A Case of Takotsubo Cardiomyopathy Complicated with Life Threatening Arrhythmia and Cardiogenic Shock

Philip Tulio,Keyvan Ravakhah,Jehad Azar,Vasant Temull,Randol Kennedy

doi:10.12691/ajmcr-7-6-4

Philip Tulio, Keyvan Ravakhah + Show 3 more

Open Access

https://doi.org/10.12691/ajmcr-7-6-4

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Abstract

Stress (Takotsubo) cardiomyopathy (CM) is defined as a transient regional systolic dysfunction of the left ventricle that mimics acute coronary syndrome (ACS) in the absence of significant coronary artery disease or plaque rupture. This phenomenon commonly occurs in postmenopausal females in the presence of emotional, physical and psychological stressors with excess catecholamine stimulation, resulting in diffuse microvascular spasm and subsequently myocardial stunning. Here we report a 58-year-old postmenopausal female patient with end stage renal disease (ESRD) who was presented to our hospital with a clinical picture suggesting ACS. Shortly after admission she progressed to cardiogenic shock and pulseless electrical activity (PEA) and was diagnosed retrospectively with Takotsubo cardiomyopathy. She was successfully treated with beta-blockers, IV fluids and inotropic agents. Intra-aortic balloon pump (IABP) was considered, however, the patient gradually improved to full recovery with resolution of left ventricular function back to normal.

Highlights

Stress cardiomyopathy (CM), a life threatening cardiovascular event characterized as an acute transient left ventricular systolic dysfunction, was first observed and reported in Japan by Satoh et al and Dote et al [1,2] Stress CM occurs predominantly in postmenopausal females and is triggered by exaggerated sympathetic stimulation as a result of emotional and physical stress [3]
Stress CM mimics symptoms seen with acute coronary syndrome (ACS), including chest pain, diaphoresis and dyspnea. 1-2% of all cases suspected initially to have ACS are diagnosed as Takotsubo cardiomyopathy [4]
We present a patient who was first assessed as possible case of acute coronary syndrome, but was later discovered to have stress induced cardiomyopathy complicated by life threatening arrhythmia and cardiogenic shock

Summary

Introduction

Stress cardiomyopathy (CM), a life threatening cardiovascular event characterized as an acute transient left ventricular systolic dysfunction, was first observed and reported in Japan by Satoh et al and Dote et al [1,2] Stress CM occurs predominantly in postmenopausal females (mean 65 ± 13 years) and is triggered by exaggerated sympathetic stimulation as a result of emotional and physical stress [3]. Stress CM, it is a reversible disease with generally good prognosis, can progress to a fatal disease with life-threatening arrhythmia and cardiogenic shock. We present a patient who was first assessed as possible case of acute coronary syndrome, but was later discovered to have stress induced cardiomyopathy complicated by life threatening arrhythmia and cardiogenic shock

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