Celiac Disease: aA Rare Cardiac Sequel

Abstract

We explore the case of a 52-year-old woman who was transferred to our facility with recurrent torsade de pointes requiring repeated defibrillations. She had no previous medical history nor did she report any clear emotional or stressful triggers. In transit there were 14 episodes of polymorphic ventricular tachycardia, 11 of which required defibrillation. Her presenting electrocardiogram showed sinus rhythm with wide spread T-wave inversions and a QTc of 544 ms. In transit she was treated with intravenous potassium and magnesium. On arrival an isoprenaline infusion was commenced, which stabilised the patient. Coronary angiography showed non–obstructive disease with the left ventricular (LV) gram showing mid-wall variant Takotsubo cardiomyopathy. Bedside echocardiography showed low–normal LV systolic function of 55%, with no significant valvulopathy. Cardiac magnetic resonance imaging showed the resolving Takotsubo cardiomyopathy with no evidence of infiltrative disease. Despite clinical improvement, she had persistent hypomagnesaemia. Cardiomyopathy screening and investigations for hypomagnesaemia returned unremarkable with the exception of a strongly positive coeliac serology. With beta blockade, aggressive magnesium replacement, and gluten avoidance her QTc shortened and episodes of polymorphic ventricular tachycardia also settled as a consequence. She was discharged when stable and at the 6-month follow-up she remained asymptomatic with a resolution of her prolonged QT interval. This case identifies coeliac disease as a cause of severe electrolyte disturbances that resulted in recurrent torsade de pointes and Takotsubo cardiomyopathy that was treated conservatively (Figure 1, Figure 2). Figure 2Takotsubo LV gram. View Large Image Figure Viewer Download Hi-res image