Letter to the Editor
Takotsubo cardiomyopathy and chronic obstructive pulmonary disease
Miocardiopatia Takotsubo e doença pulmonar obstrutiva crónica
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(March 2014 issue of the <span class="elsevierStyleItalic">Portuguese Journal of Cardiology</span>) of a 56-year-old male with chronic obstructive pulmonary disease (COPD) who developed stress-induced cardiomyopathy associated with ipratropium bromide use, administered in the context of an acute exacerbation of COPD.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although this timely and interesting case report provides important information, we would like to share some thoughts.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Acute COPD exacerbation and acute respiratory failure (hypoxemic and/or hypercapnic) have been described<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> as potential physical triggers of takotsubo cardiomyopathy (TCM). In a study by Sharkey et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> acute respiratory failure and COPD exacerbation were among the most prevalent physical triggers.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Hypoxemia and hypercapnia can induce sympathetic nerve stimulation; the effect of hypoxemia alone can produce a longer-lasting sympathetic activation than hypercapnia, however if both occur simultaneously the result may be a significant increase in sympathetic activity with concomitant increase in catecholamine release,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> which has been widely implicated in the etiology of TCM.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Acidosis has been associated with high levels of catecholamine release and may have negative inotropic effects secondary to decreasing calcium release from the sarcoplasmic reticulum. Acidosis-induced cardiomyocyte injury has been reported.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> Inhaled beta 2 agonists used in acute asthma and COPD exacerbation have also been implied as potential triggers of TCM.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Rarely, paradoxical bronchospasm may occur in the setting of inhaled ipratropium; however, this should be carefully distinguished from inadequate response and from transient nocturnal desaturation in COPD.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This patient had hypercapnia and respiratory acidosis and used inhaled salbutamol. We wonder why COPD exacerbation itself (especially in the context of a left paratracheal consolidation suggesting community-acquired pneumonia, which could potentially add hypoxia to this clinical scenario) was not considered the most likely trigger of TCM instead of a rare paradoxical reaction to an anticholinergic drug.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">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:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural history and expansive clinical profile of stress (tako tsubo) cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.W. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 11 | 10 | 21 |
| 2024 Outubro | 39 | 40 | 79 |
| 2024 Setembro | 51 | 27 | 78 |
| 2024 Agosto | 46 | 36 | 82 |
| 2024 Julho | 32 | 27 | 59 |
| 2024 Junho | 34 | 21 | 55 |
| 2024 Maio | 32 | 23 | 55 |
| 2024 Abril | 32 | 24 | 56 |
| 2024 Maro | 34 | 21 | 55 |
| 2024 Fevereiro | 32 | 28 | 60 |
| 2024 Janeiro | 28 | 27 | 55 |
| 2023 Dezembro | 35 | 21 | 56 |
| 2023 Novembro | 30 | 18 | 48 |
| 2023 Outubro | 14 | 13 | 27 |
| 2023 Setembro | 27 | 22 | 49 |
| 2023 Agosto | 26 | 17 | 43 |
| 2023 Julho | 17 | 8 | 25 |
| 2023 Junho | 29 | 10 | 39 |
| 2023 Maio | 32 | 24 | 56 |
| 2023 Abril | 14 | 6 | 20 |
| 2023 Maro | 20 | 23 | 43 |
| 2023 Fevereiro | 19 | 16 | 35 |
| 2023 Janeiro | 12 | 13 | 25 |
| 2022 Dezembro | 22 | 19 | 41 |
| 2022 Novembro | 39 | 21 | 60 |
| 2022 Outubro | 23 | 14 | 37 |
| 2022 Setembro | 27 | 27 | 54 |
| 2022 Agosto | 31 | 28 | 59 |
| 2022 Julho | 33 | 32 | 65 |
| 2022 Junho | 19 | 20 | 39 |
| 2022 Maio | 22 | 41 | 63 |
| 2022 Abril | 31 | 31 | 62 |
| 2022 Maro | 26 | 34 | 60 |
| 2022 Fevereiro | 30 | 25 | 55 |
| 2022 Janeiro | 15 | 20 | 35 |
| 2021 Dezembro | 14 | 31 | 45 |
| 2021 Novembro | 33 | 30 | 63 |
| 2021 Outubro | 21 | 42 | 63 |
| 2021 Setembro | 22 | 38 | 60 |
| 2021 Agosto | 26 | 24 | 50 |
| 2021 Julho | 26 | 23 | 49 |
| 2021 Junho | 18 | 17 | 35 |
| 2021 Maio | 17 | 25 | 42 |
| 2021 Abril | 38 | 17 | 55 |
| 2021 Maro | 63 | 18 | 81 |
| 2021 Fevereiro | 69 | 13 | 82 |
| 2021 Janeiro | 32 | 8 | 40 |
| 2020 Dezembro | 28 | 8 | 36 |
| 2020 Novembro | 42 | 10 | 52 |
| 2020 Outubro | 18 | 5 | 23 |
| 2020 Setembro | 45 | 12 | 57 |
| 2020 Agosto | 15 | 11 | 26 |
| 2020 Julho | 68 | 11 | 79 |
| 2020 Junho | 28 | 6 | 34 |
| 2020 Maio | 49 | 6 | 55 |
| 2020 Abril | 40 | 4 | 44 |
| 2020 Maro | 37 | 4 | 41 |
| 2020 Fevereiro | 51 | 47 | 98 |
| 2020 Janeiro | 30 | 16 | 46 |
| 2019 Dezembro | 27 | 11 | 38 |
| 2019 Novembro | 30 | 5 | 35 |
| 2019 Outubro | 51 | 3 | 54 |
| 2019 Setembro | 11 | 7 | 18 |
| 2019 Agosto | 34 | 7 | 41 |
| 2019 Julho | 44 | 11 | 55 |
| 2019 Junho | 21 | 10 | 31 |
| 2019 Maio | 35 | 11 | 46 |
| 2019 Abril | 21 | 17 | 38 |
| 2019 Maro | 22 | 14 | 36 |
| 2019 Fevereiro | 46 | 13 | 59 |
| 2019 Janeiro | 15 | 6 | 21 |
| 2018 Dezembro | 19 | 14 | 33 |
| 2018 Novembro | 47 | 7 | 54 |
| 2018 Outubro | 88 | 15 | 103 |
| 2018 Setembro | 28 | 11 | 39 |
| 2018 Agosto | 27 | 9 | 36 |
| 2018 Julho | 25 | 8 | 33 |
| 2018 Junho | 31 | 5 | 36 |
| 2018 Maio | 53 | 9 | 62 |
| 2018 Abril | 47 | 4 | 51 |
| 2018 Maro | 100 | 14 | 114 |
| 2018 Fevereiro | 22 | 2 | 24 |
| 2018 Janeiro | 18 | 6 | 24 |
| 2017 Dezembro | 45 | 8 | 53 |
| 2017 Novembro | 26 | 11 | 37 |
| 2017 Outubro | 27 | 10 | 37 |
| 2017 Setembro | 28 | 8 | 36 |
| 2017 Agosto | 35 | 10 | 45 |
| 2017 Julho | 25 | 10 | 35 |
| 2017 Junho | 24 | 23 | 47 |
| 2017 Maio | 25 | 5 | 30 |
| 2017 Abril | 12 | 5 | 17 |
| 2017 Maro | 21 | 50 | 71 |
| 2017 Fevereiro | 22 | 8 | 30 |
| 2017 Janeiro | 20 | 4 | 24 |
| 2016 Dezembro | 20 | 9 | 29 |
| 2016 Novembro | 22 | 17 | 39 |
| 2016 Outubro | 19 | 7 | 26 |
| 2016 Setembro | 14 | 8 | 22 |
| 2016 Agosto | 14 | 4 | 18 |
| 2016 Julho | 9 | 9 | 18 |
| 2016 Junho | 5 | 18 | 23 |
| 2016 Maio | 10 | 0 | 10 |
| 2016 Abril | 31 | 5 | 36 |
| 2016 Maro | 47 | 9 | 56 |
| 2016 Fevereiro | 71 | 21 | 92 |
| 2016 Janeiro | 42 | 8 | 50 |
| 2015 Dezembro | 48 | 12 | 60 |
| 2015 Novembro | 41 | 10 | 51 |
| 2015 Outubro | 55 | 13 | 68 |
| 2015 Setembro | 52 | 12 | 64 |
| 2015 Agosto | 46 | 10 | 56 |
| 2015 Julho | 31 | 15 | 46 |
| 2015 Junho | 41 | 6 | 47 |
| 2015 Maio | 49 | 11 | 60 |
| 2015 Abril | 36 | 7 | 43 |
| 2015 Maro | 34 | 8 | 42 |
| 2015 Fevereiro | 38 | 8 | 46 |
| 2015 Janeiro | 33 | 17 | 50 |
| 2014 Dezembro | 43 | 17 | 60 |
| 2014 Novembro | 120 | 61 | 181 |
| 2014 Outubro | 12 | 6 | 18 |
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