HP35: Takotsubo cardiomyopathy complicated with non-convulsive status epilepticus

Abstract

Takotsubo cardiomyopathy (TTC) is a cardiac condition that causes an unexpected waning of the heart occurring during a stressful emotional event and potentially leading to acute heart failure [Ghadri J 2018]. TTC can be associated with various complications including cardiogenic shock, life-threatening arrhythmias and cardiac arrest [Templin C 2015]. Here we present a case of a young woman with TTC complicating with cardiac arrest and non-convulsive status epilepticus and a good neurological outcome Case report: A 38-years-old woman with unremarkable past medical history, after a strong emotional distress presented acute chest pain, dyspnea, and loss of consciousness with perioral cyanosis and noisy breathing. Cardiopulmonary resuscitation was immediately initiated, which continued for 50 minutes until the appearance of the sinus rhythm on the ECG. Dilated apex and mid-ventricular segment akinesis were recorded on echocardiography. Brain CT was unremarkable. Continuous video-EEG monitoring showed malignant EEG patterns, firstly, suppressed and non-reactive background, followed 24h later by frontally predominant generalized spike and spike-wave discharges. Administration of diazepam 20 mg did not modify her clinical and EEG state, while infusion of phenobarbital 1200 mg [20mg/kg] resulted in significant EEG improvement. Under combined antiepileptic medication (i.e., valproate 500 mg bid and levetiracetam 750 mg bid, her EEG and clinical status improved in few days. Conclusion: Although non-convulsive status epilepticus after cardiac arrest is associated with poor outcome, our patient survived, with a Cerebral Performance Category score of 2. Good recovery in this case might be related to young age, reversible cardiomyopathy, and timely management of complications.