Takotsubo Cardiomyopathy Following Traumatic Hand Amputation: A Case Report

Introduction: Takotsubo or stress cardiomyopathy is a syndrome of transient left ventricular systolic dysfunction seen in the absence of obstructive coronary artery disease.Case Report: We describe a case of stress cardiomyopathy diagnosed in the emergency department (ED) using point-of-care ultrasound associated with traumatic hand amputation. The patient suffered a near-complete amputation of the right hand while using a circular saw, subsequently complicated by brief cardiac arrest with rapid return of spontaneous circulation. Point-of-care ultrasonography in the ED revealed the classic findings of takotsubo cardiomyopathy, including apical ballooning of the left ventricle and hyperkinesis of the basal walls with a severely reduced ejection fraction. After formalization of the amputation and cardiovascular evaluation, the patient was discharged from the hospital in stable condition 10 days later.Conclusion: Emergency physicians should be aware of the possibility of stress cardiomyopathy as a cause for acute decompensation, even in isolated extremity trauma

Takotsubo cardiomyopathy following traumatic hand amputation

Takotsubo or stress cardiomyopathy is a syndrome of transient left ventricular systolic dysfunction seen in the absence of obstructive coronary artery disease. We describe a case of stress cardiomyopathy diagnosed in the emergency department (ED) using point of care ultrasound (POCUS) associated with traumatic hand amputation.  The patient suffered a near-complete amputation of the right hand while using a circular saw, subsequently complicated by brief cardiac arrest with rapid return of spontaneous circulation. Point-of-care ultrasonography in the ED revealed the classic findings of takotsubo cardiomyopathy, including apical ballooning of the left ventricle and hyperkinesis of the basal walls with a severely reduced ejection fraction. After formalization of the amputation and cardiovascular evaluation, the patient was discharged from the hospital in stable condition ten days later. Emergency physicians should be aware of the possibility of stress cardiomyopathy as a cause for acute decompensation, even in isolated extremity trauma

Cyclin E over expression suppresses AKT pathway.

<p><b>(a)</b> Western blot analysis of the indicated proteins using whole cell lysates from MCF10A parental (P) or cyclin E over expressing cell clones {MCF10A CyE (B10) and MCF10A CyE (C3). Vinculin was used as loading control. Data is representative of three separate experiments.</p

Cyclin E over expression inhibits cell growth through autophagy.

<p><b>(a)</b> line diagram shows the growth curve of MCF10A parental (P) or cyclin E over expressing cell clones {MCF10A CyE (B10) and MCF10A CyE (C3). 10,000 cells were plated in 24-well plate and the growth pattern was studied by counting cells every other day by trypsinization followed by cell count using hemocytometer. The values shown are mean + standard error obtained by repeating the growth assay 3 times. An asterisk (*) indicates the statistically significant differences from MCF10A (P) at p < 0.05. <b>(b)</b> Bar diagram shows the % of cells dying through autophagy in cyclin E over expressing cell clones {MCF10A CyE (B10) and MCF10A CyE (C3) as compared to MCF10A parental (P). 100,000 cells were plated in 6-well plate and next day cells were stained by acridine orange, washed with PBS and sorted by flow cytometry. The values shown are mean + standard error obtained by repeating the cell cycle assay 3 times. An asterisk (*) indicates the statistically significant differences from MCF10A (P) at p < 0.05.</p

DNA damage in breast cancer risk and progression (a) Tree modeling showing predictability power of combination of several biomarkers for invasive breast cancer risk.

<p>Note that starting node in the tree model is fewer number than the total given for each risk cohort (40, 46 and 38). This reflects cases that were removed because all three biomarkers- Ki67, γ-H2AX and Caspase-3 -were not evaluable. Although this resulted in a smaller subset, this was necessary to better identify the distinct combination of the biomarkers by growing the tree based on completed data for all biomarkers of interest.</p

Cyclin E over expression increases DNA damage in normal breast cells.

<p><b>(a)</b> Bar diagram shows the expression level of γ H2AX, a marker of DNA double strand break, in terms of number of foci per cell as measured by immunofluorescence (IF) in MCF10A parental (P) or cyclin E over expressing cell clones {MCF10A CyE (B10) and MCF10A CyE (C3). The cells with 0–1 foci were considered with no DNA damage, 2–10 foci, were considered as moderate DNA damage and > 10 foci was considered as high levels of DNA damage. The values shown are mean + standard error obtained by counting more than 100 cells and was repeated 3 times. An asterisk (*) indicates the statistically significant differences from MCF10A (P) at p < 0.05. <b>(b)</b> Photomicrographs at 100× showing the nuclear accumulation of γH2AX by using IF technique where alexa-594 conjugated secondary anti-rabbit antibody was used to stain the γH2AX as red color and DAPI was used as a counter stain to visualize nuclei.</p

Activation of AKT–mTOR pathway during mammary tumorigenesis.

<p><b>(a)</b> Western blot analysis of the indicated proteins using whole cell lysates from MCF10A parental (P) or MCF10A NeoT, MCF10AT1, MCF10.DCIS, MCF10 Ca1d, and MCF10 ca1h. Vinculin was used as loading control. Data is representative of three separate experiments. <b>b)</b> Western blot analysis of the indicated proteins using whole cell lysates from MCF10A parental (P) or cyclin E overexpressing cell clone MCF10A-cy E (C3) with and with out IGF1 treatment (25ng/ml for 20minutes). Vinculin was used as loading control. Data is representative of three separate experiments.</p