Abstract
Background: Takotsubo cardiomyopathy is frequently considered as a benign disorder. We present an atypical form with cardiogenic shock that was managed by interventional cardiology measures. Case presentation: A 58 years old female patient with a past history of hypertension, obesity and multiple sclerosis was admitted at the Hospital Center of Montlucon for septic shock of urinary origin. During hospitalization in intensive care unit, the patient presented a markedly increasing of troponin levels with a diffused ST-segment elevation. Transthoracic Echocardiography showed an altered left ventricular ejection fraction at 35% with hypokinesia of apex and lateral ventricular segments in conjunction with compensatory hyperkinesis of the base; these findings were strongly suggestive of a diagnosis of Takotsubo cardiomyopathy. Despite concomitant anemia, renal failure and sepsis, all adequately treated with complete remission, the patient developed frequent episodes of ventricular tachycardia that prompted an emergency coronarography. During this procedure, the patient presented a cardiogenic shock and bradyasystole that were successfully managed by intra-aortic balloon pumping and temporary transvenous pacing. Finally, there were no coronary lesions and ventriculography confirmed a Takotsubo cardiomyopathy. Given the unstable hemodynamic status of this patient, she was addressed to the University Teaching Hospital of Clermont-Ferrand for more specialized care. Conclusion: This case alerts the physician to be more vigilant when managing all patients with Takotsubo cardiomyopathy, because some cases could be fatal. In severe cases, intra-aortic balloon pumping and temporary epicardial pacing can be life-saving.
Highlights
Takotsubo cardiomyopathy is frequently considered as a benign disorder
We present an atypical form with cardiogenic shock that was managed by interventional cardiology measures
Takotsubo cardiomyopathy (TTC) is an uncommon cardiomyopathy that should be suspected in post-menauposal women with signs that mimic acute myocardial infarction in the absence of an obstructive coronary artery disease confirmed by angiography [1]
Summary
Takotsubo cardiomyopathy (TTC) is an uncommon cardiomyopathy that should be suspected in post-menauposal women with signs that mimic acute myocardial infarction in the absence of an obstructive coronary artery disease confirmed by angiography [1]. Its name refers to a contraption used for catching octopuses and suggests the aspect assumed by the ventricle during the systole due to the typical regional wall motion abnormalities that occur after onset [2]. TTC was been considered as a benign disease since it has often not been associated with life-threatening complications and because the recovery of ventricular function occurs in the several days or weeks [2]. There is emerging evidence that suggests to pay attention of patients with TTC, because all of them are not benign [4].
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