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array:24 [ "pii" => "S0870255122002840" "issn" => "08702551" "doi" => "10.1016/j.repc.2022.07.005" "estado" => "S300" "fechaPublicacion" => "2022-10-01" "aid" => "2004" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2022" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2022;41:889-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0870255122003626" "issn" => "08702551" "doi" => "10.1016/j.repc.2021.09.017" "estado" => "S300" "fechaPublicacion" => "2022-10-01" "aid" => "2027" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2022;41:891-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Pneumopericardium and squamous cell lung carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "891" "paginaFinal" => "892" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Pneumopericárdio e carcinoma epidermóide do pulmão" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 767 "Ancho" => 755 "Tamanyo" => 47691 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carla Marques Pires, Leonor Meira" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carla" "apellidos" => "Marques Pires" ] 1 => array:2 [ "nombre" => "Leonor" "apellidos" => "Meira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255122003626?idApp=UINPBA00004E" "url" => "/08702551/0000004100000010/v1_202210061538/S0870255122003626/v1_202210061538/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0870255122003511" "issn" => "08702551" "doi" => "10.1016/j.repc.2022.08.003" "estado" => "S300" "fechaPublicacion" => "2022-10-01" "aid" => "2016" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2022;41:887.e1-887.e5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Takotsubo syndrome in a breast-feeding young woman: Highlighting the protection of oestrogens?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "887.e1" "paginaFinal" => "887.e5" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Síndrome de Takotsubo em mulher jovem durante amamentação: sublinhando a proteção dos estrogénios?" ] ] "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" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 944 "Ancho" => 1405 "Tamanyo" => 107851 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cardiac magnetic resonance Imaging (Signa HDx 1.5T, GE Healthcare®) showing preserved ejection fraction and absence of late gadolinium enhancement. (A) FIESTA Cine in two-chambers view, diastole; (B) FIESTA Cine in two-chambers view, systole; (C) four-chambers view, after late gadolinium enhancement; (D) two-chambers view, after late gadolinium enhancement.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Diogo Rodrigues Brás, Pedro Semedo, Bruno Cordeiro Piçarra, Pedro Dionísio, João Carvalho, Rui Azevedo Guerreiro, Kisa Congo, José Aguiar" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Diogo" "apellidos" => "Rodrigues Brás" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "Semedo" ] 2 => array:2 [ "nombre" => "Bruno" "apellidos" => "Cordeiro Piçarra" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Dionísio" ] 4 => array:2 [ "nombre" => "João" "apellidos" => "Carvalho" ] 5 => array:2 [ "nombre" => "Rui" "apellidos" => "Azevedo Guerreiro" ] 6 => array:2 [ "nombre" => "Kisa" "apellidos" => "Congo" ] 7 => array:2 [ "nombre" => "José" "apellidos" => "Aguiar" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255122003511?idApp=UINPBA00004E" "url" => "/08702551/0000004100000010/v1_202210061538/S0870255122003511/v1_202210061538/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "What is the role of estrogen in predisposition to Takotsubo syndrome throughout a woman's reproductive life?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "889" "paginaFinal" => "890" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Ana Rita Almeida" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Ana Rita" "apellidos" => "Almeida" "email" => array:1 [ 0 => "anaalmeida31@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Garcia de Orta, Almada, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Qual o papel dos estrogénios na predisposição à síndrome de Takotsubo ao longo da vida reprodutiva feminina?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Brás DR. et al. describe the case of a young woman who presents with a clinical picture compatible with Takotsubo syndrome five months after delivery.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This case is of particular interest because it is rare and highlights the likely influence of sex hormones, especially estrogen levels, on the occurrence of this cardiomyopathy. As this mechanism is still under investigation, it makes the case even more relevant.</p><p id="par0010" class="elsevierStylePara elsevierViewall">As the authors point out, despite the higher incidence of Takotsubo syndrome in postmenopausal women, cases have been reported in premenopausal women, especially in the immediate postpartum period,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> but not only,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> thus suggesting that this cardiomyopathy occurs not only at menopause, but at other stages of reproductive life when estrogen levels are reduced.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The role of sex hormones in the development of Takotsubo cardiomyopathy has been a subject of interest and research, and it has been suggested that reduced levels of estrogen in menopause predispose women to Takotsubo syndrome.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The young woman reported in this clinical case was taking progesterone contraceptive pill and was breastfeeding, consequently presenting low levels of estrogen, which may have predisposed her to the development of this syndrome in the presence of a trigger (discussion/epileptic seizure).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Estrogen receptors are widely expressed in the cardiovascular system and in the central nervous system. Clinical analysis of autonomic nervous system function in patients with Takotsubo cardiomyopathy revealed a transient increase in sympathetic nervous system activity and a decrease in vagal activity.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Research has been carried out in rats,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in which estrogen supplementation diminished the effects of catecholamines on the heart and attenuated stress-induced hypothalamic-sympathoadrenal discharge. It was found that in these rats estrogen supplementation increases the levels of cardioprotective substances such as atrial natriuretic peptide and the heat shock protein (HSP)704. This work suggest that the reduction of estrogen levels may lead to a predisposition to the development of this cardiomyopathy, either by direct action on the heart and indirect action on the nervous system.</p><p id="par0030" class="elsevierStylePara elsevierViewall">However, conflicting results are observed in humans. In humans, there are no studies demonstrating that hormone replacement therapy in postmenopausal women prevents the occurrence of Takotsubo syndrome, and a Swiss registry showed that during Takotsubo syndrome in postmenopausal women estrogen levels are elevated.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">These results reinforce the need for more research in this area with randomized studies that allow us to better understand the influence of sex hormones, specifically estrogen, on the predisposition of women to Takotsubo syndrome throughout their reproductive life. The case presented by the authors has drawn attention to this problem, fueling interest in research in this area.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has 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" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo Syndrome in a breast-feeding young woman: highlighting the protection of oestrogens?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.R. Brás" 1 => "P. Semedo" 2 => "B.C. Piçarra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Rev Port Cardiol." "fecha" => "2022" "volumen" => "41" "paginaInicial" => "887" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo Syndrome After Cesarean Section: Rare But Possible" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Citro" 1 => "A. Lyon" 2 => "E. Arbustini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2018.02.035" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol." "fecha" => "2018 Apr 24" "volumen" => "71" "paginaInicial" => "1838" "paginaFinal" => "1839" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29673471" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A life-threatening reverse TTS" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "C.M. 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Ammann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/clc.21986" "Revista" => array:6 [ "tituloSerie" => "Clin Cardiol" "fecha" => "2012" "volumen" => "35" "paginaInicial" => "340" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22488168" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004100000010/v1_202210061538/S0870255122002840/v1_202210061538/en/main.assets" "Apartado" => array:4 [ "identificador" => "92948" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004100000010/v1_202210061538/S0870255122002840/v1_202210061538/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255122002840?idApp=UINPBA00004E" ]
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