An Atypical Presentation of Takotsubo Cardiomyopathy Causing Torsades de Pointes

Abstract

Torsades de Pointes (TdP) may have an acquired or congenital cause [ [1] Ritter J.M. Cardiac safety, drug-induced QT prolongation and torsade de pointes (TdP). Br J Clin Pharmacol. 2012; 73: 331-334 Crossref PubMed Scopus (17) Google Scholar ]. The most common acquired causes include medications and electrolyte abnormality. Takotsubo cardiomyopathy (TC) is a reversible form of ventricular dysfunction characterised by apical akinesis and absence of coronary artery disease, associated with emotional and physical stressors. TC is often associated with abnormal repolarisation including QT prolongation [ [2] Ahn J.H. Park S.-H. Shin W.Y. Lee S.W. Lee S.J. Jin D.K. et al. Long QT syndrome and torsade de pointes associated with Takotsubo cardiomyopathy. J Korean Med Sci. 2011; 26: 959-961 Crossref PubMed Scopus (13) Google Scholar ]. However, TdP has rarely been described in TC [ [3] Samuelov-Kinori L. Kinori M. Kogan Y. Swartzon M. Shalev H. Guy D. et al. Takotsubo cardiomyopathy and QT interval prolongation: who are the patients at risk for torsades de pointes?. J Electrocardiol. 2009; 42: 353-357.e1 Crossref PubMed Scopus (60) Google Scholar , [4] Denney S.D. Lakkireddy D.R. Khan I.A. Long QT syndrome and torsade de pointes in transient left ventricular apical ballooning syndrome. Int J Cardiol. 2005; 100: 499-501 Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar ]. Furthermore, TC is usually associated with modestly elevated troponin [ [5] Pirlet C. Pierard L. Legrand V. Gach O. Ratio of high-sensitivity troponin to creatine kinase-MB in takotsubo syndrome. Int J Cardiol. 2017; 243: 300-305 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar , [6] Gopalakrishnan P. Zaidi R. Sardar M.R. Takotsubo cardiomyopathy: Pathophysiology and role of cardiac biomarkers in differential diagnosis. World J Cardiol. 2017; 9: 723-730 Crossref PubMed Google Scholar ].