardiographic abnormalities (ST-segment elevation and/or T-wave inversion), or modest elevation in cardiac troponin level; 4) absence of pheochromocytoma or myocarditis.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9,10</span></a> Nevertheless, these criteria are not consensual and various other guidelines have been proposed over the years for the diagnosis of TTS. In 2007 the Japanese Circulation Society published their own guidelines, which included a revised definition of TTS and exclusion and reference criteria for the diagnosis.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> These are now considered outmoded, since they exclude atypical forms of TTS in which cardiac segments other than the apex are involved, which have now been reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> In 2012 the Johns Hopkins diagnostic criteria were published, which include mandatory and optional criteria, and exclude TTS in patients with a history of acute coronary syndrome.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> The Gothenburg criteria were also presented in 2012, in which the main difference from the Mayo Clinic criteria relates to the possibility of under-diagnosing TTS if all patients with coronary disease or pheochromocytoma are excluded. They also highlight the possibility of milder forms of TTS or different degrees of TTS-like cardiac dysfunction in the general population.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> In 2014, in the light of increased clinical experience, new TTS diagnostic criteria were proposed that included two new notions: of <span class="elsevierStyleItalic">formes frustes</span> of TTS and of comorbidities that precipitate or are brought about by TTS, such as acute coronary disease.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The classic Mayo Clinic diagnostic criteria require cardiac catheterization for a diagnosis of TTS. However, according to some case reports, this may not be necessary in pediatric patients depending on the clinical course and if laboratory and echocardiographic findings are typical and favorable.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4,15,16</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">TTS may present echocardiographically in the classical form (with apical ballooning and involvement of the apical or mid-apical segments) or the inverted form (with involvement of the mid, basal or mid-basal segments).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> The case presented was of the inverted or global form, both reported at pediatric ages.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Treatment of TTS is basically supportive and includes angiotensin-converting enzyme inhibitors, beta-blockers, calcium antagonists or diuretics,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> which can be used until recovery of cardiac function.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> The prognosis of TTS is good,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,3</span></a> and cardiac biomarkers normalize within 5-7 days,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> the ECG within 10 weeks and the echocardiogram within six weeks after onset.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> The time to recovery of cardiac function in pediatric patients is less well established<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> but it appears to occur earlier in some cases, even as early as seven days after diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4,6,15</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In the case presented, the anesthetic procedure, together with possible associated emotional stress, may have triggered TTS. The diagnosis should be considered in children and adolescents with signs of cardiac dysfunction in the context of anesthesia induction and/or situations of emotional or physical stress.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres824765" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec821223" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres824766" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec821224" "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:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-06-14" "fechaAceptado" => "2015-09-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec821223" "palabras" => array:3 [ 0 => "Takotsubo syndrome" 1 => "Stunned myocardium" 2 => "Pediatric population" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec821224" "palabras" => array:3 [ 0 => "Síndrome Takotsubo" 1 => "Miocárdio atordoado" 2 => "Idade pediátrica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Takotsubo syndrome (TTS) is an acquired transient type of systolic dysfunction which mimics myocardial infarction clinically and electrocardiographically. TTS is also known as stress cardiomyopathy, broken heart syndrome, apical ballooning, reversible acute heart failure, neurogenic stunned myocardium or acute catecholamine cardiomyopathy. This case report describes an uncommon presentation of myocardial stunning after an anesthetic procedure.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 14-year-old girl with a history of pineal cyst and hemiplegic migraine was admitted for control brain magnetic resonance imaging. During anesthesia induction with propofol she suffered bradycardia, which was reversed with atropine, followed by tachyarrhythmia, reversed with lidocaine and precordial thump. Within hours she developed pulmonary edema and global respiratory failure due to acute left ventricular dysfunction. A transthoracic echocardiogram showed a dilated left ventricle with global hypokinesia and depressed left ventricular systolic function (ejection fraction <30%). The electrocardiogram showed persistent sinus tachycardia and nonspecific ST-T wave abnormalities. Cardiac biomarkers were elevated (troponin 2.42 ng/ml, proBNP 8248 pg/ml). She was placed on diuretics, angiotensin-converting enzyme inhibitors, digoxin and dopamine. The clinical course was satisfactory with clinical, biochemical and echocardiographic improvement within four days. Subsequent echocardiograms showed no ventricular dysfunction. The patient was discharged home on carvedilol, which was discontinued after normalization of cardiac function on cardiac magnetic resonance imaging.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Few cases of TTS have been described in children, some of them triggered by acute central nervous system disorders and others not fulfilling all the classical diagnostic criteria. In this case the anesthetic procedure probably triggered the TTS.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A síndrome Takotsubo (STT) é uma forma adquirida e transitória de disfunção sistólica, cuja apresentação clínica e eletrocardiográfica mimetiza um enfarte agudo do miocárdio. A STT é também conhecida como miocardiopatia de <span class="elsevierStyleItalic">stress</span>, síndrome do «coração partido», balonamento apical, insuficiência cardíaca aguda reversível, miocárdio «atordoado» (forma neurogénica) ou miocardiopatia aguda das catecolaminas. Os autores descrevem uma apresentação rara de STT após procedimento anestésico.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Adolescente de 14 anos, sexo feminino, com antecedentes pessoais de enxaqueca hemiplégica e quisto pineal, submetida a ressonância magnética (RM) cranioencefálica de controlo. Durante a indução anestésica com propofol verificou-se bradicardia, revertida com atropina, seguida de taquidisritmia ventricular, revertida com lidocaína e murro pré-cordial. Nas primeiras horas de internamento evoluiu para edema pulmonar associado a insuficiência respiratória global por disfunção ventricular esquerda aguda. O ecocardiograma transtorácico mostrou dilatação do ventrículo esquerdo com hipocinesia global e fração de ejeção reduzida (<30%). O eletrocardiograma revelou taquicardia sinusal persistente e alterações inespecíficas do segmento ST. Os biomarcadores cardíacos encontravam-se elevados (troponina 2,42 ng/ml, proBNP 8248 pg/ml). Foi medicada com diuréticos, IECA, digitálico e dopamina, com melhoria clínica, bioquímica e ecocardiográfica ao quarto dia. Os ecocardiogramas subsequentes mostraram normalização da função ventricular. A doente teve alta medicada com carvedilol, que suspendeu após normalização da função cardíaca e RM cardíaca não ter revelado alterações.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estão descritos poucos casos de STT em idade pediátrica. Alguns são desencadeados por patologia aguda do sistema nervoso central, mas nem todos cumprem os critérios de diagnóstico clássicos. Neste caso, o procedimento anestésico poderá ter desencadeado a STT.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Oliveira JF, Pacheco SR, Moniz M, et al. Síndrome Takotsubo após procedimento anestésico em idade pediátrica – um caso clínico. Rev Port Cardiol. 2016;35:375.e1–375e5.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1357 "Ancho" => 1585 "Tamanyo" => 83944 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray at admission showing acute pulmonary edema.</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" => 1587 "Ancho" => 1500 "Tamanyo" => 133271 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Echocardiogram at admission, short-axis parasternal view, showing global left ventricular hypocontractility.</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" => 973 "Ancho" => 1583 "Tamanyo" => 92455 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Echocardiogram at admission, long-axis parasternal view, showing left ventricular dilatation.</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" => 1068 "Ancho" => 3167 "Tamanyo" => 489959 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Electrocardiogram showing sinus tachycardia and ST-segment depression in V4 and V5.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Miocardiopatia Takotsubo: estado de arte" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Nóbrega" 1 => "D. Brito" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2012.02.014" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "589" "paginaFinal" => "596" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22795894" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0090" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Two pediatric cases of variant neurogenic stress cardiomyopathy after intracranial hemorrhage" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.G. Wittekind" 1 => "O. Yanay" 2 => "E.M. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatrics" "fecha" => "2014" "volumen" => "134" "paginaInicial" => "1211" "paginaFinal" => "1217" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0095" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurological and non-neurological triggers of Takotsubo syndrome in the pediatric population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Finsterer" 1 => "C. Stollberger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2014.11.080" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2015" "volumen" => "179" "paginaInicial" => "345" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25464483" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0100" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurogenic stunned myocardium after acute hydrocephalus. Report of 2 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Johnson" 1 => "J. Ragheb" 2 => "R. Garg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neurosurg Pediatrics" "fecha" => "2010" "volumen" => "5" "paginaInicial" => "428" "paginaFinal" => "433" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0105" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo syndrome in an anaesthetized patient undergoing arthroscopic knee surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Artukoglu" 1 => "A. Owen" 2 => "T. Hemmerling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Card Anaest" "fecha" => "2008" "volumen" => "11" "paginaInicial" => "38" "paginaFinal" => "41" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0110" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurogenic stunned myocardium: an unusual postoperative complication" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Drayer" 1 => "J. Geracht" 2 => "A. Madikians" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.PCC.0000225370.67241.AE" "Revista" => array:6 [ "tituloSerie" => "Pediatr Crit Care Med" "fecha" => "2006" "volumen" => "7" "paginaInicial" => "374" "paginaFinal" => "376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16738505" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0115" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurogenic stunned myocardium in pediatrics. A case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F.J. Alados" 1 => "L. Millán-Miralles" 2 => "M.P. Millán-Bueno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2014.10.010" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2015" "volumen" => "62" "paginaInicial" => "472" "paginaFinal" => "476" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25530429" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0120" "etiqueta" => "8" "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:5 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2004" "volumen" => "141" "paginaInicial" => "58" "paginaFinal" => "65" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0125" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Apical ballooning syndrome (takotsubo or stress cardiomyopathy): a mimic of acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Prasad" 1 => "A. Lerman" 2 => "C.S. Rhial" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ahj.2007.11.008" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2008" "volumen" => "155" "paginaInicial" => "408" "paginaFinal" => "417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18294473" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0130" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proposed Mayo Clinic criteria for the diagnosis of tako-tsubo cardiomyopathy and long-term prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Madhavan" 1 => "A. Prasad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00059-010-3339-x" "Revista" => array:6 [ "tituloSerie" => "Herz" "fecha" => "2010" "volumen" => "35" "paginaInicial" => "240" "paginaFinal" => "244" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20582391" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0135" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Takotsubo Cardiomyopathy Group" "etal" => false "autores" => array:3 [ 0 => "S. Kawai" 1 => "A. Kitabatake" 2 => "H. Tomoike" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circ J" "fecha" => "2007" "volumen" => "71" "paginaInicial" => "990" "paginaFinal" => "992" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17527002" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0140" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Why the current diagnostic criteria of Takotsubo syndrome are outmoded: a proposal for new criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.E. Madias" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2014.04.241" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2014" "volumen" => "174" "paginaInicial" => "468" "paginaFinal" => "470" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24820748" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0145" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stress cardiomyopathy: a syndrome of catecholamine-mediated myocardial stunning?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I.S. Wittstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10571-012-9804-8" "Revista" => array:6 [ "tituloSerie" => "Cell Mol Neurobiol" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "847" "paginaFinal" => "857" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22297544" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0150" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stress-induced cardiomyopathy (takotsubo) – broken heart and mind?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Redfors" 1 => "Y. Shao" 2 => "E. Omeric" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/VHRM.S40163" "Revista" => array:6 [ "tituloSerie" => "Vasc Health Risk Manag" "fecha" => "2013" "volumen" => "9" "paginaInicial" => "149" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23626469" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0155" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute myelitis with neurogenic stunned myocardium in a boy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.-J. Lin" 1 => "S.-H. Hsia" 2 => "C.-T. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pediatrneurol.2010.05.020" "Revista" => array:6 [ "tituloSerie" => "Pediatr Neurol" "fecha" => "2010" "volumen" => "43" "paginaInicial" => "348" "paginaFinal" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20933179" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0160" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurogenic stunned myocardium presenting as left ventricular hypertrabeculation in childhood: a variant of takotsubo cardiomyopathy?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. De Rosa" 1 => "M. Pardeo" 2 => "C. Di Rocco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatr Crit Med" "fecha" => "2011" "volumen" => "12" "paginaInicial" => "420" "paginaFinal" => "423" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003500000006/v2_201704050129/S2174204916300289/v2_201704050129/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/21742049/0000003500000006/v2_201704050129/S2174204916300289/v2_201704050129/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916300289?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 6 | 11 |
| 2024 October | 31 | 30 | 61 |
| 2024 September | 41 | 23 | 64 |
| 2024 August | 43 | 39 | 82 |
| 2024 July | 36 | 35 | 71 |
| 2024 June | 24 | 24 | 48 |
| 2024 May | 56 | 28 | 84 |
| 2024 April | 28 | 26 | 54 |
| 2024 March | 35 | 27 | 62 |
| 2024 February | 30 | 38 | 68 |
| 2024 January | 26 | 38 | 64 |
| 2023 December | 24 | 35 | 59 |
| 2023 November | 27 | 20 | 47 |
| 2023 October | 33 | 16 | 49 |
| 2023 September | 25 | 16 | 41 |
| 2023 August | 32 | 14 | 46 |
| 2023 July | 41 | 13 | 54 |
| 2023 June | 32 | 11 | 43 |
| 2023 May | 37 | 26 | 63 |
| 2023 April | 25 | 9 | 34 |
| 2023 March | 46 | 24 | 70 |
| 2023 February | 38 | 25 | 63 |
| 2023 January | 32 | 17 | 49 |
| 2022 December | 45 | 32 | 77 |
| 2022 November | 35 | 26 | 61 |
| 2022 October | 33 | 22 | 55 |
| 2022 September | 20 | 24 | 44 |
| 2022 August | 30 | 36 | 66 |
| 2022 July | 26 | 34 | 60 |
| 2022 June | 24 | 18 | 42 |
| 2022 May | 31 | 31 | 62 |
| 2022 April | 34 | 28 | 62 |
| 2022 March | 23 | 34 | 57 |
| 2022 February | 19 | 20 | 39 |
| 2022 January | 34 | 28 | 62 |
| 2021 December | 20 | 30 | 50 |
| 2021 November | 39 | 39 | 78 |
| 2021 October | 35 | 36 | 71 |
| 2021 September | 44 | 31 | 75 |
| 2021 August | 33 | 31 | 64 |
| 2021 July | 29 | 30 | 59 |
| 2021 June | 34 | 16 | 50 |
| 2021 May | 40 | 41 | 81 |
| 2021 April | 53 | 33 | 86 |
| 2021 March | 71 | 27 | 98 |
| 2021 February | 65 | 24 | 89 |
| 2021 January | 33 | 31 | 64 |
| 2020 December | 50 | 17 | 67 |
| 2020 November | 25 | 16 | 41 |
| 2020 October | 30 | 12 | 42 |
| 2020 September | 58 | 7 | 65 |
| 2020 August | 23 | 9 | 32 |
| 2020 July | 39 | 18 | 57 |
| 2020 June | 34 | 15 | 49 |
| 2020 May | 31 | 21 | 52 |
| 2020 April | 26 | 26 | 52 |
| 2020 March | 34 | 11 | 45 |
| 2020 February | 56 | 44 | 100 |
| 2020 January | 59 | 3 | 62 |
| 2019 December | 24 | 13 | 37 |
| 2019 November | 36 | 15 | 51 |
| 2019 October | 48 | 8 | 56 |
| 2019 September | 50 | 7 | 57 |
| 2019 August | 34 | 8 | 42 |
| 2019 July | 23 | 10 | 33 |
| 2019 June | 38 | 15 | 53 |
| 2019 May | 27 | 9 | 36 |
| 2019 April | 22 | 17 | 39 |
| 2019 March | 47 | 10 | 57 |
| 2019 February | 40 | 14 | 54 |
| 2019 January | 53 | 12 | 65 |
| 2018 December | 57 | 13 | 70 |
| 2018 November | 171 | 13 | 184 |
| 2018 October | 377 | 15 | 392 |
| 2018 September | 89 | 16 | 105 |
| 2018 August | 88 | 6 | 94 |
| 2018 July | 49 | 9 | 58 |
| 2018 June | 59 | 4 | 63 |
| 2018 May | 84 | 8 | 92 |
| 2018 April | 82 | 13 | 95 |
| 2018 March | 148 | 12 | 160 |
| 2018 February | 69 | 4 | 73 |
| 2018 January | 123 | 14 | 137 |
| 2017 December | 93 | 13 | 106 |
| 2017 November | 54 | 11 | 65 |
| 2017 October | 46 | 22 | 68 |
| 2017 September | 39 | 12 | 51 |
| 2017 August | 39 | 20 | 59 |
| 2017 July | 32 | 14 | 46 |
| 2017 June | 38 | 10 | 48 |
| 2017 May | 45 | 9 | 54 |
| 2017 April | 23 | 3 | 26 |
| 2017 March | 45 | 2 | 47 |
| 2017 February | 47 | 8 | 55 |
| 2017 January | 34 | 7 | 41 |
| 2016 December | 49 | 6 | 55 |
| 2016 November | 59 | 2 | 61 |
| 2016 October | 60 | 13 | 73 |
| 2016 September | 82 | 11 | 93 |
| 2016 August | 14 | 2 | 16 |
| 2016 July | 52 | 28 | 80 |
| 2016 June | 9 | 39 | 48 |
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