Case Report
Takotsubo Syndrome Due to Bronchoalveolar Lavage: A Rare Complication
Read
2065
Timeswas read the article
498
Total PDF
1567
Total HTML
Share statistics
array:23 [ "pii" => "S0300289623001527" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.04.006" "estado" => "S300" "fechaPublicacion" => "2023-08-01" "aid" => "3311" "copyright" => "SEPAR" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2023;59:514-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0300289623001540" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.05.001" "estado" => "S300" "fechaPublicacion" => "2023-08-01" "aid" => "3313" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2023;59:516-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Thoracic Surgical Management of Chylothorax Caused by a Neck Stab Wound" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "516" "paginaFinal" => "517" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 343 "Ancho" => 1005 "Tamanyo" => 41009 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Chest X-ray showing a left massive pleural effusion, pneumomediastinum and neck subcutaneous emphysema. (b) Postoperative chest X-ray, 24<span class="elsevierStyleHsp" style=""></span>h after right VATS for clipping the thoracic duct. (c) Chest CT showing disseminated lung septic emboli. A metallic clip can be detected (black arrow), at T9 level, between the aorta and the azygos vein.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Enrique García Franco, Mohammad Lamfon, Ahmed Alfitiani, Hani Saiedi" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Carlos Enrique" "apellidos" => "García Franco" ] 1 => array:2 [ "nombre" => "Mohammad" "apellidos" => "Lamfon" ] 2 => array:2 [ "nombre" => "Ahmed" "apellidos" => "Alfitiani" ] 3 => array:2 [ "nombre" => "Hani" "apellidos" => "Saiedi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623001540?idApp=UINPBA00003Z" "url" => "/03002896/0000005900000008/v3_202311210631/S0300289623001540/v3_202311210631/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289623001266" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.04.002" "estado" => "S300" "fechaPublicacion" => "2023-08-01" "aid" => "3306" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2023;59:512-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Cystic Fibrosis–Asthma Overlap Syndrome. Combination of Cystic Fibrosis Transmembrane Conductance Regulator Modulators and Type 2 Targeted Biologic Treatment for Asthma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "512" "paginaFinal" => "513" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1426 "Ancho" => 2925 "Tamanyo" => 321960 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Treatment, lung function and respiratory exacerbations over time. Lung function is represented as predicted volume exhaled during the first second (FEV1 percentage). Exacerbations which required antibiotics are represented as blue bars, and those requiring corticosteroids are represented as dashed green bars. ETI: elexacaftor/tezacaftor/ivacaftor.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Jiménez-Gómez, Rocío Magdalena Díaz Campos, Layla Diab Cáceres" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "Jiménez-Gómez" ] 1 => array:2 [ "nombre" => "Rocío Magdalena" "apellidos" => "Díaz Campos" ] 2 => array:2 [ "nombre" => "Layla" "apellidos" => "Diab Cáceres" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623001266?idApp=UINPBA00003Z" "url" => "/03002896/0000005900000008/v3_202311210631/S0300289623001266/v3_202311210631/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Takotsubo Syndrome Due to Bronchoalveolar Lavage: A Rare Complication" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "515" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Albert Rafecas-Codern, Paula Pujal-Montaña, Virginia Pajares" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Albert" "apellidos" => "Rafecas-Codern" "email" => array:1 [ 0 => "arafecasc@santpau.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Paula" "apellidos" => "Pujal-Montaña" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Virginia" "apellidos" => "Pajares" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3722 "Ancho" => 3175 "Tamanyo" => 1006391 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) ECG on the left performed with chest pain shows diffuse ST-segment elevation in I, II, avL and V1–V6, rectification in III and avF. ECG on the right performed after 2 months shows normalized leads. (b) Coronary angiogram on the left reveals the arteries without coronary disease. Left: right coronary artery. Right: left coronary artery. (c) Left ventriculography in systolic frame shows apical segment akinesis with a mild depressed LVEF (46%). (d) Echocardiography performed 2 months later shows a preserved contractibility with normalization of the LVEF (60%).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Takotsubo cardiomyopathy (TC) is characterized by transient and reversible systolic abnormality of the left ventricle's apex mimicking a myocardial infarction but with nonexistence of coronary artery disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The etiology of TC is not well known, however the most accepted theories are catecholamine-induced cardiotoxicity and microvascular dysfunction that leads to ventricular dysfunction. Risk factors include estrogen deficiency and emotional or physical stress.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Major complications from flexible bronchoscopy are rare (1–5%), and severe complications related to cardiovascular events are rarer still.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> We describe a case of TC induced by bronchoscopy with bronchoalveolar lavage (BAL).</p><p id="par0020" class="elsevierStylePara elsevierViewall">A 76-year-old woman, natural from Peru, was referred to our bronchoscopy unit in order to complete the study of a recently diagnosed interstitial lung disease (ILD), with antinuclear antibodies (ANA 1:160, mottled). As a relevant personal history she had hypertension under medical treatment and obesity (IMC 31).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Patient was sedated with midazolam, fentanyl and propofol. The BAL was performed with instillation of 100<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> of sterile normal saline into lingula and 60<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span> was collected for culture tests and cytology study. During the procedure hypoxemia was observed, high-flow oxygen therapy was required and finally the sedation was reversed with flumazenil.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ten minutes later she started with chest pain. In the recovery her vital signs were BP 170/100, HR 89 lpm, SaO2 91%. Electrocardiogram showed sinus rhythm with diffuse ST elevation, rectification in DIII and AVF, with a mild elevation of ultra-sensitive troponine and creatine kinase. The patient was transferred to the hemodynamics room to perform an invasive coronary angiography, showing coronary arteries without lesions. Ventriculography showed left ventricular ejection fraction 50% at the expense of akinesia of the entire apical cap, which suggested TC. At the follow-up after 2 months the ECG and the echocardiography returned to normal (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Few cases have been reported in the literature of TC after flexible bronchoscopy, at least 1 case was related to BAL.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Avoiding the bronchoscopy in myocardial infarction within firsts weeks is recommended due to the potential worsening of ischemia induced by the procedural related hypoxia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> However, there is not much evidence about the effect of this procedure in other myocardial involvement.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In our case, the patient was an elderly woman with cardiovascular risk factors affected by ILD, who suffered a transient hypoxemia during the procedure. The use of flumazenil contributed to an increase of BP and the patient presented a stressful awakening from sedation. We hypothesized all these factors probably worked in combination contributing to the development of TC.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Although the incidence of such complications is rare and unpredictable, a novel subgroup of bronchogenic stress-induced cardiomyopathies have been proposed as one of the main triggers of TC.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The authors emphasize the importance of minimizing risks and establishing proper management. Adequate level of sedation and use of supplementary oxygen allow to reduce the triggers of TC. Non-invasive hemodynamic and respiratory parameters monitoring during the examination and keeping patients in recovery after invasive procedures such as bronchoscopy<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> contribute to a rapid detection of complications.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3722 "Ancho" => 3175 "Tamanyo" => 1006391 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) ECG on the left performed with chest pain shows diffuse ST-segment elevation in I, II, avL and V1–V6, rectification in III and avF. ECG on the right performed after 2 months shows normalized leads. (b) Coronary angiogram on the left reveals the arteries without coronary disease. Left: right coronary artery. Right: left coronary artery. (c) Left ventriculography in systolic frame shows apical segment akinesis with a mild depressed LVEF (46%). (d) Echocardiography performed 2 months later shows a preserved contractibility with normalization of the LVEF (60%).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo cardiomyopathy: a brief review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.Z. Amin" 1 => "L.Z. Amin" 2 => "A. Pradipta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.25122/jml-2018-0067" "Revista" => array:5 [ "tituloSerie" => "J Med Life" "fecha" => "2020" "volumen" => "13" "paginaInicial" => "3" "paginaFinal" => "7" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Flexible bronchoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.J. Miller" 1 => "R.F. Casal" 2 => "D.R. Lazarus" 3 => "D.E. Ost" 4 => "G.A. Eapen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccm.2017.09.002" "Revista" => array:5 [ "tituloSerie" => "Clin Chest Med" "fecha" => "2018" "volumen" => "39" "paginaInicial" => "1" "paginaFinal" => "16" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inverted Tako-Tsubo cardiomyopathy associated with bronchoalveolar lavage" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.S. Ok" 1 => "B.G. Song" 2 => "K.S. Park" 3 => "H.G. Jung" 4 => "H.J. Jung" 5 => "I.N. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hlc.2011.01.004" "Revista" => array:5 [ "tituloSerie" => "Heart Lung Circ" "fecha" => "2011" "volumen" => "20" "paginaInicial" => "476" "paginaFinal" => "478" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo cardiomyopathy and subsequent seizures induced by flexible bronchoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Miyoshi" 1 => "Y. Takeda" 2 => "S. Ro" 3 => "H. Masaki" 4 => "M. Hojo" 5 => "H. Sugiyama" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Respir Care" "fecha" => "2015" "volumen" => "60" "paginaInicial" => "e151" "paginaFinal" => "e154" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An unusual complication during bronchoscopy: hypotension, global ST segment elevation, and acute severe left ventricular systolic dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Kumar" 1 => "A. Nath" 2 => "S. Singh" 3 => "T. Bhatia" 4 => "A. Kapoor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4187/respcare.02318" "Revista" => array:5 [ "tituloSerie" => "Respir Care" "fecha" => "2013" "volumen" => "58" "paginaInicial" => "e111" "paginaFinal" => "e115" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005900000008/v3_202311210631/S0300289623001527/v3_202311210631/en/main.assets" "Apartado" => array:4 [ "identificador" => "93562" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005900000008/v3_202311210631/S0300289623001527/v3_202311210631/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623001527?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 4 | 11 |
| 2024 October | 43 | 25 | 68 |
| 2024 September | 54 | 13 | 67 |
| 2024 August | 66 | 39 | 105 |
| 2024 July | 46 | 12 | 58 |
| 2024 June | 85 | 29 | 114 |
| 2024 May | 59 | 20 | 79 |
| 2024 April | 68 | 14 | 82 |
| 2024 March | 48 | 16 | 64 |
| 2024 February | 53 | 27 | 80 |
| 2024 January | 41 | 23 | 64 |
| 2023 December | 58 | 22 | 80 |
| 2023 November | 51 | 29 | 80 |
| 2023 October | 80 | 31 | 111 |
| 2023 September | 102 | 36 | 138 |
| 2023 August | 347 | 73 | 420 |
| 2023 July | 38 | 19 | 57 |
| 2023 June | 43 | 13 | 56 |
| 2023 May | 278 | 53 | 331 |
Show all
