Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

Takotsubo Cardiomyopathy during Armed Conflict: A Case Series

Sharon Bruoha
* ,
Artyom Star
,
Gili Givaty
,
Michael Shilo
,
Michael Friger
,
Vladimir Chitoroga
,
Hezzy Shmueli
,
Yigal Abramowitz
,
Elad Asher
ORCID logo ,
Jamal Jafari
,
Vladimir Shlyakhover
,
Doron Zahger
,
Moti Haim
,
Chaim Yosefy
Version 1 : Received: 28 March 2024 / Approved: 28 March 2024 / Online: 28 March 2024 (14:53:17 CET)

How to cite: Bruoha, S.; Star, A.; Givaty, G.; Shilo, M.; Friger, M.; Chitoroga, V.; Shmueli, H.; Abramowitz, Y.; Asher, E.; Jafari, J.; Shlyakhover, V.; Zahger, D.; Haim, M.; Yosefy, C. Takotsubo Cardiomyopathy during Armed Conflict: A Case Series. Preprints 2024, 2024031785. https://doi.org/10.20944/preprints202403.1785.v1 Bruoha, S.; Star, A.; Givaty, G.; Shilo, M.; Friger, M.; Chitoroga, V.; Shmueli, H.; Abramowitz, Y.; Asher, E.; Jafari, J.; Shlyakhover, V.; Zahger, D.; Haim, M.; Yosefy, C. Takotsubo Cardiomyopathy during Armed Conflict: A Case Series. Preprints 2024, 2024031785. https://doi.org/10.20944/preprints202403.1785.v1

Abstract

Introduction the outbreak of the Israel-Gaza conflict, initiated by a major attack on the civilian population in Israel provided a tragic opportunity to study the community wide association between severe emotional stressors related to acts of war and the incidence and clinical characteristics of Takotsubo cardiomyopathy (TCM) in this scenario. Methods Eight consecutive cases of TCM diagnosed during the first 50 days of the Israel-Gaza conflict were retrospectively collected from two southern medical centers who provided care to most of the war victims throughout the period of monitoring. The medical records were thoroughly reviewed and analyzed. Results During the monitoring period, the incidence of TCM increased substantially compared to the control period. Eight patients were included in the analysis. All patients were female and 100% of patients presented within the first 3 weeks of conflict whereas after this initial phase, despite the continuing war, the incidence of TCM reverted to pre-conflict levels. Two patients (25%) were under 50 years of age. All patients had hazardous clinical characteristics including severe left ventricular (LV) dysfunction (≤35%) and prolonged QTc interval (>500 ms). Five patients (62.5%) experienced complications. Nevertheless, no in-hospital mortality was reported. Conclusions Repeated exposure to severe emotional stress, on both personal and national level, due to mass crisis such as war is associated with an increased incidence of TCM potentially with high-risk phenotype in comparison to TCM following other, less potent, psychological insults.

Keywords

Takotsubo cardiomyopathy; left ventricular dysfunction; stress-induced cardiomyopathy; war

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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