Lost memories can break your heart: a case report of transient global amnesia followed by takotsubo cardiomyopathy

Abstract

Takotsubo cardiomyopathy (TC), also called apical ballooning syndrome, is characterized by an acute, transient systolic dysfunction of the apical and mid segments of the left ventricle. Recently, there have been reports showing an association with neurologic disorders including myasthenic crisis [1], Guillain–Barre–Strohl syndrome [2], seizures [3] and ischemic stroke [4]. In this article, we present the case of a woman, who suffered from a second episode of transient global amnesia (TGA) followed by TC. A 62-year-old woman presented to our emergency room with typical symptoms of TGA, thereby asking repetitive questions regarding the situation and events over the last hours. Symptom onset had occurred during the visit to a public swimming pool. Apart from isolated global amnesia, the neurologic examination was normal; a CT-scan of the brain was unremarkable. An EEG was done and ruled out an epileptic cause of the syndrome. Extracranial and transcranial vascular ultrasound did not reveal any pathologic findings. The patient had a past medical history of hypothyroidism with need for oral substitution and a previous episode of TGA 2 years before. Four hours after the patient was admitted to our intermediate care unit, she developed acute chest pain and dyspnoea. The troponin I level was elevated at 4.64 ng/ml. Acute coronary syndrome was suspected and an emergency coronary angiography was performed, which did not show relevant coronary artery disease. Ventriculography revealed severe hypokinesis of mid and apical segments of the left ventricle with the characteristic shape of takotsubo cardiomyopathy (Figs. 1, 2; supplemental ultrasound video Movie—TakoTsubo.mpg). The patient was stable during the further course and showed full recovery from all amnestic deficits within 18 h. On follow-up echocardiography, a complete normalization of cardiac function with normal left ventricular diameter, no wall motion abnormalities and a normal ejection fraction were found. The patient was then discharged in a good state of health. Transient global amnesia was first described in 1956 by Guyotat and Courjon as an acute cognitive disorder with predominantly anterograde amnesia for up to 24 h [5]. Most episodes occur at the age of 50–80 years, do not show an association with vascular risk factors and are frequently precipitated by emotional stress, physical effort, water Electronic supplementary material The online version of this article (doi:10.1007/s00392-013-0590-1) contains supplementary material, which is available to authorized users.