Abstract
Tako-tsubo syndrome or cardiomyopathy also referred to as transient apical ballooning syndrome, stress cardiomyopathy or broken heart syndrome is a well-recognized syndrome typically characterized by transient and reversible left ventricular dysfunction that develops in the setting of acute severe emotional or physical stress. Increased catecholamine levels have been proposed to play a central role in the pathogenesis of the disease, although the specific pathophysiology of this condition remains to be fully determined.
Highlights
Tako-tsubo syndrome (TTS) or Cardiomyopathy (TC) is an increasingly recognized entity characterized by transient apical and mid left ventricular (LV) dysfunction in the absence of significant coronary artery disease that is potentially triggered by severe emotional, physical stress, medical illness procedures or surgeries [1,2,3,4,5]
We present in this report a 3-year follow-up of a rare case of recurrent apical ballooning syndrome in a woman with several hospitalizations for chest pain, dyspnea, and electrocardiographic (ECG) changes triggered by diabetic ketoacidosis (DKA) and remarkable resolution and full recovery after strict glycemic control
A 56-year-old female with poorly controlled type 2 diabetes due to medication noncompliance who had 4 hospital admissions over 3 years (2013-2016) for chest pain, dyspnea, acute ST-T elevation, cardiac biomarkers elevation, left ventricular apical severe hypokinesis and ballooning diagnosed by echocardiography
Summary
Tako-tsubo syndrome (TTS) or Cardiomyopathy (TC) is an increasingly recognized entity characterized by transient (reversible) apical and mid left ventricular (LV) dysfunction in the absence of significant coronary artery disease that is potentially triggered by severe emotional, physical stress, medical illness (acute exacerbations of multiple medical conditions such as asthma, sepsis, gastrointestinal bleeding or 3 hypoglycemia) procedures or surgeries [1,2,3,4,5]. A 56-year-old female with poorly controlled type 2 diabetes due to medication noncompliance who had 4 hospital admissions over 3 years (2013-2016) for chest pain, dyspnea, acute ST-T elevation, cardiac biomarkers elevation, left ventricular apical severe hypokinesis and ballooning diagnosed by echocardiography She always received acute coronary syndrome (ACS) management at presentation and had urgent coronary angiogram during the initial three presentations and all revealed normal coronary arteries. Histological examination of biopsy samples from the affected left ventricle of patients with TC has shown intracellular accumulation of glycogen, many vacuoles, disorganized cytoskeleton and contractile structure, contraction band necrosis and increased extracellular matrix proteins, which is associated with clinical states of catecholamine excess [33,34,35] These alterations resolved nearly completely after functional recovery. Data on diabetes as a trigger for TC is scarce and previous reports suggest even a protective role of diabetes against TC [19,20,21,36], as compared to the higher prevalence of diabetes in ACS as shown in our previous study [22]
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