Introduction: Takotsubo cardiomyopathy or stress cardiomyopathy is a syndrome of transient left ventricular (LV) dysfunction mimicking myocardial infarction, but lacking obstruction of coronary artery disease (CAD) or acute plaque rupture. A characteristic differentiation from CAD is that regional motional abnormality extends beyond a territory perfused with a single epicardial coronary artery. Clinically, it is characterized by apical ballooning of the LV due to due to depression of mid and apical segments, with hyperkinesis of cardiac basal walls. Women are affected more than men, predominantly in the postmenopausal age. Case Report: A 54-year-old Caucasian female with a history of COPD, hypertension, uncontrolled diabetes mellitus, hyperlipidemia, depression and ongoing tobacco use presented with complaints of worsening shortness of breath two days prior to admission. She denied chest pain, worsened cough, palpitations, nausea or vomiting. On examination, she was in distress and anxious, with labored breathing. Upon examining the chest, decreased air entry was present in both lung fields with bibasilar wheezing. Initial lab tests showed mild respiratory acidosis, with pH of 7.24, pCO2 of 47.4 and pO2 of 65. Troponins on the day of admission was Soon after admission, she started complaining of severe right neck pain. Repeat EKG revealed localized lateral J point, anteroseptal q waves and 4mm ST-segment elevation in leads V3 and V4 reciprocal changes and without chest pain. Repeat troponins were slightly elevated to 0.42 ng/ml and CK-MB was elevated to 20.2 ng/ml. A transthoracic echocardiogram showed regional abnormalities in left ventricle with the apex, mid to distal septum and the anterior part of septum was akinetic. Discussion: Takotsubo cardiomyopathy presents in 1 to 2 percent of troponin-positive acute coronary syndrome (ACS) with various clinical manifestations and various outcomes. Some patients have favorable outcomes based on their clinical performance and extent of cardiac muscle involvement. As in the case we presented, this syndrome can be entirely idiopathic, without a definitive underlying cause. Supportive management while hospitalized and early identification of complications improve the prognosis.

Det är cirka två procent av de patienter som insjuknar med symtom förenliga med akut kranskärlssjukdom (AKS) som istället drabbas av takotsubo syndrom (TS). TS anses vara kraftigt underdiagnostiserat och även ofta felaktigt diagnostiserat. Brister i rekommendationer och avsaknad av riktlinjer, i kombination med att patienterna inte är särskilt vanligt förekommande, kan påverka förutsättningarna för sjuksköterskor att erbjuda dessa patienter evidensbaserad och personcentrerad omvårdnad.   Syftet med studien var att beskriva sjuksköterskors erfarenheter av omvårdnad vid takotsubo syndrom.   Metoden var en kvalitativ, deskriptiv intervjustudie med induktiv ansats. Semistrukturerade intervjuer genomfördes med tio sjuksköterskor verksamma inom hjärtsjukvård. Insamlade data transkriberades och analyserades med inspiration från Graneheim och Lundmans kvalitativa innehållsanalys.   Resultatet genererade i de fem kategorierna: sjuksköterskornas erfarenheter av insjuknandet i TS, sjuksköterskornas erfarenheter av omvårdnadsbehovet vid TS, sjuksköterskornas erfarenheter av omvårdnadsåtgärder vid TS, kunskap och evidens i omvårdnadsarbetet vid TS och sjuksköterskans copingstrategier vid bristande evidens och kunskap. Sjuksköterskorna hade varierande erfarenheter av omvårdnaden och de flesta tyckte att omvårdnadsarbetet vid TS var svårt. Många av sjuksköterskorna upplevde svårigheter att besvara patienternas frågor och att detta påverkades av begränsad kunskap inom området och av att det inte fanns några riktlinjer att följa för omvårdnadsarbetet. Detta gjorde att sjuksköterskorna inte visste om det fanns några särskilda restriktioner och rekommendationer för dessa patienter. Sjuksköterskorna upplevde även att patienterna var i stort behov av samtal och information och att en stor del av omvårdnadsarbetet bestod av att försöka tillgodose detta behov.   Slutsatsen i denna studie är att sjuksköterskorna upplevde att det saknades kunskap om specifik omvårdnad vid TS. De ville erbjuda patienterna bästa möjliga omvårdnad och de efterfrågade mer kunskap och stöd för att kunna åstadkomma detta. Sjuksköterskorna upplevde frustration eftersom de inte kunde erbjuda evidensbaserad omvårdnad till dessa patienter på samma sätt de vanligtvis kunde erbjuda till andra patienter. Den omvårdnad som erbjöds till patienterna varierade mellan sjuksköterskorna och nedprioriterades ofta, bland annat till fördel för det medicinska arbetet och för andra patienter i större behov av omvårdnad. / About two percent of the patients who suffer from symptoms consistent with acute coronary syndrome (ACS) have instead been affected by takotsubo syndrome (TS). TS is considered to be severely under-diagnosed and also often incorrectly diagnosed. Deficiencies in recommendations and lack of guidelines, in combination with the fact that patients are not particularly common, can affect the prerequisites nurses have to offer these patients evidence-based and person-centered care.   The purpose of the study was to describe nurses' experiences of nursing care in takotsubo syndrome.   The method was a qualitative, descriptive interview study with inductive approach. Semi-structured interviews were conducted with ten practicing nurses in heart care. The collected data was transcribed and analyzed with inspiration from Graneheim and Lundman's qualitative content analysis.   The results generated five categories: nurses´ experiences of suffering from TS, nurses’ experiences of nursing care, nurses’ experiences of nursing actions, knowledge and evidence in nursing care and nurses´ coping strategies in case of lack of evidence and knowledge. The nurses had different experiences with the nursing care, and a majority expressed difficulties nursing patients with TS. Many nurses experienced difficulties in answering the patients' questions and that this was affected by limited knowledge as well as there were no specific guidelines for the appropriate nursing care. This meant that the nurses did not know if there were any particular restrictions and recommendations for these patients. Furthermore, the nurses expressed the need for patients being given proper support and information.   The conclusion of this study is that the nurses experienced lack of knowledge in specific nursing care of patients with TS. The nurses wanted to offer the best possible care and they asked for more knowledge and support in order to achieve this. Due to lack of support and information the nurses felt frustrated as they were unable to offer evidence-based nursing equal to that of any other patient. The results also showed that the nursing care offered to the patients varied between the nurses and that the nursing care of the patients with TS to a large extent was given less priority. This down-prioritization was to the benefit of the medical work and other patients who were deemed to be in greater need of nursing care. The discrimination of TS patients was largely to prioritize other patients in greater need of nursing care.   About two percent of the patients who suffer from symptoms consistent with acute coronary syndrome (ACS) have instead been affected by takotsubo syndrome (TS). TS is considered to be severely under-diagnosed and also often incorrectly diagnosed. Deficiencies in recommendations and lack of guidelines, in combination with the fact that patients are not particularly common, can affect the prerequisites nurses have to offer these patients evidence-based and person-centered care.   The purpose of the study was to describe nurses' experiences of nursing care in takotsubo syndrome.   The method was a qualitative, descriptive interview study with inductive approach. Semi-structured interviews were conducted with ten practicing nurses in heart care. The collected data was transcribed and analyzed with inspiration from Graneheim and Lundman's qualitative content analysis.   The results generated five categories: nurses´ experiences of suffering from TS, nurses’ experiences of nursing care, nurses’ experiences of nursing actions, knowledge and evidence in nursing care and nurses´ coping strategies in case of lack of evidence and knowledge. The nurses had different experiences with the nursing care, and a majority expressed difficulties nursing patients with TS. Many nurses experienced difficulties in answering the patients' questions and that this was affected by limited knowledge as well as there were no specific guidelines for the appropriate nursing care. This meant that the nurses did not know if there were any particular restrictions and recommendations for these patients. Furthermore, the nurses expressed the need for patients being given proper support and information.   The conclusion of this study is that the nurses experienced lack of knowledge in specific nursing care of patients with TS. The nurses wanted to offer the best possible care and they asked for more knowledge and support in order to achieve this. Due to lack of support and information the nurses felt frustrated as they were unable to offer evidence-based nursing equal to that of any other patient. The results also showed that the nursing care offered to the patients varied between the nurses and that the nursing care of the patients with TS to a large extent was given less priority. This down-prioritization was to the benefit of the medical work and other patients who were deemed to be in greater need of nursing care. The discrimination of TS patients was largely to prioritize other patients in greater need of nursing care.

Bakgrund: Takotsubo kardiomyopati är ett akut tillstånd för vårdsökande personer som symtommässigt liknar hjärtinfarkt men i själva verket är en reversibel hjärtsvikt. I det akuta skedet har sjuksköterskan en viktig roll i att inhämta anamnes, vilket är avgörande för att kunna vidta adekvata omvårdnadsåtgärder. Syfte: Att beskriva vårdsökande personers erfarenheter av att drabbas av takotsubo kardiomyopati. Metod: Integrativ litteraturöversikt vilken sammanfattar 13 vetenskapliga artiklar. Resultat: Litteraturöversikten visar tre huvudkategorier: Utlösande faktorer, Akuta skedet och Dagligt liv. De som drabbas av takotsubo kardiomyopati främst är kvinnor samt personer med liknande personlighetsdrag, där oro, ångest och stress är en stor del av vardagen. Emotionella eller fysiska stressorer är de främsta bakomliggande orsakerna till att drabbas av takotsubo kardiomyopati. Symtomen är främst dyspné och bröstsmärta som flera av de drabbade till en början ignorerar. Slutsats: Takotsubo kardiomyopati medför existentiella frågor och oro för framtiden där stresshantering och sjuksköterskans personcentrerade förhållningssätt är avgörande för att återfå god hälsa. Det krävs ytterligare forskning för att utforma strategier för väl anpassad personcentrerad omvårdnad för de drabbade. / Background: Takotsubo cardiomyopathy is a critical condition for the care recipient that is symptomatically similar to myocardial infarction but in fact is a reversible form of heart failure. In the critical stage, the nurse has an important role in acquiring anamnesis, which is crucial in order to be able to perform adequate nursing actions.Aim: To describe care recipients experience of suffering from takotsubo cardiomyopathy.Method: Integrative literature review of 13 scientific articles.Result: Common findings lead to three main categories: Triggering factors, Critical stage and Everyday life. Those affected by takotsubo cardiomyopathy are mainly women and have similar personality traits, where uneasiness, anxiety and stress are major parts of the everyday life. An emotional or physical stressor are often the underlying cause of the person being affected by takotsubo. The symptoms are mainly dyspnoea and chest pain, symptoms that several of the affected initially ignore. Conclusion: Takotsubo cardiomyopathy brings up existential concerns and questions about the future where stress management and the nurse’s person centered approach are crucial for regaining good health. Further research is needed to obtain strategies to form well-adjusted person centered care for those affected.

Bakgrund: När någon drabbas av en allvarlig sjukdom som kan vara livshotande blir det i regel en förändring i livet. Upplevelsen av hjärtinfarkt eller takotsubo kan bli både skrämmande och främmande inte bara för den drabbade, utan även för deras närstående. Hjärtinfarkt är en sjukdom som drabbar många och är ett av vår tids mest förekommande sjukdomstillstånd. Takotsubo är en nytillkommen diagnos som kan misstolkas som hjärtinfarkt. Det är värdefullt att ha förståelse och kunnande om insjuknandet och livet efter för de personer som drabbats av sjukdomen, även för deras närstående och sjukvårdspersonal. Syfte: Syftet var att beskriva kvinnors upplevelser av att ha drabbats av hjärtinfarkt eller takotsubo. Metod: En beskrivande litteraturstudie baserat på åtta vetenskapliga artiklar med kvalitativ ansats och en studie med mixad ansats. Sammanlagt nio artiklar. Artiklarna söktes via CINAHL och PubMed via Medline. Huvudresultat: Kvinnornas vanligaste upplevelser var förnekelse av symtomen och de såg sig inte vara i riskgruppen att drabbas av hjärtsjukdom. En rädsla att bli betraktad som hypokondriker och dålig erfarenhet av vården ledde till fördröjning av att söka vård. Kvinnorna upplevde skillnader på vårdens kompetens, mellan olika vårdinrättningar. Kvinnorna upplevde en tacksamhet över att ha överlevt och insåg behovet av livsstilsförändringar. Merparten av kvinnorna upplevde oro och ångest över att drabbas av hjärtinfarkt igen. Slutsats: Kvinnorna förväntades inte att drabbas av hjärtinfarkt eller takotsubo. Kvinnorna samt vårdpersonal uppfattade inte symtomen som en hjärtinfarkt eller takotsubo, vilket leder till fördröjd vård. Kvinnorna upplever också ojämn kvalitet på vård. Kvinnorna upplever en stor förändring av livet samt att dess rädsla och oro alltid kommer att vara närvarande. Nyckelord: Myocardial infarkt, Takotsubo kardiomyopati, Upplevelser, Kvinnor. / Background: When someone suffers a serious illness that can be life-threatening, there is usually a change in life. The experience of a myocardial infarction or takotsubo can be both frightening and foreign not only to the affected, but also to their loved ones. Myocardial infarction is a disease that affects many people and is one of the most common conditions of our time. Takotsubo is a recent diagnosis that can be misinterpreted as a myocardial infarction. It is valuable to have an understanding and knowledge of the illness and life of the people affected by illnesses, including those of their relatives and health care professionals. Aim: The purpose was to describe women's experiences of having suffered from myocardial infarction and takotsubo. Method: A descriptive literature study based on eight scientific articles with a qualitative approach and one study with a mixed approach. A total of nine articles. The articles were searched via CINAHL and PubMed through Medline. Results: The most common experiences among the women were denial of the symptoms and they did not see themselves in the risk group of suffering from heart disease. Fear of being considered hypochondriacs and poor experience of care led to a delay in seeking care. The women experienced differences in care skills, between different healthcare institutions. The women felt gratitude for surviving and realized the need for lifestyle changes. Most of the women experienced anxiety about being affected by a heart attack again. Conclusion: The women were not expected to suffer a myocardial infarction or takotsubo. The women as well as health care workers did not perceive the symptoms as a myocardial infarction or takotsubo, which led to delayed care. The women also experience uneven quality of care. The women experience a great change in life and that their fears and anxieties will always be present. Keywords: Myocardial infarction, Takotsubo cardiomyopathy, Experiences, Women.

Bakgrund:Takotsubo syndrom har länge behandlats som ett metaforiskt tillstånd. Det harbevisats att det sker en fysisk förändring i hjärtat och att det förorsakas avemotionell och fysisk stress. Av alla dem som blir diagnostiserade med Takotsubosyndrom är det 97% som är kvinnor.Syfte:Syftet med litteraturstudien var att beskriva kvinnors upplevelser av diagnosenTakotsubo syndrom. Metod:En systematisk litteraturstudie med en induktiv ansats. Datainsamlingen bestod aven systematisk litteratursökning i databaserna Cinahl, PubMed och PsycInfo. Tioartiklar av god kvalité inkluderades i resultatet via en integrerad analys enligtKristensson (2014). Resultat:I resultatet framkom det tre kategorier; Upplevelser innan sjukdomsdebut,upplevelser vid sjukdomsdebut och upplevelser efter sjukdomsdebut. Resultatetvisade att kvinnorna hade varit utsatta för flertalet stressrelaterade livshändelserunder sitt liv, samt att symtom har ignorerats fram till sjukdomsdebut. Debuten avsjukdomen har utlösts av emotionella och fysiska faktorer. Kvinnorna har upplevtliknande symtom som en hjärtinfarkt vilket gjorde att diagnosen av Takotsubosyndrom upplevdes chockerande. Efter sjukdomsdebuten beskrivs upplevelsen avatt drabbas av sjukdomen och hur kvinnornas dagliga liv förändrades, samt vad somorsakade den stress relaterande sjukdomen. Slutsats:Tillståndet utlöses av emotionella och fysiska faktorer. Huvudsymtomen varbröstsmärta, andnöd, yrsel, illamående samt oro och ångest. Vårdpersonalen har enriktigt roll i bemötandet av patienterna med Takotsubo syndrom genom att biståmed rätt diagnos oh behandling. Det kan uppnås genom utbildning och ökadkunskap hos vårdpersonalen.

Cardiovascular disease is responsible for the loss of one life every 38 seconds and accounts for 26.6 percent of all infants that die of congenital birth defects. Adrenergic hormones are critically important regulators of cardiovascular physiology in embryos and adults. They are key mediators of stress responses and have profound stimulatory effects on cardiovascular function, and dysregulation of adrenergic function has been associated with many adverse cardiac conditions, including congenital malformations, arrhythmias, ischemic heart disease, heart failure, and sudden cardiac death. Despite intensive study, the specific roles these hormones play in the developing heart is not well-understood. Further, there is little information available regarding how these important hormones mediate stress responses in adult females (before and after menopause) in comparison to males. My thesis thus has two major foci: (1) What role(s) do catecholamines play in the embryonic heart?, and (2) Do catecholamines differentially influence cardiac function in aging male and female hearts? Initially, we sought to uncover the roles of adrenergic hormones in the embryonic heart by utilizing an adrenergic-deficient (Dbh-/-) mouse model. We found that adrenergic hormones influence heart development by stimulating expression of the gap junction protein, connexin 43, facilitating atrioventricular conduction, and helping to maintain cardiac rhythm. As development progresses, cardiac energy demands increase substantially, and oxidative phosphorylation becomes vital. Adrenergic hormones regulate metabolism in adults, thus we hypothesized they may stimulate energy metabolism during the embryonic/fetal transition period. We examined ATP, ADP, oxygen consumption rate, and extracellular acidification rates and found these metabolic indices were significantly decreased in Dbh-/- hearts compared to Dbh+/+ controls. We employed transmission electron microscopy of embryonic cardiomyocytes and found the mitochondria were significantly larger in Dbh-/- hearts compared to controls, and had more branch points. Taken together, these results suggest adrenergic hormones play a major role mediating the shift from predominantly anaerobic to aerobic metabolism during the embryonic/fetal transition period. Since there are known differential cardiac responses due to sex, age, and menopause to stress, we used echocardiography to measure left ventricular (LV) function in adult (9, 18 and 21 month) male and female mice (pre and postmenopausal) in response to epinephrine, and immobilization stress to investigate the roles of these factors. My results show 9-month premenopausal female mice display significantly decreased LV responsiveness to epinephrine compared to males, and an increased response to epinephrine due to age, especially in the premenopausal females. Similar LV function was also observed between postmenopausal females and males, and this pattern persisted after immobilization stress. I also investigated anatomical differences in the distribution of adrenergic cells within the heart comparing age, sex, and menopausal status. Notably, the density of cells derived from an adrenergic lineage in the heart was significantly increased in postmenopausal mice compared to age-matched males and cycling females. The selective re-appearance of adrenergic cells in the heart following menopause may provide an explanation for the differential stress responses observed in our system, and could have important clinical ramifications for stress-induced cardiomyopathies.

Takotsubo cardiomyopathy (TTC) is a disease characterized by transient left ventricular (LV) dysfunction and typical wall motion abnormalities in apical parts, without obvious signs of coronary influence. Due to its elusive natural cause and the lack of clarified pathology, further studies are needed. Thirteen patients presented with an episode of TTC, and referred to Örebro University Hospital (USÖ), were prospectively included and investigated by comparisons made at onset (acute phase) against at follow-up three months later (recovery phase). Including echocardiographic measurements, focused on biventricular systolic long-axis function and conventional diastolic function (DF) variables. Systolic improvement was shown, while most DF data were unchanged, suggesting that TTC is mainly a systolic disease affecting both ventricles. Diagnosis should include multidisciplinary engagement, as TTC associates both with emotional stress and pathological markers of physiological stress. In this thesis, such approach was offered to the aforementioned patients; to see if a common denominator could be found, thus, contributing to better handling. Emotional state was assessed, along with an array of cardiac investigations in addition to echocardiography. Acutely, imbalance in the autonomic cardiac control was shown, as well as a trend toward posttraumatic stress, but specific findings allowing conclusions on differential diagnosis could not be demonstrated. By adding another 15 TTC patients (i.e. 28 in total), through collaboration with observers from USA, a retrospective echocardiographic analysis could be done to further study DF; concluding that TTC associates with impairment of conventional DF variables which tends to parallel the systolic recovery, in contrary to the initial result but in line with other causesof LV dysfunction. Magnetic resonance imaging (MRI) is another method of choice at TTC. The USÖ patients had cardiac MRI, thus, a retrospective analysis was done to investigate the effect on LV geometry, both echocardiographic and by MRI; suggesting that TTC is consistently associated with increased LV mass, due to a local impact that seems to follow the change in LVconcentric wall motion.

Context:Broken heart syndrome or Takotsubo cardiomyopathy (TC) is a disorder characterized by transient left ventricular apical ballooning that almost invariably precedes emotional or physical stress. Although the patients with chronic kidney disease on hemodialysis have shown to exhibit sustained activity of sympathetic nervous system, the presentation of TC in these patients is a rare entity with few case reports in the literature. Case Report: A 75-year-old female with past medical history of end-stage renal disease presented with chest pressure and heaviness that started during her maintenance hemodialysis session. Electrocardiogram showed ST elevation and T wave inversion in V3-V6 leads. Emergent left heart catheterization was done that showed normal coronaries and akinesis of apical left ventricle wall consistent with TC. She was started on maximal medical management and underwent hemodialysis the next day without recurrence of the symptoms. Conclusion: TC may an underdiagnosed entity in patients on hemodialysis. However, it should be considered in the differential diagnosis in hemodialysis patients, particularly who presents with chest pain and/or symptoms.

Takotsubo cardiomyopathy, also known as “broken heart syndrome,” is a transient left ventricular dysfunction associated with stress (usually emotional) induced myocardial injury and stunning. It often presents as myocardial infarction on surface electrocardiogram (EKG). Diagnosis is made by coronary angiography, which rules out coronary artery disease and shows pathognomonic apical ballooning. In this article, we present a case of a 72-year-old woman who initially presented with an ST segment elevation myocardial infarction on EKG. Coronary angiography showed severe left anterior descending artery and diagonal lesions requiring percutaneous coronary intervention. Post–percutaneous coronary intervention, EKG changes resolved. The next day, the patient developed recurrent chest pain and her EKG showed diffuse T-wave inversion in precordial leads with reemerging ST segment elevations concerning for stent thrombosis. The patient underwent repeat emergent coronary angiography, which showed patent stents and findings consistent with takotsubo cardiomyopathy.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as a global pandemic with an unprecedented death toll worldwide. Although it primarily affects the respiratory tract presenting as pneumonia or acute respiratory failure, it is also known to cause significant cardiovascular complications, including acute coronary syndrome (ACS), arrhythmia, myopericarditis, cardiomyopathy, venous thromboembolism, heart failure, and cardiogenic shock. Morbidity and mortality secondary to cardiovascular complications are higher in patients with preexisting cardiovascular risk factors. Here, we present a case report of a 69-year-old male who was recently diagnosed with COVID-19 illness presenting with ST-elevation myocardial infarction (STEMI) and eventually with Takotsubo cardiomyopathy (TTC), and the course was complicated by right atrial thrombus and a pulmonary embolism (PE).